In Vitro Fertilization (IVF)


In Vitro Fertilization (IVF)

IVF General Information

In 1978, Louise Brown made headlines as the world’s first test-tube baby. This event marked the beginning of the modern age of reproductive medicine. There has been an estimated one million children born through artificial reproductive technologies. In 2004, an expected 200,000 children will be born from In Vitro Fertilization.

IVF is probably the most well known of the “Assisted Reproductive Technologies,” and has helped infertile couples conceive and bear children for over two decades. It was originally developed to help couples overcome tubal factor infertility, but has become useful in treating other factors, such as immunological problems, unexplained infertility and male factor infertility.

There are now treatments for virtually any reproductive problem from the most severe sperm problems to the use of donor oocytes to combat the effects of maternal aging.

IVF is basically a five step process:

  1. Pituitary Suppression – Patients involved in our IVF program should expect to begin using a birth control pill on menstrual cycle day 3-6 prior to their IVF cycle. A GnRH agonist medication, such as Synarel nasal spray, will overlap the birth control pill for the last four days. The combination of the birth control pill and GnRH agonists, such as Synarel, help prevent the pituitary gland from interfering with the Follicle Stimulating Hormone (FSH) used to stimulate your ovaries.
  2. Ovarian Follicular Development – You will begin medication such as Repronex, Follistim or Gonal-F (Follicle Stimulating Hormones or FSH) to stimulate your ovaries. These medications allow for more that one egg to develop and improve chances for multiple oocytes to fertilize and develop. FSH will be used for approximately 8 – 10 days depending upon how quickly ovarian stimulation progresses. These medications have been used for many years and present no increased risk of birth defects with their use. Follicular and uterine lining development is monitored by ultrasound. When it is determined that the follicles and the uterine lining are appropriately mature, a trigger shot of Human Chorionic Gonadotropin (hCG) is then administered.
  3. Sonographic Aspiration of the Eggs – Approximately 34 hours after the trigger shot, the eggs are retrieved by an ultrasound-guided-needle aspiration, an in-office procedure under conscious sedation anesthesia, administered by an anesthesiologist. The physician places the ultrasound probe into the vagina and guides the aspirating needle through the vaginal wall into follicles in the ovary by watching the ultrasound image of the needle and follicles on a viewing screen. Fluid is aspirated from the follicles and is inspected microscopically for the presence of an egg.
  4. Fertilization and development of the pre-embryos – Once the eggs are received in the laboratory, they will be placed in special fluid media and be allowed to remain there for approximately 4 to 6 hours. During that time, the semen specimen will be washed, incubated and placed in with the egg(s) and left for approximately 16 hours. The egg(s) will then be examined for evidence of fertilization, removed and passed into a special growth media. Normally developed embryos will be transferred back into the uterus 48-72 hours after retrieval.
  5. Transfer of the pre-embryos back into the uterus – You will be positioned on the procedure table in our office as though you were going to have a pelvic exam. There will be no anesthetic required. A very fine catheter will be placed through the cervix into the uterus and the embryo(s) will be transferred into the uterine cavity. After the transfer, you will rest for 1 hour. You will need someone to drive you home (or to your hotel) after the transfer. You should be off your feet for the first 48 hours then you may slowly begin light activities until your pregnancy test. Because of your ovaries being stimulated, your ovaries will be tender and your pelvis will feel bloated and fully. These symptoms will gradually diminish but may not completely disappear.

IVF Couple

The Odds of Success

Women under age 35 without a male infertility factor involved have an average 40-50 % (percent) chance of conceiving and giving birth to a baby using IVF in our clinic over the past ten years. Success typically increases with the number of cycles attempted. You can access the success rates of fertility clinics in the United States through CDC website (see our success page for more information).

New Delopments in IVF

In a study of our pregnancy rates over the past two years, we have found that the use of segmented IVF cycles have produced a 5-8% increase in pregnancy rates over the conventional IVF rates. Segmented IVF cycles are ones where the embryo transfer is not done in the fresh stimulated IVF cycle. All of the embryos are frozen and therefore no fresh embryo transfer is performed. Cryopreserved embryos are subsequently used in a programmed frozen embryo transfer cycle.The increased pregnancy rates in these cycles are due to several factors. First, in stimulated IVF cycles, the endometrial lining is slightly out of phase with the embryo development. Secondly, the endometrial development can be over stimulated (thicker) or under developed when compared to normal physiologic cycles. Thirdly, the ovaries in these cycles are hyperstimulated and are at an increased risk for ovarian hyperstimulation syndrome (OHSS) should a pregnancy result from the fresh transfer.Segmented IVF is able to eliminate all of these shortcomings. Our embryo survival rate from the freeze/thaw process was over 95% in the past two years so virtually none of the embryos are lost secondary to freezing them.

This allows us to use a programmed hormone replacement cycle to create an ideal physiologic endometrial lining and precise timing for the embryo transfer. Since the ovaries are not stimulated it eliminates ovarian hyperstimulation syndrome.

The combination of these factors has resulted in a 5-8% increase in pregnancy rates over our already high IVF pregnancy rates.


Not only has IVF been successful, studies have also suggested that this procedure and intracytoplasmic sperm injection (ICSI) (in which one sperm is injected into an egg in the lab) are safe. A study of nearly 1,000 children conceived using either IVF or ICSI found that they were as healthy five years later as those conceived naturally. IVF success rates have continued to improve as the scientists and doctors improve their understanding of the IVF process to make it more physiologic.

The Future

Medical scientists are striving to boost IVF birth rates even further by perfecting current methods while developing new ones. One example is the development of improved techniques to identify which embryos are of the highest quality for transfer to a woman’s uterus. This process seeks to not only improve overall success but decrease multiple birth rates as well.

Egg Freezing

Egg freezing is another assisted reproductive technique that is being developed. The technique has yet to be perfected, but could be used to help women who want to delay pregnancy and overcome the age related decline in female conception.