Definition

The most commonly used method of assisted reproduction usually proceeds in three steps:

  1. Ovulation induction is done to make eggs mature. This step is done with hormone treatments.
  2. Harvest or retrieval of mature egg cells (oocytes) from the ovaries. This is done after treatment for their maturation. The egg cells are then mixed with sperm cells in a lab dish.
  3. The fertilized eggs will in the lab for a few days. They are then transferred into the womb or uterus for further development.

Parts of the Body Involved

  • Uterus
  • Vagina
  • Cervix
  • Ovaries
  • Pituitary (affected with treatment of hormones)

Fallopian Tube, Ovary, and Uterus

Fallopian Tube, Ovary, and Uterus

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Reasons for Procedure

IVF is done to help a woman become pregnant. It is most often performed when infertility is due to:

  • Damaged fallopian tubes
  • Endometriosis
  • Ovulation disorders
  • Cervical factors
  • Male factors, such as infertility , low sperm count, or poor quality sperm

Risk Factors for Complications During the Procedure

  • Age—Older women (> 40 yrs) are less likely to conceive and carry to term

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical and pelvic exam
  • Infertility testing for both you and your partner
  • Hormone treatments (clomiphene citrate, human menopausal gonadotropins) to stimulate production of multiple eggs (oocytes)
  • Repeated blood tests and ultrasound exams to monitor the development of multiple egg follicles
  • Schedule appropriate time for harvesting mature eggs—closely timed to coincide with ovulation

Anesthesia

  • General , spinal, or IV sedation during harvesting
  • None during the transfer of fertilized embryo

Description of the Procedure

Egg Harvesting

An ultrasound-guided technique is often used to harvest the eggs. A laparoscopic method may be used to assess the pelvic organs. A laparoscope has a light and lens for a clearer view of the organs. The ultrasound is faster and easier on the patient. It is also as effective as laparoscopic retrieval.

The ultrasound probe has an attached needle. They are inserted into the vagina. The needle punctures the egg follicles. Fluid is removed through the needle. The fluid is inspected. Then it is immediately placed in a sterile, nutritive culture material. The fluid will be kept in an incubator.

The male, if fertile, refrains from ejaculating for two or three days. He then collects semen through masturbation. Penile scar tissue or other conditions may block the natural release of sperm. If this is the case, a sperm aspiration may be done. Sometimes, the man's sperm can be frozen ahead of time. If the male partner is unable to produce viable sperm, donor sperm may be used.

Between 50,000 and 100,000 of the most mobile, healthy sperm are chosen. They are mixed with the harvested eggs. The sperm may be treated to increase the chance of fertilization. The culture dish is kept at normal body temperature inside an incubator for 2-3 days. During that time, sperm are expected to fertilize 60%-80% of the eggs. Once fertilized, early cell division begins. Embryos develop.

Transferring Procedure

A certain number of the embryos (usually 1-5) are placed into your uterus. Fewer embryos decrease the chance of multiple pregnancy (eg, twins, triplets). The other embryos may be frozen. They may be saved for future IVF cycles. You may also choose to donate them to other infertile couples.

A catheter is inserted into the vagina. It will be threaded through the cervical canal and into the uterus. The embryos are then passed into the uterus. You may be positioned face down with your knees at your chest. A special table that tilts the uterus downward may also be used. These positions allow gravity to help keep the embryos in the uterus for implantation.

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After Procedure

Expect to rest at the center for a few hours before going home. You'll have a pregnancy test 10-12 days after the procedure.

How Long Will It Take?

  • Harvesting—30 minutes or less
  • Transfer procedure—lasts about 10 minutes

Will It Hurt?

The egg harvesting can be uncomfortable. Anesthesia is given to decrease the discomfort.

Possible Complications

  • Multiple conceptions
  • Ectopic pregnancy (embryo develops outside the uterus)
  • Anesthesia-related problems
  • Short- and long-term adverse effects from fertility drugs
  • Rare: ovarian rupture

Average Hospital Stay

None

Postoperative Care

  • Follow the instructions for any medicine given.
  • Return in two weeks for a pregnancy test.

Outcome

You'll probably be able to resume normal activities within a few days.

It can be difficult to wait two weeks for the results. Even if pregnancy occurs, a miscarriage remains a possibility.

If the pregnancy test indicates conception, an ultrasound will be scheduled for two weeks later. This is done to confirm a fetal heartbeat. It will also be able to see if more than one egg is growing. Pregnant women are referred to an obstetrician for follow-up.

If pregnancy did not occur, the next attempt should be at least one month later.

Success rates for the first three cycles are about the same (about 10% per cycle). The rates then start to decrease. Success rates are influenced by both age and the cause of infertility. Only 15% to 20% of couples using IVF conceive and deliver a baby.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Increasing pain, excessive bleeding, or discharge
  • Any unusual symptoms
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting