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In Vitro Fertilization

The world’s first “test tube baby” turns 30 years old this year! Now almost 2 million babies have been born through the medical miracle of In Vitro Fertilization, also known by its initials IVF. This procedure allows a couple to conceive a child even when the woman’s fallopian tubes are blocked or when the man’s sperm count is next to zero. These infertile conditions are fairly common. One out of every 8 American couples is designated as infertile by failing to conceive within one year of trying. A medical condition such as either endometriosis or a silent pelvic infection is a frequent cause of damaged fallopian tubes. IVF is also offered to couples who fail to conceive despite trying less aggressive medical treatments.

The IVF process begins by helping the woman’s ovaries to mature several eggs at once through the use of injectable fertility medications. The eggs are then retrieved via a thin needle guided by ultrasound while the woman is under sedation. This procedure is fairly simple and is usually completed in less than 20 minutes. The eggs are microscopic in size, invisible to the naked eye. They are placed in petrie dishes onto which the sperm is introduced. The following day the eggs are observed to see if they fertilized. The average number of mature eggs that are retrieved is 10. Typically 7 or 8 of these will fertilize normally. These fertilized eggs are called “embryos.” The embryos are cultured for 2 to 5 more days in a specially designed nutrient broth that simulates the environment of the fallopian tube. An average of 5 of these embryos will grow nicely at the correct pace until it is time for their transfer to the uterus. Usually 1, 2, or 3 embryos are placed gently into the uterus where they will implant in its soft lining and hopefully continue to grow into a baby. The return of the embryos to the uterus is performed under ultrasound guidance with a thin flexible plastic catheter. The woman usually feels no pain since the procedure resembles a simple Pap smear.

Obviously there is the potential for having several babies at once since more than one embryo is usually returned to the womb. The chance for obtaining a pregnancy increases slightly when more than one embryo is transferred into the uterus. Pregnancies with 3 or more fetuses are quite risky both for the mother and for the fetuses. Often the pregnancy ends in a premature delivery when one or more of the newborns are too small to survive outside of the womb. Our center has been at the forefront of lowering the incidence of triplet pregnancies. We have accomplished this without sacrificing the overall pregnancy rate. For over 9 years we have been using a new technique to extend the embryo culture 2 days longer than most other IVF centers in order to determine which embryos are most likely to continue growing into a baby. These well-developed embryos are called blastocysts. Using this method we don’t need to return high numbers of embryos to the uterus in order to maintain a good pregnancy rate. Clearly the risk of triplets or quadruplets is much lower if fewer embryos are placed in the uterus. Our IVF statistics from the year 2007 show that of those patients with pregnancies, only 3% were triplets. None were quadruplets. Yet the overall clinical pregnancy rate was still 35%. During the past 3 years, over 300 women have delivered babies that were conceived through our IVF center.

We have been performing successful IVF cycles since 1989. Arelatively new technique has been developed that allows men with nearly absent sperm to father pregnancies. This procedure is called ICSI, an abbreviation for IntraCytoplasmic Sperm Injection. Our center has had hundreds of successful pregnancies using ICSI since its initiation in 1995. ICSI involves the injection of a single sperm directly inside the egg so that the sperm does not need to be motile or able to penetrate the shell of the egg on its own. Men who have no sperm in their ejaculate will often have sperm found in their testes. This sperm can be extracted from the testicle in our facility to be used for ICSI to allow these men to father a pregnancy which would have been impossible just over a decade ago.

In vitro fertilization techniques have made great progress over the years. One percent of babies born each year in this country were conceived through IVF. It is no longer a rarely used treatment for the many infertile couples in our society.

 

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