In vitro fertilization is the process of fertilization outside of the body. The name comes from the Latin “in vitro” which means “in glass” referring to the petri dish where the eggs and sperm are brought together. Successful IVF in humans began in the 1970s and the popularity and success rates of this treatment have only increased since that time. IVF is used by couples who want a biologically related child, men with low sperm count or motility, and women who want to carry their own pregnancy despite challenges in getting pregnant.
History of IVF
The first baby conceived as a result of in vitro fertilization was born in 1978. At the time IVF was considered experimental and potentially unethical by both the medical community and the public, but quickly became more mainstream. Since that time, success rates with IVF have doubled, and freezing technology has expanded the timeline from fertilization to implantation almost infinitely. Today, the reasons for choosing IVF have expanded beyond the original uses. Some of the most common reasons for IVF include:
- inability of egg to reach uterus
- inability of sperm to reach egg
- opportunity to test for genetic abnormalities
Damage or obstruction in the fallopian tubes may make it impossible for an egg to reach the uterus after ovulation. Not only can this prevent pregnancy from occurring unassisted, in some cases the risk of an ectopic pregnancy can increase.
Low sperm motility - the ability of the sperm to move normally - can prevent sperm from reaching the egg, as can low sperm count or abnormal sperm morphology.
For couples at risk for passing on a genetic condition to their children, IVF provides an opportunity to test for those genetic disorders before implantation and pregnancy. Some of the conditions commonly tested for are cystic fibrosis, muscular dystrophy, and sickle cell anemia. If any genetic disorders are identified, IVF makes it possible to select only the healthiest embryos with the highest chance of success.
The process of IVF begins with ovarian hyperstimulation and ovulation induction. In a normal monthly cycle, a woman’s body will mature and release one egg. When preparing to undergo IVF, the woman producing the eggs, whether the woman who will be carrying the pregnancy or an egg donor, will begin a regimen of medications that cause the ovaries to mature multiple eggs at once.
Once matured, the eggs are collected in an outpatient procedure where the woman is under anesthesia. These collected eggs are then taken to the lab where the actual in vitro fertilization takes place. Sperm that has been processed to remove all seminal fluid - an important process called sperm washing which leaves only the healthiest and most mobile sperm - is introduced to the collected eggs. The combined eggs and sperm are then monitored for the next 18 to 24 hours to make sure that fertilization occurs and embryos are created.
This is the point in the IVF process where genetic testing is possible. There are two basic categories of genetic testing:
- Pre-implantation genetic diagnosis (PGD)
- Pre-implantation genetic screening (PGS)
PGD is used for patients with know potential genetic disorders or defects that they would like to test for in their embryos. PGS allows the opportunity to identify embryos with the right number of chromosomes. Both genetic defects and the incorrect number of chromosomes can cause a pregnancy to fail, so this type of testing can be an important step to ensure the best chance at a successful implantation and pregnancy.
Once embryos have been successfully created (and genetic testing has taken place (if wanted or warranted), a few will be chosen to be transferred into the uterus of the woman carrying the pregnancy. Now comes a difficult part of the process commonly called the Two Week Wait. This refers to the amount of time it takes to identify pregnancy hormones in the bloodstream and confirm that implantation and pregnancy have occurred.
Sometimes implantation can’t be done immediately. This can be for many reasons, but some of the most common are:
- Future medical treatments that may damage reproductive organs
- Genetic conditions that cause damage to reproductive organs
- Planning for a future pregnancy
The most common way to freeze both eggs and embryos is the vitrification - or fast-freezing - technique. This process causes the least amount of damage to the embryos and results in higher rates of successful pregnancy than slower-freezing techniques.
Is IVF Right for You?
IVF is so closely associated with fertility treatments that some people don’t know what other options are available. Depending on your unique family situation there may be some less invasive treatments that will be recommended before turning to IVF. The first step on the road to growing your family with fertility treatments is to choose a fertility specialist and set up a consultation. Contact us today for your free consultation and begin the journey to parenthood!
ASRM Reproductive Facts: https://www.theguardian.com/society/2013/jul/12/story-ivf-five-million-babies