In Vitro Fertilization (IVF)
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Video: IVF Treatment
David Barad, MD, one of CHR's experts in vitro fertilization, discusses why individualization
is crucial in order to achieve the highest IVF treatment success rate for each patient.
CHR's IVF Treatment Program in New York City, NY
The Center for Human Reproduction (CHR), located in New York, NY, was one of the first in vitro fertilization (IVF) centers in the United States and has been recognized as one of the best IVF centers in the world. Since 1981, more than 17,000 pregnancies have been achieved at our center using in vitro fertilization (IVF) and other Assisted Reproductive Technologies (ART). The CHR experts work closely with women and couples undergoing the many different types of IVF cycle protocols. We are renowned for our specialized knowledge and high IVF success rates, even in difficult cases. CHR's expertise in IVF lies in our willingness and ability to individualize our approach to best suit each and every one of our patients, as Dr. Barad explains in the video above.
What is In Vitro Fertilization?
In an in vitro fertilization procedure, eggs are gathered from the woman's ovaries and mixed with the man's sperm outside the body, usually in a glass dish in a laboratory. "In vitro" comes from Latin and literally means "in glass," a reference to the glass container where fertilization of the egg (oocyte) takes place. (While this is usually a dish, the term " test-tube babies" has become widely used.) The fertilized eggs are then cultivated for a few days and transferred to the woman's uterus.
Who Needs In Vitro Fertilization (IVF)?
Couples may benefit from in vitro fertilization (IVF) treatment if the any one of the following factors are present:
|Female Factors||Male Factors|
How IVF Works
IVF is offered to patients, when some initial infertility testing to establish the cause of infertility (such as a sperm count, a few hormone tests and an evaluation of the uterine cavity) indicates that IVF is an appropriate treatment approach.
Medications are administered over the course of about 21 days to suppress normal ovarian function
Injectable fertility medications are administered for 8-12 days to stimulate the woman's ovaries to mature multiple eggs
Egg Collection and Fertilization
Eggs are removed from the ovaries in a surgical procedure, then fertilized in a lab setting with the partner's or a donor's sperm
One to three embryos are selected and transferred into the woman's uterus through a small catheter inserted through the cervix
Pregnancy Testing and Confirmation
Approximately two weeks after the transfer is complete, a blood test will be done to detect the pregnancy. If this is positive, an ultrasound will be performed for further confirmation several weeks later
Stage1: Hormone Suppression
CHR Publications on IVF
- Reproductive Biology and Endocrinology Comparing needles with smaller and larger diameters, this study found no difference in oocyte yields between two needle sizes. Smaller diameter needles significantly prolonged time of egg retrieval, suggesting superiority of larger diameter needles in most cases.
Do hormonal contraception prior to in vitro fertilization (IVF) negatively affects oocyte yields? A pilot study.Reproductive Biology and Endocrinology Investigating 43 oocyte donors in 71 IVF cycles, this study found that exposure to high androgenic oral contraceptives prior to IVF cycles suppress functional ovarian reserve and oocyte yields, even in young oocyte donors. The finding of the study suggests that routine use of oral contraceptives in preparation for IVF may require reevaluation, especially in women with diminished ovarian reserve.
- Human Reproduction In response to a Finnish study advocating for single embryo transfer (SET) for even women in their 40s, this article questions the ever-popular trend of SETs in IVF cycles based on risk-benefit analysis of twin and singleton pregnancies following IVF.
The first stage of IVF involves stimulating the woman's ovaries so that several eggs mature. Normally, a woman produces one egg in each menstrual cycle, but with IVF, many ovarian follicles are produced by hormone stimulation and several eggs are obtained (usually 7-15) and a number of embryos are produced after fertilization. Two or three embryos are replaced into the woman's uterus to increase the chance of getting pregnant the first time.
To achieve this, a woman will need to take fertility medications to suppress her own hormones. This phase lasts for about 21 days. The drugs have the effect of putting the body into a temporary low hormone state (similar to a short-term menopause), along with all of the side effects that might be expected such as hot flashes and mood swings.
Stage 2: Ovarian Stimulation
Once the woman's own hormones have been suppressed, she can begin taking the medication that will stimulate the ovaries and egg production. She may need to have injections daily for 8-12 days. CHR physicians will modify this according to the way the individual patient's body is responding. The response of the ovaries will be carefully monitored using ultrasound scanning to show the size and number of developing follicles and frequently a blood test.
Monitoring of the woman during this stimulation period is essential, because a woman's ovaries sometimes respond too strongly to these medicines. This may result in the ovarian hyperstimulation syndrome (OHSS), which can cause a range of symptoms from mild abdominal pain to severe pain, vomiting, nausea and dehydration. On rare occasions, a treatment cycle has to be abandoned because of hyper stimulation. On the other hand, some cycles are canceled if not enough follicles are produced or the follicles grow very poorly. CHR physicians strive to strike a balance between these two unfavorable outcomes, based on their decades of clinical experience and up-to-date knowledge of the medical literature.
Stage 3: Egg Collection and Fertilization
If all goes well, however, the next stage of the procedure is egg collection. This takes place when the ultrasound scan shows a sufficient number of large follicles. The woman is given an injection late at night to give the ovaries containing the eggs their last 'push' towards maturity. Ovulation normally occurs 37-40 hours after this injection, so egg collection is scheduled to take place just before ovulation occurs (at about 34 hours).
The eggs are usually collected using a fine, hollow needle guided by ultrasound. Around the same time of the oocyte collection for the woman, the man produces a semen sample. The sperm is assessed and prepared for fertilization. As soon as the eggs are extracted from the ovaries, they are placed into a nutrient "embryo culture" medium with the sperm and then placed in an incubator overnight. The next day, the eggs are observed through a microscope to see if fertilization has occurred. By the next day, cell division will have started and the embryo might now have two or four cells.
Stage 4: Embryo Transfer
The embryos will be checked by our expert embryologists to ensure that they are developing normally and, if all is well, embryo transfer can take place. The embryos, together with a tiny amount of nutrient fluid, are put into a catheter and placed into the woman's uterus through her cervix with a special ultrasound guidance by one of our IVF doctors. By transferring one or two embryos we reduce the risk of a multiple pregnancy. Occasionally, in older patients, we transfer three embryos. If there are 'spare' embryos of good quality, these can be frozen and stored for use in a future treatment cycle if needed.
The embryo transfer procedure is critical. The procedure is short and generally painless. Afterwords, the woman will be advised to rest for a short time and then go home and "carry on as normal".
Stage 5: Pregnancy Testing and Confirmation
It will be about two weeks before a pregnancy test can be done, and this waiting is one of the most stressful times of the cycle. During this time, the woman will be prescribed progesterone, which is needed to provide hormonal support to any potential pregnancy.
If the pregnancy blood test is positive we will confirm this with a few more blood tests. Then an ultrasound scan a couple of weeks later will identify a normal pregnancy in the uterus and the heartbeat of the new embryo. If all is developing normally, the newly pregnant patient will be referred back to her obstetrician to make the transition to prenatal care.
While the in vitro fertilization procedure described above sounds simple, in reality, IVF is a complex and emotionally demanding process. It can take between six weeks and two months on average for a single treatment cycle and most couples find it both physically and mentally draining. CHR staff members' extensive experience with couples going through IVF treatment allows us to provide all the support needed to assist individuals during this emotional time.
IVF with Donor Eggs
One of the most important things to remember about IVF treatment is that it only works about half the time in the best of cases. So, sometimes the patient needs to repeat the IVF cycle. Other times, a woman who is older or has "premature aging" of her ovaries might not have a successful in vitro fertilization (IVF) cycle. In these cases, which are not that uncommon at CHR due to our special expertise in treating women with ovarian aging, patients may opt to use donor eggs. Donor IVF allows the woman who otherwise would have no chance for pregnancy carry and deliver her own baby using the sperm from the husband. Donor egg cycles are usually less expensive than adoption. CHR also offers an embryo adoption program that has been very successful.
In vitro fertilization (IVF) pregnancy rates have been improving since the inception of the technique, but the rate of improvement has slowed considerably in the past few years, as the national data shows. Especially in women above age 42 and those with diminished ovarian reserve, IVF has become more successful in the recent years, but there is still a huge room for improvement. In addition, different centers treat different types of patients, resulting in different levels of "success rates." This means that an IVF treatment center with the highest IVF success rates may not be the best IVF center for everyone. For a detailed discussion of how IVF pregnancy rates should be interpreted when comparing IVF clinics, please take a look at our guide for IVF success rates.
IVF and Twins
Nearly every infertility treatment, including IVF treatment, increases the risk for twins and higher-order multiple births. The process of an IVF treatment cycle typically results in multiple embryos, of which sometimes 2 (and in some cases 3) are transferred into the uterus to try and establish a pregnancy. The more embryos that are transferred, the higher the likelihood that a pregnancy will result. However, in some cases more than one embryo survives, leading to a twin or multiple pregnancy.
Recently, there has been a movement to try and reduce the number of IVF twins and multiples through a practice called single embryo transfer (sET). With sET only one embryo is transferred into the uterus, greatly diminishing the chance of a twin pregnancy. However, our experts at the CHR believe that sET reduces the chances of a resulting pregnancy and therefore mandating sET infringes upon the rights of patients who desire to implant multiple embryos.
In our experience, many patients are not opposed to the idea of having twins (and some are even eager to have twins!). As long as the patient does not have contraindications for twin pregnancy, CHR physicians do not blindly restrict the number of embryos for transfer to one. At CHR, we believe that it is a decision that should be made by the patient, in consultation with her physician.
Benefits of IVF at the CHR
Trusted IVF Center of "Last Resort"
Because of our world-wide reputation as the IVF center of "last resort," patients from all over the world come to CHR with complex infertility cases, often after they have had failed IVF treatment cycles elsewhere, or been outright denied treatment due to supposed poor prognosis. There are three components to our success in providing successful IVF treatment to these patients:
- Individualization of care: Unlike at some larger IVF centers, there is no "one-size-fits all protocol" at CHR. Thanks to our experience with patients with multifactorial infertility and sometimes other medical conditions that require attention, CHR physicians are able to offer individualized approach that is best suited for each patient.
- Aggressive approach when necessary: Especially when a patient has diminished ovarian reserve (indicated by high FSH or low AMH), every egg and every embryo matters. We fight for every egg and embryo!
- Intimate atmosphere of a private center combined with a cutting-edge research program that rivals major university hospitals': Our rigorous fertility research program has been the driving force behind our success in developing and providing the cutting-edge fertility treatments. A recent example is the introduction of DHEA supplementation into fertility treatment for women with diminished ovarian reserve.
Thorough Pre-IVF Consultations and Testing
Perhaps less known is our work with individuals and couples who are considering assisted reproduction, but who are uncertain of their next step. We encourage anyone, before they make a decision, to consult with one of our IVF treatment experts. While an in-office or telephone consultation and a round of testing will be necessary to thoroughly assess each patient's situation, the first step is the free Pre-IVF email consultation.
There are many issues to consider that can influence your prospects of conceiving. Both partners require a careful evaluation. in vitro fertilization (IVF) doctors at CHR take a thorough approach, covering all aspects of both partners' physical and emotional well-being. After completing this evaluation, you may find that you have a good chance of getting pregnant naturally, with a bit more time. Most of the time, there are some specialized fertility tests to be performed depending on the type of infertility. Many of the couples who have been unsuccessful in starting a family before consulting our center have a long history and all the tests have been done. These couples can usually move directly into in vitro fertilization.
Financial assistance for IVF treatment
CHR offers special financial conditions for patients who do not have insurance coverage, and at times can offer access to free infertility medications. Learn more about the cost of in vitro fertilization and available IVF treatment financing options from our IVF costs page. CHR also offers a Shared Risk IVF program for women with diminished ovarian reserve (DOR).
To determine whether our IVF treatment program in NY is right for you, please complete the Pre-IVF email consultation form.
Written by David Barad, MD
Last Updated: November 21, 2013