IVF-When Things Are Taking Too Long
Now, with the advent of in vitro fertilization (IVF), men and women who have been infertile have a chance to create their own biological family. The use of IVF to assist in fertility is determined by a number of factors. Generally, couples who have failed to conceive after trying for one year, and have specific problems with reproduction are common candidates for IVF. Fertility problems include blocked fallopian tubes or pelvic adhesions due to endometriosis, tubal ligation (women) or vasectomy (men) reversals, male factor infertility or failed cycles of intrauterine insemination (IUI) and ovarian reserve issues (not enough eggs).
When the natural fertility process is not very efficient, IVF is able to increase efficiency. IVF takes eggs from the woman, fertilizes them with her partner’s sperm, and then implants them in her uterus to grow. This, of course, is over simplification of the process.
Stimulating The Growth Of Eggs For Implantation
In order to maximize the opportunity for the success of IVF, a large number of “high quality” eggs are needed from the woman. Using the egg retrieval process, between 8 and 15 eggs are removed from the woman’s ovaries and made available for fertilization. To increase the production of the eggs, ovarian stimulation medication protocols are used to generate sufficient follicles and eggs. Injectable medications containing follicle-stimulating hormone (FSH)-also known as gonadotropins-are used to help the development of a sufficient number of follicles. GnRH-agonist and GnRH-antagonist medications are used to suppress the luteinizing hormone (LH) surge and ovulation to facilitate maturation of the follicles. Final maturation is triggered with the use of HCG (human chorionic gonadotropin). The trick is in stimulating the production of eggs without over stimulating the ovaries, causing distress to the woman, or under-stimulating the ovaries resulting in an inadequate number of eggs produced.
Watching The Eggs Grow, Harvesting Them And Watching Them Again
The production of the eggs is monitored by ultrasound, which can measure the follicle quite accurately. The size of the egg is an indication of its maturity. It is important for the woman to have at least five follicles of adequate size to have success with IVF. When it is established that the eggs are mature enough, they are removed from the ovaries using an aspiration process. The woman is unconscious and does not feel anything during the procedure. Using an ultrasound as a guidance device, a needle is passed through the vagina to the ovary and ultimately to the follicles. The fluid in the follicles is removed by aspiration through the needle and the eggs separate from the follicle. They are then sucked out of the ovary. Both eggs and fluid go to the IVF lab where the eggs are identified, rinsed, and placed in culture drops in dishes. Under carefully controlled circumstances, the eggs are kept in special IVF incubators until they are mixed with the sperm, about four or five hours after aspiration. Evidence of fertilization is usually seen within 24 hours.
And Then…Wait And See
The fertilized eggs are then cultured for two to five more days before they are inserted in the woman’s uterus using the embryo transfer procedure. Two weeks later, the woman has a blood test where they look for HCG, the pregnancy hormone.
