In Vitro Fertilization (IVF)
Advanced reproductive technologies started in 1978 with the birth of Louise Brown, born as a result of in vitro fertilization (IVF). Today, IVF is one of the most common advanced reproductive procedures in the world. IVF involves extracting a woman’s eggs, fertilizing them in the laboratory and transferring the resulting embryo(s) into the woman’s uterus. IVF is useful in patients with blocked fallopian tubes, endometriosis, pelvic adhesions, male infertility, or unexplained infertility.
IVF with ARMS
Our Phoenix, Arizona IVF team trained at The Jones Institute for Reproductive Medicine, the center that pioneered IVF in the United States and has lead the nation in research and treatment for many years. At The Jones Institute our physicians saw hundreds of the most complex infertility cases from around the world. Training at The Jones Institute provided our physicians with a wealth of experience that benefits Arizona Reproductive Medicine Specialists patients each day. Since then, our IVF tem has gone on to establish a center of excellence in Arizona that has consistently produced pregnancy rates among the highest in the nation. Our PhD lab director has twenty years of experience in assisted reproduction and is certified as a highly complex Laboratory Director. The laboratory is CLIA and JCAHO certified.
Intracytoplasmic sperm injection (ICSI) is a method of assisted reproduction that involves combining an egg with sperm in a laboratory dish. It utilizes the direct microinjection of a single sperm into a single egg in order to assist fertilization. If the egg fertilizes and begins cell division, the resulting embryo is transferred into the woman’s uterus where it will hopefully implant in the uterine lining and further develop. In vitro fertilization may be performed in conjunction with medications that stimulate the ovaries to produce multiple eggs in order to increase the changes of successful fertilization and implantation.
Ask about our new simple medication treatment. ARMS now offers an IVF medication plan that uses one injection per day (rather than three) at 15 percent less cost.
Typical steps or phases in IVF treatment include:
We will meet with you to review your medical history and to understand the factors involved in your infertility. During these consults, we will talk with you about your treatment options so that we may tailor your treatment to your specific problems. After providing you with information on your cause of infertility and the options available to treat those problems, we will seek your guidance on how you would like us to proceed. Your treatment is a team effort between many skilled professionals and yourselves. It is during this period that you will be given consent forms that will educate you to what will be done and will seek your opinion for the various options.
2.) Pre-treatment testing
We want to make sure that your treatment has the highest probability for success. Instead of providing one type of treatment for everyone, we will perform testing so that we will treat your specific infertility. Blood tests will tell us whether you have a hormonal problem and will help us to determine the right amount of hormones you will need to take to produce the optimum numbers of eggs. Some tests, like the sonohysterogram or the HSG, are done to ensure that your uterus is normal and that no untreated problems exist – problems that would make your treatment futile. Other tests, like trial transfers are done so that prior to the actual treatment we know whether to expect problems so that we can solve those problems before we are at the critical stage of embryo transfer. A semen analysis is often performed to determine whether the amount and quality of sperm are sufficient standard IVF or whether we will need to use ICSI (sperm injection) to avoid possible fertilization failure. We try to leave as little as possible to chance and we will never perform unnecessary tests.
3.) Hormone treatment
During this phase, you will be given medications that will allow us to cause your ovaries to produce many eggs for in vitro fertilization. Our pre-tests will help us to determine starting dosages of hormones to produce a maximal effect while minimizing your chances for hyperstimulation. You will be given medications that will cause you to produce many follicles. Other medications will trigger the final stages of egg maturation while others are given to enhance implantation of the embryo after transfer. While you are on medications to produce follicles you will need to come in to have blood drawn for hormone analysis and to have your ovaries monitored via ultrasound.
4.) Egg retrieval
This is the process of collecting the eggs in your ovaries. These eggs are collected under anesthesia using an ultrasound. The fluid in your follicles is removed and the embryologist will examine the fluid for eggs. The eggs will then be prepared for fertilization so that they will produce embryos.
Depending on the quality of your husband’s sperm, the eggs will either be fertilized by placing the sperm and eggs into a dish with a special fertilization fluid, or by injecting an individual sperm into each egg (ICSI). Prior to fertilization, the large clumps of cells that surround the eggs will be dissected away under a microscope. About 18 hours after fertilization, the eggs will be examined to determine the number that have fertilized. These fertilized eggs will be cultured for 3 to 5 days at which time they will be placed into the uterus.
6.) Embryo transfer
Ideally, we prefer to transfer blastocyst embryos. These are embryos that are produced after 5 to 6 days of culture. By transferring blastocysts, the healthiest embryos will be selected for – those that have the best chance of producing a baby. While the percent of embryos that implant from embryos that are 3 days old is about 15 or 20 percent, the percentage of blastocysts that implant is in the 40 to 50% range. Frozen blastocyst embryos also produce higher pregnancy rates than frozen day 3 embryos. Any embryos that remain after transfer can be frozen for future use. Our goal is to provide you the best chance for a healthy pregnancy while reducing the risks to you and your future children by transferring a minimum number of embryos.
About two weeks after your egg retrieval, you will be scheduled for a pregnancy test at ARMS. If you are pregnant, you will return to ARMS in a few weeks to determine the number and size of implantations. After observation of a beating heart you will be referred back to your obstetrician.
It is necessary to take certain medications during the in vitro fertilization cycle in order to prepare the body for the treatment. The instructions for each medication vary from patient to patient. Your ARMS medical team will analyze your case closely to determine which medications to use, what dosage to take, when to administer the medications, and how long to take them.
Typical medications may include:
GnRH Agonists – Lupron, taken as an injection just below the skin and Synarel, a nasal spray, allow the body to produce a greater number of high quality eggs during the treatment cycle. They also prevent the mid-cycle hormonal surge that can result in the cancellation of a cycle.
Antagonists – Antagon and Cetrotide are antagonists of gonadotropin releasing hormone (GnRH) and are used to prevent premature ovulation. These medications are given by injection and the duration of treatment is usually three or four days.
Gonadotropins – Gonadotropins are taken as subcutaneous injections that provide stimulation to the follicles that contain the eggs during the stimulation phase. Gonal F, Bravelle, Follistim, Pergonal, and Repronex are the most commonly used gonadotropins.
hCG – hCGs are taken as an intramuscular injection and are used to induce the final maturational changes in the eggs and prepare them for retrieval. The most commonly prescribed hCGs are Pregnyl, Profasi, and Novarel.
Medrol – Medrol is a steroid hormone given daily, typically for a period of four days during the cycle, to assist pre-embryo implantation.
Doxycycline – Doxycycline, an antibiotic administered in pill form, is given to the male partner during the wife’s stimulation cycle to further reduce the low levels of bacteria that may be found in the semen and which may compromise the performance of the sperm during an in vitro fertilization cycle. It is also given to the female partner to reduce the risk of inferior following aspiration of the follicles at the time of egg retrieval.
Progesterone – Natural Progesterone may be taken as a daily intramuscular injection beginning two days after egg retrieval and continuing until the placenta is making adequate amounts of Progesterone. Progesterone can also be given in the form of a vaginal gel or vaginal suppositories or pills (Prometrium).
You will be given injections to cause the recruitment of many follicles. Daily administration of these drugs cause an increase in FSH, a hormone involved in the production of the follicles that contain the egg. The monitoring process will allow the physician to choose the most suitable protocol, to obtain best possible outcome, and to try to avoid complications. This monitoring of both your blood levels of the hormone estradiol and ultrasound monitoring of the growth of follicles will allow us to determine when the time is optimum for final maturation of the eggs.