Assisted reproductive technology (ART)

In a normal ovulation cycle, one egg matures per month. The goal of an in vitro fertilization (IVF) cycle is to have many mature eggs available, as this will increase your chances of success with treatment. In order for there to be more than one egg available, stimulation of the ovaries needs to occur. It’s important to note that the eggs being stimulated would have grown or died that month, so stimulating the ovaries does not deplete eggs for the future. This is a common question that patients ask, so rest assured.

PART I: STIMULATION OF THE OVARIES

In the stimulation phase of an IVF cycle, you will use injectable medications for approximately 8 to 14 days to stimulate the ovaries to produce eggs. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both produced naturally within the body, comprise the medications. During this phase, you will come into the office approximately 7 to 8 times for morning monitoring, which allows the physician to track the progress of your cycle and adjust medication dosages as needed.

The trigger shot is the final step in the stimulation phase of treatment. Depending on your individual protocol, you will either have a human chorionic gonadotropin (hCG) or Lupron trigger shot. This shot helps the developing eggs complete the maturation process and sets ovulation in motion. Timing is very important here, as the physician must perform the egg retrieval prior to the expected time of ovulation.

PART II: EGG RETRIEVAL

A physician will perform your egg retrieval procedure at our clinic. On the morning of your egg retrieval, a physician will meet with you before the procedure to review your protocol. You will also meet with an anesthetist, who will review your medical history and will administer the intravenous fluid you will receive prior to the start of the procedure to induce sleep.

Obtaining the sperm: If you are using a fresh sperm sample, a lab technician will come to accept the sample. If you are using a frozen sperm sample or donor sperm collected previously, the technician will verify those details with you. Our andrology laboratory will wash and prepare the sperm, so that the healthiest sperm are brought together with the eggs for fertilization (after the physician performs the egg retrieval).

Obtaining the eggs: The egg retrieval itself takes about 20 to 30 minutes. During the procedure, the physician will guide a needle into each ovary to remove the egg-containing fluid in each follicle. The physician utilizes an ultrasound during the procedure to see where to guide the needle.

Recovery will take about 30 minutes and you will be able to walk out on your own. It’s important that a responsible adult drive you home after the procedure, as it is unsafe to drive after receiving anesthesia. The person who is driving you, will need to stay at our center during your procedure. He or she should anticipate being at our center for approximately 3 hours in total.

PART III: FERTILIZATION

After the egg retrieval, the embryologist will sort and prepare the eggs and sperm. There are two ways that fertilization can take place: conventional insemination or intracytoplasmic sperm injection (ICSI). The physician will discuss with you which method to use based on sperm quality; this is traditionally planned in advance. In some cases, the embryologist may see that semen parameters for conventional insemination are not being met, so she or he will recommend the switch to ICSI to produce the greatest chance of success. Your clinical team will let you know if they recommend an unanticipated ICSI procedure.

Conventional insemination: For conventional insemination, the embryologist takes the prepared sperm sample and isolates the healthiest sperm. He or she will then incubate this sperm with the eggs in a Petri dish. This gives the egg and sperm the opportunity to find one another and fertilize.

Intracytoplasmic sperm injection (ICSI): is a process in which an embryologist injects a single sperm into the cytoplasm (center) of each egg. After the embryologist fertilizes the egg with the sperm, he or she will observe the egg over the next day or so.

PART IV: EMBRYO DEVELOPMENT

Embryo development begins after fertilization. An embryologist examines each developing embryo over the course of the following 5 to 6 days. The goal is to see progressive development, with a two- to four-cell embryo on day 2 and an six- to eight-cell embryo on day 3. After the eight-cell stage, rapid cell division continues and the embryo enters into what is called the blastocyst stage at day 5 or 6. It is your physician’s goal to transfer the highest-quality embryo(s) to give you the greatest chance of reproductive success.

PART V: GENETIC ANALYSIS BEFORE IMPLANTATION

PGS PRE-IMPLANTATION GENETIC SCREENING (Detects aneuploidies of all chromosomes)

In vitro embryos created in laboratory may undergo pre-implantation genetic control PGS. Genetic analysis involves the detection of aneuploidies (numerical abnormalities) for all 24 chromosomes of embryonic cells. These cells are detached from the embryo and then are sent to the genetics laboratory where they are analyzed. The embryo from which the cells are taken is at the stade of blastocyst, that is mainly achieved on the 5th day of its being maintained in culture. The ultimate goal is to transfer only the healthiest embryo to the womb.

This reduces the risk of:

• In vitro fertilization failure.
• Experiencing repeated abortions.
• Giving birth to children with Down syndrome or other aneuploidy syndromes.

PGS is mainly advised when:

• The woman is over 35 years old.
• A woman has undergone several infertility treatments without success.
• The woman has experienced repeated abortions.

PGD ​​ Pre-Implantation Genetic Diagnosis (Detects Genetic Disorders for a Single Gene)

PGD (pre- implantation genetics diagnosis) is a procedure that allows the identification of genetic abnormalities in embryos created through in vitro fertilization before these embryos are transferred to the woman’s womb. PGD is performed when parents are exposed to a known genetic pathology, such as Cystic Fibrosis, Thalassemia, etc. In this way the embryo is specifically tested for a known defect in a carrier gene, thereby enabling the transfer to the womb only of the healthy embryos without genetic abnormalities. Some cells are taken from the embryo and sent to the genetic laboratory for detailed analysis. The embryo from which the cells are taken is at the stage of the blastocyst, which is mainly achieved at the 5^th day of its holding in culture.

PART VI: EMBRYO TRANSFER

Embryo Transfer is a very simple procedure that only takes a few minutes to complete. The nurse will give you necessary information how to get prepared, for example: the bladder should be filled to give a better view of the contours of the uterus and therefore a better placement of the embryos. In advance you will decide with the doctors the number of embryos you are going to transfer. Before the transfer you will confirm your name and the number of embryos you will transfer. The embryos will be loaded into the embryology lab adjacent to the transfer room and loaded into the uterus using a specific catheter while the procedure is monitored by ultrasound technique. After the embryos have been transferred, the embryologist makes a final check on the microscope to make sure the embryos are released from the catheter. The nurse will give you information for the next two weeks until the pregnancy test is performed.

PART VII: BETA-HCG PREGNANCY TEST

Two weeks after the embryo transfer, you will have a pregnancy test. This test is performed by taking a peripheral blood sample and measuring the level of the Beta hCG hormone released from the developing embryo.