How does ivf work?

Answer 1

IVF OverviewThe Center for Human Reproduction (CHR) was one of the first IVF centers in the nation. It is a world-renowned infertility center located in New York, NY and has offered world-class IVF treatment since 1981. With the assistance of the CHR, more than 17,000 pregnancies have been achieved using in-vitro fertilization (IVF) and other assisted reproductive technologies (ART) . The CHR experts work closely with couples undergoing the many different types of assisted fertility treatments available. We are renowned for our specialized knowledge and successful IVF results.

• Dr. Barad explains CHR's IVF program

Many patients go to the CHR after they have failed elsewhere. The CHR also offers special financial conditions for patients who do not have insurance coverage and at times can offer access to free infertility medications.

Perhaps less known is our work with individuals and couples who are considering assisted reproduction, but who are uncertain of their next step. We encourage anyone, before they make a decision, to consult with us. Currently, we are offering a Free Pre-IVF E-Mail Consultation.

The advances in ART have allowed thousands of couples to have the chance of having children, who might otherwise not have been able to conceive and CHR is the leader in this field.

There are many issues to consider that can influence your prospects of conceiving. Both partners require a careful evaluation. CHR will utilize a thorough approach, covering all aspects of both partners physical and emotional well-being. After completing this evaluation, you may find that you have a good chance of getting pregnant naturally, given a bit more time. This is one consideration during our pre-IVF consultation. Oftentimes there are some specialized tests to be performed depending on the type of infertility. Many times, however, couples who have been unsuccessful in starting a family have a long history and all the tests have been done. These couples can usually move directly into IVF.

The first step to schedule a Free Pre-IVF E-Mail Consultation with one of our licensed infertility specialists is to complete the Pre-IVF E-Mail Consultation Form.

Couples may be offered IVF if:

• The woman has damaged or blocked fallopian tubes

• The ovaries do not respond to infertility medications

• The man has low sperm count

• The man has sperm that does not move well

• There are immunological factors

• The woman has significant endometriosis leading to infertility

• The infertility is "unexplained"

In-vitro fertilization (IVF) can be of benefit to many couples. In IVF, eggs are gathered from the woman's ovaries and mixed with the man's sperm outside the body, usually in a glass dish in a laboratory. "In vitro" comes from Latin and literally means "in glass", a reference to the glass container where fertilization of the egg (oocyte) takes place. (While this is usually a dish, the term " test-tube babies" has become widely used.) The fertilized eggs are then cultivated for two or three days to embryo stage and transferred to the woman's uterus.

While the procedure described above sounds simple, in reality, IVF is a complex and emotionally demanding process. It can take between six weeks and two months on average for a single treatment cycle and most couples find it both physically and mentally draining. CHR's extensive experience with couples going through IVF allows us to provide all the support needed to assist individuals during this emotional time.

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How does IVF work?Appropriate patients are offered IVF, after some initial testing such as a sperm count, a few hormone tests and an evaluation of the uterine cavity to establish the cause of infertility. The first stage involves stimulating the woman's ovaries so that several eggs mature. Normally, a woman produces one egg in each menstrual cycle, but with IVF, many ovarian follicles are produced by hormone stimulation and several eggs are obtained (usually 7-15) and a number of embryos are produced after oocyte fertilization. Two or three embryos are replaced into the woman's uterus to increase the chance of getting pregnant the first time.

To achieve this, a woman will need to take drugs to suppress her own hormones. This phase lasts about 21 days. The drugs have the effect of putting the body into a temporary low hormone state (similar to a short-term menopause), along with all of the side effects that might be expected such as hot flashes and mood swings.

• Dr. Barad explains CHR's IVF program

Once the woman's own hormones have been suppressed, she can begin taking the medication that will stimulate the ovaries and egg production. She may need to have injections daily for 8-12 days, but this will vary according to the way her body is responding. The response of the ovaries will be carefully monitored using ultrasound scanning to show the size and number of developing follicles and frequently a blood test.

Monitoring of the woman during this stimulation period is essential, because a woman's ovaries sometimes respond too strongly to these medicines. This may result in the ovarian hyperstimulation syndrome, which can cause a range of symptoms from mild abdominal pain to severe pain, vomiting, nausea and dehydration. Sometimes a treatment cycle has to be abandoned because of hyper stimulation. On the other hand some cycles are canceled if not enough follicles are produced or the follicles grow very poorly. If all goes well, however, the next stage of the procedure is egg collection. This takes place when the ultrasound scan shows a sufficient number of large follicles. The woman is given an injection late at night to give the ovaries containing the eggs their last 'push' towards maturity. Ovulation normally occurs 37-40 hours after this injection, so egg collection is scheduled to take place just before ovulation occurs (at about 34 hours).

The eggs are usually collected using a fine, hollow needle guided by ultrasound. Around the same time of the oocyte collection in the woman, the man produces a semen sample. The sperm is assessed and prepared for fertilization. As soon as the eggs are extracted from the woman, they are placed into a nutrient "embryo culture" medium with the sperm and then placed in an incubator overnight. The next day, the eggs are observed through a microscope to see if fertilization has occurred. The next day cell division will have started and the embryo might now have two or four cells.

The embryos will be checked by our expert CHR embryologist to ensure that they are developing normally and, if all is well, embryo transfer can take place. The embryos, together with a tiny amount of nutrient fluid, are put into a catheter and placed into the woman's uterus through her cervix with a special ultrasound guidance. By transferring one or two embryos we reduce the risk of a multiple pregnancy. Occasionally in older patients we transfer three embryos. If there are 'spare' embryos of good quality these can be frozen and stored for use in a future treatment cycle if needed.

The embryo transfer procedure is critical. The procedure is short and generally painless. Afterwards, the woman will be advised to rest for a short time and then go home and "carry on as normal". It will be about two weeks before a pregnancy test can be done, and this waiting is one of the most stressful times of the cycle. During this time, the woman will be prescribed progesterone, which is needed to provide hormonal support to any potential pregnancy.

If the pregnancy blood test is positive we will confirm this with a couple more blood tests. Then an ultrasound scan a couple of weeks later will identify a normal pregnancy in the uterus and the heartbeat of the new embryo.. If all is developing normally, the newly pregnant woman will be referred back to her obstetrician to make the transition to antenatal care.

However, one of the most important things to remember about IVF is that it only works about half the time in the best couples. So sometimes the patient needs to repeat the cycle. Other times, a woman who is older or has "premature aging" of her ovaries might not have a successful IVF cycle. In these cases, which are not that uncommon, patients are offered the opportunity to use eggs from a donor. These donor egg cycles allow the woman who otherwise would have no chance for pregnancy carry and deliver her own baby using the sperm from the husband. Donor egg cycles are usually less expensive than adoption. CHR also uses an embryo adoption program that has been very successful.

IVF ConsultationThe first step is to register for a Free Pre-IVF E-Mail Consultation and complete the Pre-IVF E-Mail Consultation Form. IVF and TwinsIn two papers published in Human Reproduction (Gleicher et al. 2006;21:1945-50) and Fertility and Sterility (Gleicher et al. 2007;87:1301-5), Drs. Gleicher and Barad were probably the first to point out the considerable differences in IVF pregnancy rates between US and European programs, with the USA experience offering patients dramatically higher overall pregnancy rates, though also higher multiple pregnancy rates. While the message initially was not very well received by European colleagues, their attitude now seems to have finally come around.

A lead article in the January issue of Focus in Reproduction, the official monthly magazine of ESHRE, the European counterpart of ASRM (January 2008, pp28-33), mostly offered information from an interview with Dr. Gleicher (and even his photo) on the topic, and CHR's two above noted publications were widely quoted.

That Europeans have started to take these outcome differences seriously can also be deducted from the fact that a special symposium on the topic has been scheduled for the coming Annual Meeting of ESHRE, which this year will take place in Barcelona, Spain. Dr. Gleicher was, indeed, invited to join the faculty of speakers for this symposium.

Practice patterns have been diverging between Europe and the USA for quite some time. A more regulated environment in Europe has led to lower multiple pregnancy rates but also to dramatically lower pregnancy success with IVF and, therefore, to much higher cycle utilization. Europe has also been leading in efforts to avoid twin pregnancies and has attempted to do so at practically all cost. This has led to the active promotion of single embryo transfer (s-ET), in Belgium, for example, even mandated by law.

s-ET, of course, reduces pregnancy chances in comparison to 2-embryo transfer (2-ET). The increasing utilization of s-ET in Europe can, therefore, be predicted to lead to further reductions in pregnancy chances and, at least in the short term, to a further increasing par in pregnancy rates between Europe and the USA.

The aggressive pursuit of s-ET has primarily been based on the argument that singleton pregnancies have lower complication rates in mothers and offspring than twin deliveries. Drs. Gleicher and Barad in a just very recently published paper demonstrated, however, that these assumptions are statistically incorrect (Gleicher and Barad. Fertil Steril 2008; doi:10.1016/j.fertnstert.2008.02.160) Since most infertile women under treatment are planning on more than once child, a treatment cycle leading to a singleton delivery will have to be followed by a second such cycle in order to give this patient the desired two children. In contrast, a patient would be a mother of two in only one twin pregnancy. A correct statistical analysis can, therefore, not compare outcomes between one singleton and one twin pregnancy, but has to consider outcomes of one twin gestation in comparison to two singleton deliveries. When this is done, twin pregnancies no longer demonstrate higher risk profiles and/or costs than singletons.

Even though going against widely prevailing opinions, these data are practically undisputable. CHR's recently published study, thus, pulls the rug from under the principal argument in favor of s-ET and will with great likelihood, therefore, be subject to very active discussion at this year's ESHRE and ASRM meetings.