Glossary

Ovarian Suppression and Stimulation

Key elements of the IVF procedure are techniques designed to suppress and stimulate the ovaries so eggs (oocytes) can be retrieved before they are spontaneously released during natural ovulation. Administered with daily injections by the patient at home, medications control ovarian activity, stimulate the production of multiple eggs and increase the lining of the uterus to support pregnancy. Multiple eggs increase the potential availability of embryos (fertilized eggs) for transfer and possible cryopreservation.

Monitoring

Our physicians closely monitor each patient with frequent ultrasound and blood tests. Vaginal ultrasound is used to watch the development of follicles (the sacs of fluid within the ovaries which contain eggs) and determine how well a patient is responding to the medication. The follicle size gives an idea of the number and maturity of eggs (oocytes). The thickness and pattern of the uterine lining is also evaluated to ensure adequate lining to sustain a pregnancy. Frequent blood tests are used to measure hormone levels which indicate a patient’s response to the medication.

Oocyte (Egg) Retrieval

When monitoring by the physician determines the eggs are ready for retrieval, a procedure is performed under conscious sedation administered by an anesthesiologist. Using an ultrasound probe, a needle is guided through the vaginal wall and fluid is aspirated from each follicle, immediately taken to the laboratory where eggs are identified, and moved to an individual dish of nutrient media stored in an incubator. Egg retrieval is not painful and recovery is brief.

Insemination and Fertilization

During the retrieval, the male partner will provide a semen specimen to be used for fertilization. The semen is processed so that the strongest are selected and placed in the dishes for insemination. At least 50 thousand sperm are placed in each dish with the eggs and left to incubate together with in the carefully controlled lab environment. Fertilization will be frequently monitored over the next few days.

Intracytoplasmic Sperm Injection (ICSI)

If not enough active normal sperm are available, a process called ICSI is used where an embryologist injects a single sperm into the egg to fertilize it. This painstaking process is performed under a special microscope using a micro-suction instrument to hold the egg while one sperm in a fine glass needle is injected into it. ICSI requires great skill and expertise, but allows couples to overcome the barriers of low sperm count, motility, morphology and sperm maturity.

Embryo Transfer and Implantation

Three to five days after egg retrieval (based on cell growth), the embryos will be transferred into the uterus in a non-surgical procedure in our special procedure room. Usually taking only 15-20 minutes, patients can resume normal activity the following day. The number of embryos transferred will depend on patient age, quality of the embryos and patient’s medical history. Implantation will occur over the next two to five days. Cryopreservation can be performed on remaining embryos not transferred if quality shows they can sustain the freeze and thaw procedures.

Successful implantation is verified by a series of blood pregnancy tests two weeks after the egg retrieval. If implantation has not occurred, the patient will have a menstrual period soon after stopping the medications.

Cryopreservation

Cyropreservation is the process of freezing and storing embryos for later use. Freezing of extra embryos gives a couple the opportunity to attempt another IVF cycle without going through stimulation and egg retrieval procedures.

Not all embryos are suitable for freezing. Based on the quality and rate of growth of the embryo, the embryologist will determine which, if any, embryos are suitable for freezing. Embryos can remain frozen for many years without compromising the quality at which they were frozen. However, there is no guarantee that all the embryos will survive the freezing and thawing process.

Donor Egg Cycle

If eggs are not available from the patient, an egg donor can be used. In this therapy, eggs from another woman are fertilized with the patient’s partner’s sperm. The resulting embryos are transferred to the patient.

The donor may be known to the couple or anonymous. If anonymous, an agency will coordinate the procedure.

Blastocyst

A blastocyst is formed when an embryo reaches the five to seven day development stage. At this point in development, the embryo has between 60 and 100 cells distributed in two areas: an outer embryo lining (which will later form the placenta), and an inner mass (which will later become the fetus). During a natural cycle, the embryo needs to have entered into the blastocyst stage once it arrives in the uterus to ensure proper implantation.