What is In Vitro Fertilization (IVF)?

In Vitro Fertilization, or IVF, is the most common of all assisted reproductive technology (ART). The techniques, which was first developed in the United Kingdom by Doctors Patrick Steptoe and Robert Edwards and resulted in the first pregnancy in 1978. Fertility treatment centers in the United States began to adopt the process which resulted in the first IVF pregnancy in the US in 1981, and over 45,000 since that time.

The IVF process involves removing the eggs, or ova, from a woman’s body and placing them in a lab dish with the sperm. After fertilization occurs, the eggs are transferred to the woman’s uterus where they continue to develop.

Before the IFV Process begins, the patient is evaluated by the reproductive endocrinologist to see if IFV is a possible solution to over come their infertility problems. Fertility specialists understand the patient’s desire to have a child but also balance that with the biologic understanding of the possibilities for each patient. Reputable fertility treatment centers will assure that the patient understands their choices and will help guide them to ones bet fit for situation.

Best candidates for IVF include:

• Those with blocked or damaged fallopian tubes
• Male factor infertility
• Those with Endometriosis
• Problems concerning the uterus
• Problems concerning the ovaries
• Unexplained infertility

The IFV Process is very involved and will include many visits to the fertility treatment center for  evaluation, treatments and monitoring. The process includes:

• Ovulation induction medication, such as Pergonal, are administered.
• Eggs are commonly retrieved using ultrasound guided needle which collects the follicular fluid which is placed in an incubator.
• Semen is collected and prepared.
• Sperm and egg are incubated together and fertilization should occur.
• Fertilized eggs are transferred to the woman’s body
• Woman returns to the fertility treatment center in two week for a pregnancy test
• If successful, she is monitored by the physician at the fertility treatment center for a short time then care is released to her regular OB/GYN. If unsuccessful, the woman will wait a month to recover, and then be reassessed for the next or further treatment.

IVF Concerns
The IVF process has involved some controversy over the years, and does evoke some serious considerations. The process has made headlines enabling women well beyond childbearing years to conceive and other to become pregnant with multiples well beyond what medicine deems safe. The medical standard is the placement of no more than two embryos into the womb at a time. Some consideration of IVF include:

• Cost
• How many children desired
• How many embryos remain after treatment
• What will be done with unused embryos

Not every fertility treatment center shares the same protocol, philosophies, or success rates. It is very important for any patient considering fertility treatments to check the physician’s standing with the board as well as the fertility treatment center’s results with the CDC.

What is ART (Assisted reproductive Technology)

As many couples are delaying having children until later in life, those experiencing difficulty in conceiving is also on the rise. To over come these difficulties, many see the help of reproductive specialists and fertility treatment centers, to diagnose the sources of problems. For many, conventional drug therapies are tried and are successful. Others find hope in Assisted Reproductive Technology, or ART.

ART Defined
According to the Center for Disease Control and Prevention, Assisted Reproductive Technology includes all fertility treatments in which both the egg and sperm are handled. Performed under the care of specialists at fertility treatment centers, Art procedures generally include the removal of eggs from a woman’s ovaries, combining them with sperm in a laboratory and then placing them back in the woman’s body.

Typical ART Cycle

1. Documentation of cycle and ovulation
2. Beginning of GnRH agonist therapy
3. A baseline ultrasound of the pelvis
4. Gonadotropins are used to stimulate ovaries
5. Serum hormone levels monitored
6. Follicle development is closely monitored by ultrasound
7. The administration of Human chorionic gonadotropin, hCG, given as intramuscular injection
8. Transvaginal oocyte retrieval
9. Embryo is transferred
10. Progesterone supplementation begins
11. Pregnancy test administered and  patient undergoes hormonal studies
12. Patient follows up with physician for several weeks at the fertility treatment center to monitor pregnancy, or further consultation.

The ART process requires careful timing and patients are closely monitored by physicians who specialize in reproductive technologies. Medications are used to stimulate the ovaries, after which the development of the follicles, or eggs, is closely monitored through blood tests and ultrasound. These tests determine the timing of the administration of the hCG, which is critical to the proper maturation of the oocytes. Typically, oocyte retrieval is performed 34 hours after this time. The procedure is performed under the care of your physician and an anesthesiologist in the fertility treatment center. Once the oocytes are collected and semen prepared, the woman is inseminated. Once the embryo is transferred, the patient will receive progesterone supplements daily. A pregnancy test is administered around 12 days after the transfer.

ART Treatments
IVF, the process of combining the egg and sperm in a lab and fertilized eggs are transferred to the woman, is the most frequently used form of ART. Many fertility treatment centers offer other ART treatments which include:

•Intracytoplasmic sperm injection (ICSI) where a single sperm is injected into an egg which is then placed in the patient’s uterus or fallopian tubes.
•Gamete intrafallopian transfer (GIFT) where collected eggs are placed with sperm in a tube then injected into the fallopian tubes for fertilization.
•Zygote intrafallopian transfer (ZIFT) which combines the IVF and GIFT processes.

Treatments Not Considered ART
Not all reproductive therapies received at fertility treatment centers are considered ART. Treatments such as intrauterine insemination (IUI), also called artificial insemination (AI), in which only the sperm is handled or therapies in which only medication is used to stimulate the production of eggs to achieve a pregnancy is not considered to be in this category.

Choosing a Fertility Treatment Center
All ART treatments are performed by endocrinologists in fertility treatment centers, specially equipped to meet the needs of reproductive medicine. Centers and physicians may differ in treatment plans and philosophies, and fertility treatment centers may vary in their success rates. Patients should consider these things in choosing a fertility treatment center.

ART is the common broad term for reproductive treatments that include a combination of medications and handling of eggs or embryos.

• IVF (In vitro fertilization)-Eggs are combined with sperm in a laboratory. After fertalization, eggs are placed in the uterus.
• ICSI (Intracytoplasmic sperm injection)- Sperm is injected directly into the egg and embryo is placed into the uterus.
• GIFT (Gamete intrafallopian transfer) Eggs and sperm are placed in a lab dish and inserted into the fallopian tubes. Fertilization and implantation happens naturally.
• ZIFT (Zygote intrafallopian transfer) eggs and sperm are placed in lab dish and after fertilization, doctor places the embryo in the uterus.

The process of dealing with infertility is likely to include many trips to the fertility treatment center while specialists identify the problem and once the problem has been found, develop a treatment plan. Fortunately, most problems can be solved with the use of medications or corrective surgery. Some patients require more invasive treatments in assisted reproductive technologies, such as IVF. The treatment approach and philosophy of each fertility treatment center may vary and patients should find one that best meets their needs.

The most successful fertility treatment centers combine compassion and expertise of reproductive endocrinologists in developing a treatment plan. The success rates of fertility treatment centers varies by clinic and state, and a patient has the right to view information regarding the success rates, broken down by treatments, for each fertility treatment center at CDC.GOV. Because many treatments are either not or only partially covered by insurance, a patient should always carefully review the fertility treatment center’s protocol, philosophy and rates of success while choosing.