IVF, in vitro fertilization,
was first performed successfully in the United States at the Jones Institute
for Reproductive Medicine, Eastern Virginia Medical School. Our specialized
IVF team includes reproductive
endocrinologists, IVF nurse coordinators,
IVF laboratory specialists,
and andrologists. The combined
efforts of these individuals are responsible for our superior pregnancy
IVF success rates.
In vitro fertilization
( IVF ) is a process that involves the use of medications ( FSH ),
to stimulate the development, growth, and maturation of eggs located within
follicles on the ovaries. FSH dosages are individualized for each patient;
responses are carefully monitored using ultrasound and estradiol measurements.
IVF bypasses the fallopian tubes
and is therefore the treatment of first choice for most patients with
damaged or absent fallopian tubes. IVF
also has been instrumental in helping patients with endometriosis,
moderate to severe male factor infertility,
infertility of unknown causes, and many other infertility disorders.
In the vast majority of cases, egg retrieval is performed
transvaginally with ultrasound guidance. This usually is performed under
intravenous sedation with local anesthesia, but general anesthesia may
be given.
Laparoscopy
is usually performed for gamete intrafallopian transfer ( GIFT ) and zygote
intrafallopian transfer ( ZIFT ) procedures. The risks of anesthesia should
be discussed with the anesthesiologist in charge prior to retrieval.
The risks of egg retrieval include bleeding, which may
require transfusion and a laparoscopy and / or laparotomy to correct the
situation, and infection, which may require hospitalization with intravenous
antibiotic therapy. Ovarian torsion also has been described. Death has
been reported ( though not from our clinic ) following transvaginal follicular
aspiration. Major complications are extremely rare but do occur, as with
any minor operative procedure.
The eggs are then combined with sperm in culture
dishes; the resulting embryos are placed in an incubator where they are
nourished until they are ready for transfer usually in 3 - 5 days. The
IVF incubator is a highly controlled environment that maintains precise
temperatures, gas concentrations, and uses highly filtered purified air.
On average, approximately 80% of the eggs collected
are mature. Thus, 20% of the eggs are immature at the time of egg retrieval.
Although approximately 60% of the immature eggs will mature with overnight
incubation of an in vitro culture, a pregnancy rarely occurs ( < 2%
) from the transfer of only embryos that originate from immature eggs.
Egg freezing is offered in our program as an approved
clinical research procedure. Candidates are infertile patients who are
undergoing IVF treatment and do not wish to freeze excess embryos and
single women who will receive chemotherapy and / or irradiation for a
treatable form of cancer. Patients are charged for the involved ancillary
procedures such as hormonal testing, ultrasounds, office visits, and embryo
transfer but are not charged for the laboratory cost of freezing and thawing
the eggs. If you are interested in this procedure, talk with the clinic
coordinator and discuss with your physician.
Once mature, the embryos are removed from the
incubator and placed into the uterus where they are allowed to continue
normal fetal development ( transfer ). Embryo transfer is usually performed
under no anesthesia and lasts only a few minutes. On occasion, dilatation
of the cervical canal may be required at the time of transfer in order
to facilitate the procedure. Minor side effects include mild cramping
and minimal bleeding, mostly from the use of a cervical tenaculum to straighten
the cervical canal. We are now performing all embryo transfers with transabdominal
ultrasound guidance.
Other ART procedures include
tubal transfer, such as gamete intrafallopian transfer
( GIFT ), zygote intrafallopian transfer ( ZIFT ), and tubal embryo transfer
( TET ). In tubal transfer, the embryo is transferred into the fallopian
tube instead of into the uterus as in IVF. Procedures such as GIFT or
ZIFT or are rarely performed. Their costs are higher due to the need for
general anesthesia and laparoscopy, and there is no increase in fertility
success rates.
Embryo cryopreservation has revolutionized the process
of IVF and positively affected success
rates. The advantages include inseminating all of the available oocytes,
limiting the number of pre - embryos transferred to reduce the incidence
of multiple pregnancy, and giving patients an added chance of achieving
a pregnancy without having to undergo a complete stimulated IVF cycle
( which offers tremendous cost and time advantages ).
At the Jones Institute, pre - embryo cryopreservation
has been available since 1986. After consent is obtained from both partners,
the appropriate number of pre - zygotes or pre - embryos are cryopreserved.
Cryopreservation is performed on fertilized pre - zygotes or pre - embryos
with a slow freezing protocol using a cryoprotectant. Thawing and transfer
of the pre - zygote or pre - embryos is performed in a natural cycle following
ovulation, or in a programmed cycle that includes exogenous administration
of estrogen and progesterone.
Since the beginning of the cryopreservation program
at the Jones Institute, more than 17,000 pre - embryos have been cryopreserved
in more than 2,900 patient cycles. The mean survival rate of cryopreserved
pre - zygotes is approximately 68%. The clinical pregnancy rate per transfer
is 30%, and the delivery rate per transfer ranges from 10% ( with one
cryopreserved embryo transferred ), to 28% ( with three or four cryopreserved
embryos transferred ).
To illustrate the effect of cryopreservation on
success rates, the total reproductive
potential ( TRP: the chances of a live birth from either fresh or
cryopreserved embryos from the same stimulated cycle ) is calculated.
Based on data from our program, the TRP is greater than 55% for patients
under 35 years of age. Embryos that are developing suboptimally may not
be frozen, as determined by the embryology lab.
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Phone
800-515-6637 or 757-446-7100