In vitro fertilization (IVF) is a common option for many couples who have not been able to conceive. IVF can be the solution for a variety of fertility problems:
- A women’s fallopian tubes are absent or blocked, preventing the sperm and eggs from meeting
- A man has very poor sperm counts
- A women has exhausted her own supply of quality eggs and requires donor eggs
- A woman has severe endometriosis
- A man has immunologic infertility, which occurs when antibodies to sperm prevent normal motility and function
- Other fertility methods, such as artificial or intrauterine insemination, have not been successful
- Infertility is unexplained
Depending on the fertility problem, the eggs and sperm used in IVF may be the couple’s own or may come from donors.
Members of our staff guide each couple through every step of the IVF process. Professional counseling with a psychotherapist is also offered.
The IVF Process — How IVF Works
A fresh IVF cycle consists of four stages: stimulation, egg retrieval, fertilization and transfer.
- Stimulation — Frequent ultrasound exams are performed to evaluate the growth of the follicles that will produce the eggs. Hormonal monitoring with blood tests may also be used. Adjustments will be made to the stimulation medication doses based on these findings.
- Egg retrieval — When the follicles and the eggs within them are judged to be mature, the eggs are retrieved by needle aspiration. During this procedure, a physician uses ultrasound to guide a needle through the vagina and into the ovaries to collect eggs. An anesthesiologist is present to provide pain medication and sedation so the patient does not feel pain. All follicles are aspirated to maximize the number of eggs collected.
- Fertilization — Once the eggs have been collected, the male provides a semen sample. Sperm and eggs can be joined in one of two ways. They can be mixed in a laboratory dish or a single sperm can be injected into each egg, a process called intracytoplasmic sperm injection, or ICSI. The following day, eggs are examined to check for fertilization. Fertilized eggs become embryos. Typically, about 75 percent to 80 percent of the eggs become fertilized.
- Embryo Transfer — Three to five days after fertilization, embryos will be selected and transferred to the woman’s uterus.
- About 10 days later — Two weeks after the egg retrieval – a blood test is performed to check for pregnancy. If the results are positive, the test is usually repeated 48 hours later to check that the pregnancy is progressing. If these results are also good, an ultrasound is planned for around seven weeks of gestational age (about five weeks from egg retrieval) to assess the location and number of pregnancies.
Minimal Stimulation Cycles
The Reproductive Medicine Center offers minimal stimulation in vitro fertilization (IVF) cycles. Minimal stimulation cycles have the advantage of fewer medications and significantly reduced overall costs compared to standard in vitro fertilization.
Ideal candidates for this type of protocol are women who:
- Are 40 years or older
- Have not had success with traditional cycles of IVF
- Would like to reduce overall costs and reduction in the number of eggs retrieved and number of embryos created
EmbryoScope May Improve IVF Success Rates
The EmbryoScope® is an incubator with a built-in camera that takes pictures of the embryos every 10 to 15 minutes, resulting in recorded serial time-lapsed images. The embryologist uses the images to select the highest quality embryo to later transfer to the woman’s uterus.
IVF with the EmbryoScope differs from standard IVF treatment, which calls for embryos to be removed from an incubator once a day for evaluation. This exposes the embryos to the IVF labs’ environment, including light and temperature changes, and the embryologists’ data is based on just one observation per day.
A patient produces multiple embryos during an IVF cycle. The embryologist grades each one on its appearance, giving it a quality score from A to E. With the EmbryoScope, the embryologist gives the embryos an additional grade, called the developmental score. It is possible for an embryo to have an A quality score, but a D developmental score. The better the developmental score, the higher the clinical pregnancy rate.
Our Reproductive Medicine Center has been using the EmbryoScope since 2013, shortly after the incubator was FDA approved. All of our IVF patients benefit from the technology. Data from the Froedtert & MCW IVF laboratory shows a trend that the EmbryoScope helps women get pregnant faster.
The lab’s data also indicates the EmbryoScope may also help minimize the risk of multiple births, such as twins or triplets, by implanting the highest quality embryo first and freezing the rest.
Fewer than 30 fertility centers in the United States have access to Embryoscope technology, and in Wisconsin, it is only available through the Froedtert & MCW health network.
IVF success rates depend on a variety of factors, including the woman’s age and health history. View the most recent statistics through the Society for Assisted Reproductive Technology.
Day 5 Blastocyst ("Blast") Transfers
Traditionally during the in vitro fertilization process, embryos were transferred to a woman’s uterus three days after the eggs were retrieved. Recent advances in the culture media in which embryos grow have allowed the extended growth of embryos to day five, or the blastocyst stage. These blast transfers have advantages and disadvantages.
Potential advantages of blast transfers include:
- Transfer occurs closer to the natural time an embryo enters the uterus when the uterine lining may provide a better environment for the embryo.
- Allowing embryos to develop in the laboratory for a longer period of time allows for selection of the hardier embryos that are more likely to survive.
- Because of this selection, fewer embryos can be transferred which allows for a reduction in the risk of multiple pregnancies (twins, triplets).
Potential disadvantages include:
- The main risk for blast transfer is that some embryos will die in the laboratory. While these embryos have reduced potential of resulting in a live birth, some may have survived if transferred at an earlier stage.
- There is a risk that no embryos will survive to day five, leaving no embryos for transfer.
- There may be fewer embryos for freezing and subsequent cryopreservation cycles.
At the Froedtert & the Medical College of Wisconsin Reproductive Medicine Center, we look at individual cases and offer blastocyst transfer to patients with a large number of quality embryos to try to avoid having a situation where no transfer occurs due to the loss of all embryos. Patients undergoing preimplantation genetic diagnosis (PGD) also have blast transfers due to the fact that the embryo biopsies occur on day three and the processing takes two days.
In vitro fertilization patients commit to taking several medications to help improve the likelihood of pregnancy.
A woman receives various stimulation hormones to encourage the growth of follicles, as well as a medication to prevent premature ovulation. Once the follicles are mature, another medication triggers the final maturation of the eggs prior to retrieval.
Progesterone, a female hormone that prepares the uterus to receive and sustain an embryo, is given after egg retrieval and is continued until 10 weeks of pregnancy (eight weeks after retrieval). A woman then continues prenatal care with her obstetrician.
A few days (six to seven) after fertilization, the thin shell surrounding the embryo—the zona pellucida—should erupt. This “hatching” occurs to allow the embryo’s cells to come in contact with the uterus, allowing implantation – and pregnancy. Without hatching, implantation cannot take place.
In some women, the zona becomes toughened, preventing the embryo from hatching. Therefore, “assisted hatching” may be necessary in certain IVF procedures. Three days after egg retrieval, eggs are viewed under high magnification and a small hole is mechanically made in the zona. Specialists at the Reproductive Medicine Center typically recommend hatching for women who have repeated implantation failures, older women and situations where the embryologist notes a thickened zona.
Risks of In Vitro Fertilization
The main risks associated with IVF are:
- Over-stimulation of the ovaries Ovarian hyperstimulation syndrome, or OHSS, causes body fluid to collect in the abdomen. Severe OHSS, requiring hospitalization, occurs in less than 1 percent of women who undergo IVF.
- Multiple births Because two embryos are usually placed in the uterus during an IVF cycle, 20 percent to 25 percent of births will result in twins; in older women, more than two embryos may be transferred, which slightly increases the rate of higher order multiples.
- Egg retrieval complications Egg retrieval is a minor surgical procedure and carries the same risks as other surgical procedures. Complications are uncommon but may include infection, bleeding and injury to surrounding tissues.
In an abundance of caution, care and concern for our patients, staff and community, we are delaying fertility treatment starts until we have a greater sense of the degree of COVID-19 transmission in our region. We will closely follow ASRM and CDC recommendations as they become available.