In Vitro Fertilization (IVF)

The Core Elements of IVF

Ovarian Stimulation

Fertility drugs (injectable gonadotropin drugs) are administered in order to induce the ovaries to produce multiple eggs. This step requires monitoring by blood tests and ultrasounds. Atrius Health has 4 monitoring sites (Burlington, Kenmore, Wellesley and Quincy Hancock Street) during weekdays and two (Kenmore and Wellesley) for the weekends. Each patient has an individualized schedule and plan determined by her physician.

Egg Retrieval

This is a minimally-invasive procedure performed in the surgical suite next to the IVF laboratory we use in Lexington. Deep intravenous sedation is given by an anesthesiologist during your procedure to make you completely comfortable. The eggs are retrieved trans-vaginally using a needle that is guided into the ovary using ultrasound. The overall procedure takes approximately 15 minutes.

Fertilization/Embryo Development

The eggs are evaluated in the laboratory and fertilization is achieved by mixing eggs with sperm (standard) or by injecting a single sperm into each egg (Intracytoplasmic sperm injection or ICSI). The fertilized eggs become embryos and these are grown in the laboratory under controlled temperature and humidity for several days.

Embryo Transfers

Embryos may be transferred on day 2, 3 or 5 after retrieval of oocytes and fertilization. The embryo(s) are placed in the uterus using a soft catheter. This procedure is performed under ultrasound guidance and takes approximately 15 minutes. The number of embryos transferred as well as the transfer date is determined after a discussion between the couple and the physician, usually at the beginning of the IVF treatment. In general, we follow national guidelines and recommendations to maximize pregnancy and minimize multiple gestations.

Preimplantation Genetic Diagnosis (PGD)

Preimplantation Genetic Diagnosis (PGD) is a laboratory procedure that provides genetic information about embryos prior to their transfer, or implantation, into the uterus. The information obtained through PGD is used to select the best embryos for transfer.

• How PGD Works

  A single cell is removed from an eight-cell embryo (day 3 embryo) and this cell is used for diagnosis while the remaining embryo continues to grow in culture until day 5 for embryo transfer. We use a laser to create an opening in the zona pellucida (or strong membrane that forms around an ovum as it develops in the ovary), which then allows the cell to be extracted.

• What PGD Can Detect

  • Aneuploidy (An Abnormal Number of Chromosomes) - any deviation from the normal number of chromosomes (extra or missing chromosomes) can lead to miscarriages or birth defects (such as Down syndrome). Counting the chromosomes and ensuring a correct number allows the selection of the best embryos for transfer. We presently can check for all 46 chromosomes using an advanced microarray technique.

  • Single Gene Defects- a variety of conditions (cystic fibrosis, muscular dystrophy, sickle cell anemia) are a result of a defect in a single gene. By using PGD, we can possibly identify defective genes and transfer unaffected embryos.

Cryopreservation of Embryos

Additional (extra) embryos can be frozen and stored for extended periods. The frozen embryo transfer (FET) can then be performed at a later date. In a “thaw” cycle, there is no need for ovarian stimulation so many side effects of fertility drugs are avoided.

Egg freezing is recommended for various reasons, including:

• Preserving eggs in women without partners for future use prior to surgery or medical treatment that can potentially cause loss of ovarian function(such as ovarian surgery or chemotherapy).
• For single women who are concerned about the loss of ovarian function with age. To determine whether you are an appropriate candidate for egg freezing, a physician consultation will evaluate your current ovarian status and discuss the process of IVF including ovarian stimulation to harvest the eggs.

To determine whether you are an appropriate candidate for egg freezing, a physician will evaluate your current ovarian status and discuss the process of IVF including ovarian stimulation to harvest the eggs.