Infertility affects people of all races, economic classes, and geographic areas. MedStar Health offers assisted reproductive technologies (ART) to help those who are:
- Unable to become pregnant after one year of unprotected, well-timed intercourse
- Unable to carry a pregnancy that results in a live birth
In Vitro Fertilization and Embryo Transfer
In Vitro Fertilization and Embryo Transfer (IVF-ET) are procedures designed to enhance the likelihood of conception in an individual or couple for whom other techniques have not been successful. This procedure involves multiple steps culminating in the fertilization of eggs in a laboratory.
Specific steps of an IVF cycle carry risks which will be explained in detail by your doctor.
Step 1: Ovulation Stimulation
If you're using your own eggs, you will begin treatment with synthetic hormone injections to stimulate your ovaries to produce multiple eggs rather than the single egg that normally develops monthly. Several eggs are necessary because they will not all fertilize or develop normally after fertilization.
After hormonal stimulation numerous follicles develop in the ovaries, each contains one egg.
Typically, one or two weeks of ovarian stimulation is needed before the eggs are ready for retrieval.
Step 2: Egg Retrieval
Egg retrieval is the removal of eggs from the ovary and it can be typically be undergone in your doctor's office or a clinic 34 to 36 hours after the final injection and before ovulation.
A physician can harvest these eggs by inserting a transvaginal ultrasound probe into the vagina which allows the ovary to be viewed. The follicular fluid can be seen as dark areas on the ultrasound. A needle is then inserted through the vaginal wall and into the follicle, removing the fluid by suction. The fluid is placed into a tube which is passed onto the lab personnel who look through the fluid to see if they can find an egg. This is repeated until fluid is removed from all available follicles.
Step 3: Sperm Collection and Preparation
If you're using your partner's sperm, he'll provide a semen sample at your doctor's office or a clinic through masturbation the morning of egg retrieval. A semen specimen must be produced within two hours of egg retrieval unless cryopreservation of the sperm has been previously arranged through your physician and the ART Laboratory personnel. Abstinence from ejaculation for two to five days prior to providing this specimen is requested. Donor sperm also can be used.
The sperm will be prepared for insemination of the collected eggs in the laboratory.
Step 4: Fertilization and Development of Eggs
During the retrieval process, multiple eggs are frequently obtained. All mature eggs will be fertilized using one of two common methods:
- Insemination: healthy sperm and mature eggs are mixed and incubated overnight
- Intracytoplasmic Sperm Injection (ICSI): a single healthy sperm is injected directly into each mature egg
Under controlled laboratory conditions, fertilized eggs are allowed to develop for up to 6 days. Each embryo is evaluated for stage of development. The healthiest embryos, one to a maximum of four, will then be prepared for transfer.
Step 5: Embryo Transfer
Embryo transfer is done at your doctor's office or a clinic and usually takes place three to six days after egg retrieval. Embryos are transferred to the uterine cavity with a catheter. This does not require anesthesia and resembles a standard pelvic examination. Upon completion of embryo transfer, you will be asked to remain resting in a designated transfer room for approximately 30 minutes.
If successful, the embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.
Step 6: Assisted Hatching
For implantation to take place, the embryo must escape from the outer membrane which surrounds it. This is call hatching. Sometimes the membrane appears thick or some other reason makes the embryo unable to escape. For this reason, assisted hatching may be undertaken to dissolve away part of the membrane with a mild acid. This is done with a micropipette designed for holding the embryo steady while the hatching pipette is used to apply the acid.