In Vitro Fertilization

In Vitro Fertilization (IVF) is the most powerful treatment available to help infertile patients achieve pregnancy from their own eggs and sperm. IVF can also be an excellent test of egg and sperm quality.

Gentle Treatment at Bay IVF
We use gentle, individualized ovarian stimulation protocols and strive for the highest egg quality rather than quantity. This approach minimizes the number of clinic visits and decreases the likelihood of ovarian hyperstimulation without reducing the probability of a successful outcome.

Over the years, we have streamlined and simplified the process of In Vitro Fertilization to minimize interference with your lifestyle. A cycle of IVF treatment can take as little as six to eight weeks and only requires a few brief visits to the Clinic.

Most patients will be able to continue their everyday lifestyles during their treatment. It is our goal to make your conception experience pleasant, relaxed, and as natural as possible.

Indications for In Vitro Fertilization
You should consider IVF treatment if any of the following apply to you:

• History of tubal blockage or pelvic adhesions
• Male Factor Infertility
• Infertility associated with endometriosis
• Infertility associated with Polycystic Ovary Syndrome (PCO)
• Unexplained infertility
• Long-standing infertility: no contraception for more than a year and a half
• Decreasing "ovarian reserve"
  IVF may be the most appropriate treatment for women over the age of 37.
• You did not become pregnant with intrauterine insemination (IUI) cycles.
• You did not become pregnant with ovarian stimulation cycles with oral or injectable medications.

 

In Vitro Fertilization Procedure

 

 

In Vitro Fertilization treatment consists of:

1. Ovarian stimulation
2. Egg retrieval procedure
3. Fertilization of eggs
4. Culture of embryos
5. Assisted hatching of embryos (when indicated)
6. Embryo transfer
7. Implantation

 

1. Ovarian Stimulation

   There are several different forms of ovarian stimulation protocols, each with many modifications. Your treatment is always individualized to maximize the probability of a successful outcome. The selection of an optimal protocol for your IVF treatment is based on your reproductive history and your pre-treatment evaluation. Below are three examples of IVF treatment protocols used at Bay IVF. Your individualized protocol may take less or more time to complete.

 

 

 

 

 

 

 

2. Egg Retrieval Procedure

   The egg retrieval procedure is performed at our Clinic. The procedure only takes a few minutes, and we use very comfortable conscious sedation for analgesia.

   Since 1985, we have done many thousands of egg retrievals and are very experienced in retrieving eggs from the ovaries.

   Under ultrasound guidance, the tip of a thin needle is passed through the top of the vagina into the cul-de-sac (space behind the uterus). The ovaries are located near the bottom of the cul-de-sac allowing the tip of the aspirating needle to enter the ovarian follicles and aspirate the follicular fluid from them. The fluid is examined under a microscope to identify the eggs.

3. Fertilization of Eggs

   On average, eight to fourteen eggs are aspirated during the egg retrieval procedure. After their identification, the eggs are placed in petri dishes filled with culture medium. The composition of the culture medium resembles the fluid secreted by the Fallopian tubes. This allows the eggs and embryos (fertilized eggs) to develop in our laboratory environment at the same rate as inside the Fallopian tubes.

   The male partner collects a semen specimen by masturbation on the day of egg retrieval. The highest quality sperm are extracted from the semen and combined with the eggs six hours after the egg retrieval. This process of in vitro fertilization takes place over several hours during the evening after the egg retrieval.

   If the male partner has never caused pregnancy, or if his test results indicate a possibility of significant male infertility, Intracytoplasmic Sperm Injection (ICSI) is performed. In ICSI, a single sperm is inserted into an egg. This can significantly increase the probability of normal fertilization for selected patients.

4. Culture of Embryos

   Evidence of fertilization can be seen the next day, 16 hours after insemination. The fertilized eggs are transferred into a growth medium and continue to be cultured in our laboratory.

   A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm.

   The following day, embryos should divide into 4 cells, the day after into 8 cells.

   This picture shows a morphologically exquisite, day three, 8-cell embryo.

 

 

By the fifth to seventh day after the insemination, embryos should reach the blastocyst stage (80 or more cells).

This picture shows an advanced stage of blastocyst development. Notice the central fluid-filled cavity. The cells within the blastocyst have already differentiated into the inner cell mass (at seven o’clock) that will give rise to the fetus and the trophectoderm cells that will form the future placenta.

At this stage, human embryos are still microscopic and invisible to the naked eye.

 

 

5. Embryo Transfer

   The embryo transfer procedure is usually performed five days after the egg retrieval, depending on the development of your embryos. The gamete embryologists assess the embryos prior to the embryo transfer to determine their likelihood of implantation.

   This probability of success is one of the factors determining the number of embryos to transfer. Dr. Polansky will help you with your decision, but you will have the "last say." Most patients select one or two embryos for the transfer.

   By the time of your embryo transfer, the length of your uterus has been measured twice: once during your pre-treatment evaluation and the second measurement is done at the end of your egg retrieval.

   Just prior to the embryo transfer, the embryo(s) is/are placed into the tip of a thin embryo transfer catheter. The catheter is then passed through the cervical canal to within 15 mm of the top of the uterine cavity, and the embryos are gently released.

   Having done thousands of embryo transfer procedures, Dr. Polansky will precisely place your embryo(s) within the endometrial cavity. The embryo transfer usually takes only a few seconds to complete, and no resting is required afterward.

   There may be more embryos than the future parents wish to have transferred. It is possible to vitrify (freeze) these embryos and store them in liquid nitrogen. A large majority of the embryos will survive the vitrification and thawing process. The implantation rate of the thawed embryos is equal to the "fresh" embryo implantation rate.

6. Assisted Hatching

   Assisted hatching is a laboratory procedure used to create a "weak spot" in the eggshell of an embryo. Used primarily for cryopreserved embryos, assisted hatching increases the likelihood of an embryo being able to hatch out of its eggshell, implant, and result in a baby.

   This picture shows an embryo after assisted embryo hatching with an opening breaching the eggshell at the 12 o’clock position.

 

 

7. Implantation

   After the embryo transfer, the endometrial lining gently holds the embryo(s) within the top of the uterus. There is no restriction on your physical activity.

 

 

This picture shows a healthy blastocyst in the process of "squeezing out" of its eggshell. Once fully hatched, it will stay in the uterus unattached for one to two days and then implant.

The lining of the uterus is made receptive for the embryos through the action of the hormones estrogen and progesterone produced by the ovaries. Ovarian progesterone production is supplemented with vaginal progesterone capsules.

A blood pregnancy test is done two weeks after the embryo transfer. If the pregnancy test is positive, an ultrasound examination is scheduled two weeks later to visualize the implantation site and to look for a heartbeat within the embryo. Once a heartbeat is seen, there is a 95+% probability that the pregnancy will continue to live birth.

 

 

This ultrasound picture shows a six-week pregnancy. The pregnancy sac is 25 mm in diameter. The baby inside the sac is only 13 mm long. It is already possible to distinguish the baby’s head and body and to see the cardiac activity.

 

 

At this point, the pregnancy becomes indistinguishable from conception through intercourse, and your obstetrical care should be no different than if you conceived without any treatment.