In vitro fertilization (IVF) was first developed in the 1970’s to help women with severely damaged tubes to conceive. Since then, IVF has also been used to help couples with endometriosis, poor sperm parameters, unexplained infertility, and other indications. The success of IVF has increased as the technology in the process has dramatically changed through the years. More recently IVF has been used as a means of fertility preservation – freezing eggs or embryos to be used at a later time when parents are ready to conceive.
In the simplest of terms, IVF is the fertilization of an egg outside of the body and the resulting embryo transferred to the uterus for implantation. Eggs are removed from a woman’s body in a simple, quick procedure called an egg retrieval. The eggs may be cryopreserved (frozen) at this time or fertilized with sperm in our laboratory. A fertilized egg (embryo) may be either cryopreserved at this time or transferred to the uterus if patients are ready to conceive.
The process takes preparation, evaluation, and thorough counseling to inform the patients about what to expect. In general, an IVF cycle takes approximately 6-8 weeks from start of a menstrual cycle and ending in pregnancy test with two active weeks (appointments and egg retrieval) in the middle. At Pacific NW Fertility, we will tailor the treatment to your needs and walk you through the process each step of the way.
The success of an in vitro fertilization procedure depends upon the patients undergoing treatment. Success rates depend on age, fertility diagnosis, personal history, ovarian reserve testing, and other evaluations. The pregnancy rates at Pacific NW Fertility are consistently among the highest reported in the United States. Part of the process of IVF is understanding success rates for each individual patient and Pacific NW Fertility is dedicated to providing the highest chance of success for each patient depending on that patient’s individual situation.
There are two options for fertilizing eggs after the egg retrieval. Either conventional insemination or intracytoplasmic sperm injection (ICSI).
Conventional insemination involves placing eggs and sperm together and allowing fertilization to occur without assistance.
ICSI is a technique pictured above in which a single sperm is placed into a mature egg to assist with fertilization. Patients may be having difficulty conceiving due to problems at the level of fertilization (egg or sperm issues). In general, we recommend ICSI for patients with poor sperm parameters, however, our Pacific NW Fertility provider will give a recommendation taking into account all history and evaluation parameters.
Traditionally, embryos have been transferred to the uterus on the second or third day of development after fertilization when the embryos are composed of 6-8 cells. Culturing embryos further to the blastocyst stage (usually day 5 after fertilization) when they are 100-120 cells allows for more accurate embryo selection for embryo transfer. The ability to select embryos that have a higher chance of implantation allows for us to transfer fewer embryos but maintain high success rates for our patients. Transferring fewer embryos decreases the risks of pregnancy that can occur with multiple gestations.
PGS (also referred to as Comprehensive Chromosomal Screening or simply Chromosomal Screening/CS) allows for selection of embryos with the correct number of chromosomes. Pacific NW Fertility provides this highly advanced embryo selection tool in which cells are biopsied (removed) from the developing embryo and tested for chromosomal content.
PGD (Preimplantation Genetic Diagnosis) is a similar technique in which cells are biopsied from the developing embryo and then tested for genetic content but in this technique very specific mutations are detected. Patients who know they carry mutations for diseases such as cystic fibrosis, spinal muscular atropy, and hundreds of others, can prevent having children with these diseases using PGD technology at Pacific NW Fertility.
Genetic screening of embryos for chromosome content and/or specific mutations may be considered a highly specific technique for selecting an embryo with the highest chance of implantation. It allows patients to maintain a high success rate with a single embryo transfer.
The technology for freezing embryos has changed. In the past with the slow freezing method, we used to counsel patients that 30% of the embryos frozen may not survive the freezing and thawing method and that pregnancy rates were lower with transfer of frozen embryos compared to transfer in a fresh IVF cycle. Since 2009, we have been freezing embryos with vitrification which is considered a fast freezing method. With vitrification in the Pacific NW Fertility embryology lab, 97% of the embryos frozen survive the freezing and thawing process and success rates are the same as transfer in a fresh cycle and in certain cases better. Vitrification has dramatically changed success rates and options for fertility preservation.
The first thing I put in my baby's baby book was a pasted in sheet of paper showing that we were pregnant, from PNWF. Below it I wrote, "Mom and Dad worked HARD for you." We deserve it even more, I say. Because the baby that comes from PNW Fertility and their crew of helpers is one loved baby. That is a pretty amazing legacy to be able to tell that kid someday.