ART PROCEDURE
In Vitro Fertilization (IVF) :
IVF refers to the creation of embryos by placing sperm and eggs in a test tube or culture dish in a laboratory setting. In order to perform this procedure, oocytes (eggs) must be obtained by stimulating the ovaries with fertility medications, and then retrieving the oocytes from the ovaries by having the woman undergo a minor surgical procedure. This procedure is performed in an operating room after you are sedated with intravenous anesthesia.
The oocyte retrieval involves the passage of a needle through the thin posterior wall of the vagina into the ovary and aspirating the oocytes from the ovary. After collection of the oocytes, the sperm and oocytes are prepared and then mixed together in the embryology laboratory in an incubator for the purpose of creating embryos.
These embryos are allowed to grow in the incubator for an additional 2 to 3 days before being transferred. The transfer procedure uses a small tube placed through the cervix directly into the uterus with the hope that the embryos will implant in the uterus, and result in a pregnancy.
Intra cytoplasmic Sperm Injection (ICSI) :
ICSI is a procedure utilized to treat male factor infertility. It is performed in the embryology and involves the injection of a single sperm into an oocyte for the purpose of creating embryos.
This procedure is a form of in vitro fertilization because fertilization occurs in a laboratory, but is different from “routine” IVF because the sperm is injected with microsurgical instruments into an oocyte. Couples with male factor infertility, prior demonstration of poor fertilization or polyspermic fertilization are candidates for this procedure.
Cryopreservation :
Cryopreservation refers to the freezing of excess embryos not transferred to the uterus. Approximately 1 in 4 couples undergoing an IVF procedure will have an excess number of embryos which may be cryopreserved (on culture Day 2 or 3).
Good quality embryos may be cryopreserved or frozen (stored in liquid nitrogen) with the intention of later thawing (defrosting) these embryos for future pregnancy attempts. Pregnancy rates using frozen and thawed embryos are usually lower than fresh embryo rates.
Medications :
Gonadotropins- hormones, specifically Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which act directly on the ovaries to induce egg production. Gonadotropins are produced endogenously in the pituitary gland, but can be given in pharmacologic doses by way of fertility drugs. Currently, there are multiple brands of gonadotropins available commercially.
Historically, the first generation of gonadotropins was produced by extracting FSH and LH from the urine of menopausal women, and purifying the preparations so that they were suitable for intramuscular or subcutaneous injection. Another currently available preparation of human gonadotropins contains FSH alone (second generation gonadotropins).
Other commonly used gonadotropins include the ‘recombinant FSH’ preparations and are the product of genetic engineering technology. Examples include Gonal-F and regecon.
Lupride- a gonadotropins –releasing hormone (GnRH) agonist acts on the pituitary gland to control the secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH). Initially Lupride causes a release of stored FSH and LH, but continual doses prevent further production of additional gonadotropins.
Because of the initial release of gonadotropins during Lupride administration, Lupride must be given for at least 10 days before effectively suppressing pituitary production of gonadotropins. Lupride is an injectable medication administered subcutaneously.
Antagon / Cetrotide- are gonadotropin-releasing hormone (GnRH) antagonists- that act by directly inhibiting the release of FSH and LH from the pituitary gland. Your physician may recommend the use of these medications instead of Lupride for certain clinical situations.
Because there is no initial burst or flare as with Lupride, these medications are started after the start of stimulation medications, usually around day 6 (typically). These medications are also given subcutaneously.
Human Chorionic Gonadotropin (HCG)- is a special type of gonadotropin that is given to mimic the LH surge and trigger ovulation. This is done because of the structural similarities between HCG and LH. After HCG is given, the final steps of egg maturation occur and the eggs are released from the ovary.
Depending on the brand used, HCG can be given intramuscularly (Fertigyn, Pregnyl) or subcutaneously (Ovidrel) 36 hours before the oocyte retrieval procedure.
Progesterone- is a hormone that is vital for successful uterine implantation. Usually progesterone is only produced by the ovaries after ovulation (Iuteal phase). Progesterone supplementation is started after oocyte retrieval because natural production may be compromised by either the egg retrieval process itself or the medications used to down-regulate the pituitary.
Progesterone is usually given as an intramuscular injection once a day. Our nurses can provide tips to minimize this discomfort. In certain situations, a combination of oral progesterone and intra vaginal progesterone can be used for Iuteal support. If pregnancy is successful, progesterone supplementation is usually continued for an additional 12 weeks.
