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IVF/ART Overview
The Rocky Mountain Center for Reproductive Medicine (RMCRM) opened in Fort Collins Colorado for patient care in 1995.
The In Vitro Fertilization (IVF) center was built on the premises of the clinic for patient convenience and was immediately successful in bringing the first babies to a Northern Colorado IVF center.
Over the years, IVF has undergone many important changes. While initially the technology world wide suffered from universally low pregnancy rates, advances in technologies involving fertilization, embryo culture conditions, as well as improvements in embryo transfer techniques have all contributed vastly to improved pregnancy rates.
The original indication for IVF was in women who had irreparably damaged fallopian tubes, but it has now become a standard and effective technique for couples where sperm parameters are abnormally low as well as for couples who have unexplained infertility.
Endometriosis in the female partner is another common indication for IVF. In some cases where female age, surgery of the ovaries, or other conditions have resulted in insufficient numbers of good quality eggs, an egg donor coupled with IVF can result in extremely high pregnancy rates.
In many couples the initial treatment choice may have been intrauterine inseminations (IUI). Generally, if this is not successful after two to three attempts, couples should consider moving on to IVF. In contrast to treatments that involve an IUI, cycles involving IVF are much more complex and time consuming. An “overview” of an IVF cycle is included here, and more detailed descriptions are included elsewhere on the Website for couples contemplating this as a treatment option.
IVF Pretesting
IVF requires some testing that is specific to this particular treatment. It is typically relatively easy to complete these tests as they involve blood work on both partners, as well as sperm testing and cryopreservation of sperm from the male. In the female an ultrasound, a mock transfer procedure utilizing a catheter that simulates the transfer of embryos into the uterus, as well as a possible office hysteroscopy to establish uterine normality is performed.
Oocyte (Egg) Stimulation
A combination of medications (FSH & LH) is given to stimulate the ovaries to produce multiple eggs. Many eggs are desirable as some will not fertilize or develop to maturity. In addition, other medications such as GnRH agonists or GnRH antagonists are given prevent premature ovulation.
Monitoring of the maturation of the oocytes and the endometrium of the uterus are accomplished by ultrasound as well as measurements of estradiol and progesterone hormones in the blood. Once the oocytes are felt to be mature, another injection of human chorionic gonadotropin (hCG) is given to accomplish the final phase of oocyte maturation and allow for the removal of the oocytes from the ovary.
Oocyte Retrieval
Once the oocytes are mature, an egg retrieval is scheduled at out IVF center operating suite. Patients are given conscious IV sedation so there is little discomfort associated with the procedure. An aspiration needle, guided by ultrasound, is inserted through the wall of the upper vagina and the eggs are aspirated from the ovaries. Once collected, the egg is immediately identified by the embryologist (Dr Olson) and fertilized later that same day.
Fertilization and Embryo Culture
mmediately after the egg retrieval, Dr Olson carefully identifies each egg and readies them for fertilization. If intracytoplasmic sperm injection (ICSI) is scheduled, individual sperm are injected into individual eggs. This is commonly performed in couples where normal fertilization is in question. In many couples, sperm numbers and quality are felt to be sufficient to allow the sperm to fertilize on their own.
Once fertilization occurs, the embryos are allowed to continue to grow and divide into multiple cells in special incubators that control the temperature and other environmental conditions. Embryos remain in the incubators until mature, which is generally 3-5 days.
Advanced stage embryos that divide to the morula or blastocyst stage have higher implantation and pregnancy rates. Because of this greater viability, fewer embryos can be transferred to the uterus lowering the incidence of multiple births. At the RMCRM, Dr Bachus has been careful to minimize the multiple pregnancy rates, yet maintain the highest pregnancy rates possible.
Embryo Transfer
When the embryos are determined suitable for transfer, the patient returns to the IVF center. The embryo transfer is typically performed under ultrasound guidance and a full bladder is needed. The procedure utilizes an extremely flexible catheter, lasts for only a few minutes, and is typically painless.
Post Transfer
Following the transfer, the patient is typically kept at the center for approximately one hour at bed rest. Modified bed rest is continued at home for another 48 hours.
Progesterone injections or vaginally administered progesterone and estrogen patches are given as supplements after the oocyte retrieval and continued post transfer until the pregnancy test. For those with a positive test these medications will be continued into the first trimester.
Disposition of Surplus Embryos Not Transferred
Many couples are fortunate to have embryos in excess of those chosen for the transfer. Unless other arrangements had been agreed to, these "surplus embryos" are typically frozen to allow another pregnancy attempt at some future time. It would appear that these embryos could survive indefinitely when kept in liquid nitrogen.
As a result, many couples have an opportunity to attempt another pregnancy at a fraction of the cost or involvement physically as the embryos are already "created". Thus, a frozen embryo transfer is relatively easy compared to another "fresh" attempt.
