The first successful IVF cycle was conducted by Dr. Patrick Steptoe and Robert Edwards in England in 1977 resulting in the first IVF baby, Louise Brown. The Jones Institute for Reproductive Medicine performed the first successful IVF case in the United States. At the time, IVF babies were referred to as “miracle children” and “test tube babies”, however, no test tubes were involved. To date, millions of babies have been born as a result of IVF. Many couples who once had no hope of ever having children now have families.
“In vitro” literally refers to “in glass” and “outside of the body” which is where fertilization occurs in an IVF cycle. Fertilization takes place in a Petri dish as opposed to a test tube. The “IVF process” involves recruiting, maturing and retrieving eggs, which are then combined with sperm to create an embryo. The embryo is cultured until mature and ready for transfer.
A successful IVF cycle requires several steps. First, the ovaries must be stimulated to produce multiple eggs, which are needed for the IVF procedure. FSH is the natural hormone, produced by the pituitary, responsible for follicular (each follicle contains one egg) recruitment and development. In an IVF cycle, additional FSH (Gonal-F, Follistim, Menopur, etc.) is administered by injection to stimulate the development of many eggs, a process known as ovulation induction.
Women undergoing ovulation induction must be carefully monitored using ultrasound, estradiol measurements, and physical examination. This monitoring helps insure the safety of the ovulation induction cycle and provides information used for FSH dosage adjustments. The ultrasound allows the physician to view the developing follicles and estradiol measurements document the growth of the follicles and help prevent ovarian hyperstimulation syndrome (OHSS). OHSS is a potentially serious side effect of ovulation induction and abnormally high estrogen levels can signal its onset. Ovulation induction cycles should only be performed by a reproductive endocrinologist/infertility specialist thoroughly familiar with the use of fertility medications. The number of times a woman must come to our office for monitoring is dependent upon how she responds to ovulation induction, but is typically three times per cycle.
The patient receives either Lupron or Ganirelix while undergoing FSH ovulation induction. These drugs prevent ovulation by blocking the production of LH. A “surge” of LH is needed to finally prepare the eggs and stimulate ovulation. Since ovulation cannot occur while on these drugs, the physician can administer FSH until the follicles are the optimal size. It is very important that ovulation not occur prior to egg retrieval or the IVF cycle will be “lost”. When the physician judges the follicles mature, an injection of hCG is given and the egg retrieval is scheduled.
The eggs are retrieved using transvaginal guided ultrasound while the patient is under light general anesthesia. A small “needle” is passed through the back of the vagina into the follicle and the egg is withdrawn. The withdrawn follicular fluid is passed to the embryologist who separates the eggs.
Sperm is added to the eggs in a Petri dish and fertilization is allowed to occur. Once fertilized, the pre embryos are placed in an incubator, which is strictly controlled for environmental variables such a temperature, gases in the air, etc. The pre embryos remain in the incubator until mature, usually three to five days. Embryos that have differentiated into two distinct cell types (usually incubated 5 or more days) are known as blastocysts. Blastocysts are heartier than day 3 embryos and have a higher implantation rates meaning fewer need to be transferred to the uterus. Blastocysts are transferred where possible but not all couples will have embryos that reach the blastocyst stage.
Once the embryos mature, the patient comes to our office for the embryo transfer, where the embryos are placed into the uterus in a painless procedure taking less than 15 minutes. Thereafter, the patient takes supplemental estrogen and progesterone to support endometrial development. A pregnancy test is performed 14 days after egg retrieval.
Conditions which often require IVF include:
- Tubal blockage or failed tubal reversal
- Endometriosis
- Cervical factor
- Pelvic adhesions
- Male factor
- Unexplained infertility
- Failed conventional therapy.
- Female age related infertility
Donor egg IVF is often an option when a woman cannot use her own eggs. Egg donors are young, fertile women and success rates are typically high, matching the age group of the donor. For example, if the eggs of a 22 year old are used in a 38 year old, the success rates equal the 22 year old group.
Our physicians provide a complete overview of the IVF procedure for patients who are candidates. Please see our “donor egg program” and “IVF Success Rates” pages.
