In 1978, the birth of Louise Brown heralded a new era in reproductive medicine. Since then, over five million babies have been born through this once 'revolutionary procedure. While IVF was originally designed to bypass blocked or damaged fallopian tubes, its application has been extended to male factor infertility, unexplained infertility, or failure of conventional treatment such as ovulation induction with intrauterine insemination.
The IVF process involves stimulation of the ovaries to obtain multiple egg development and the removal of those eggs by ultrasound guided needle aspiration. The patient is given anesthesia for the procedure which takes fifteen to twenty minutes.
After the eggs are isolated in the laboratory and the partner's sperm is prepared, the eggs are either inseminated or injected with the sperm. The resulting embryos are cultured in the incubator and evaluated daily.
The embryos are returned to the uterus in three to five days by a thin soft catheter. Blastocysts are embryos in a more advanced state of development and commonly developed by the fifth day in culture. Blastocysts are often the hardiest embryos and are more likely to be of good quality.
In 1978, the first baby that was conceived through in vitro fertilization was born in London. Almost 40 years later, IVF has become a common and recommended option for some couples struggling with infertility. IVF is when the egg is removed from the intended female parent or the egg donor and joined with the intended male parent or sperm donor in a petri dish. Ideally the sperm and the egg will form an embryo that will be monitored for a few days for viability. The viable embryo will then be placed in the intended female parent or surrogate. Dr. Blotner discusses when IVF is an appropriate option for patients hoping to build their family.
When is IVF the Best Option
Impaired Fallopian Tube
IVF was initially designed for patients who had tubal obstruction, diagnosed by HSG or a previous laparoscopy. Damaged tubes, or in some cases, patients who had their tubes removed due to excessive scarring or previous ectopic pregnancy, had little hope of conceiving. The development of IVF allowed the egg to surpass the tube, become fertilized and be placed safely back into the uterus. IVF is still recommended for patients with tubal abnormalities.
There are some medical issues that can make it impossible for a woman to carry a child to term. Diseases such as cancer and adenomyosis can cause a woman to lose her uterus prematurely. There are even cases where women are born without a uterus or have severe uterine defects. For women with healthy egg reserves, IVF allows women who do not have the option of carrying their child to still contribute genetically to their offspring. A patient’s eggs can be extracted during an IVF cycle from the intended female parent and combined with the intended male parent or sperm donor to form an embryo. The embryo can then be placed in a gestational carrier. For gay male couples, IVF allows the use of an egg donor, coupled with a gestational carrier, which lets the intended fathers contribute genetically to their child.
Low Ovarian Reserve
There are a few factors that could diminish a patient’s ovarian reserve. A patient’s age, a genetic factor contributing to low ovarian reserve or an autoimmune disorder are just some of the reasons why a patient may not have a high ovarian reserve. IVF is usually recommended for these patients for a greater chance at conceiving. For some patients who have severely diminished ovarian reserve, using an egg donor would be another option to explore. When using an egg donor, IVF allows he donor eggs to be extracted and then combined with the sperm of the intended male parent or sperm donor. The embryos would then be put back in the intended female parent.
Male Factor Infertility
ICSI is a technology that was created after IVF was in practice. Instead of merely combing the eggs and sperm in a dish to fertilize, ICSI is when a single sperm is directly injected into a single egg to help promote fertilization. This technology benefits male patients who have a low sperm count, compromised morphology or motility or problems ejaculating sperm or holding an erection to do an injury or disorder. Once the egg is fertilized, the embryo is assessed for viability and then put back in the intended female parent or gestational carrier.
Patients who undergo IVF have the added benefit of using CGH, a process of testing embryos for any genetic abnormalities. For patients who have a history of life-threatening genetic diseases in their family or for those who have other chromosomal defects, like a translocation, which can cause recurrent pregnancy loss or can have a devastating effect on the fetus, CGH is an excellent option to help decipher which embryos are viable. After the embryos are tested, only the healthy embryos are placed back into the uterus.
Some couples never get an answer as to why their attempts to conceive are not working out. According to RESOLVE, it is estimated that one in five couples are diagnosed with unexplained infertility. For these couples, IVF can sometimes be a useful tool. The chances of achieving a healthy pregnancy is 3x times higher using IVF than using IUI. When you place the embryo directly into the uterus it eliminates a lot of variables, such as the sperm having issues finding the egg or wondering if the embryo develops. For couples going through unexplained infertility, IVF can give them a greater chance of conceiving.
In the past 40 years, incredible advances have been made in the field of Reproductive Endocrinology. Dr. Blotner is elated to offer these many tools to his patients trying to conceive. He uses all the latest technologies to try to assist patients in their dreams of achieving a healthy pregnancy.