In Vitro Fertilization Program

Cutting Edge Reproductive Technology

In vitro fertilization (IVF) is the joining of sperm and egg or eggs outside a woman's body. Mature eggs are retrieved from the woman's ovaries and mixed with sperm in the laboratory. The fertilized eggs (embryos) are then transferred to the woman's uterus. If an embryo successfully implants itself in the uterine wall, the woman may become pregnant. If pregnancy occurs, the embryo grows and develops naturally within the mother's uterus.

The IVF Program at the Center for Reproductive Medicine at Bryn Mawr Hospital offers comprehensive services for individuals trying to achieve pregnancy. Our services include:

• Egg collection and insemination
• Embryo transfer
• Embryo cryopreservation, storage, thawing and transfer
• Intracytoplasmic sperm injection (ICSI)
• Assisted hatching
• Gamete intrafallopian transfer (GIFT)
• Patient information seminars

Reasons for IVF

IVF is suitable for couples who are infertile for any of several reasons. Women who have been unable to conceive because of missing, blocked or damaged fallopian tubes may become pregnant through IVF. Women experiencing endometriosis are also good candidates for IVF.

IVF is an option for couples when the man has a low sperm count or poor sperm motility. In some males with less-than-ideal sperm production or movement, the sperm may have a difficult time traveling though the female reproductive tract to meet the egg. Since IVF joins sperm and egg outside the body—eliminating the sperm's travel—there is a greater chance for successful fertilization. In cases of severe problems with sperm quality, an assisted fertilization procedure (ICSI) can be performed where a single sperm is injected into an egg to promote fertilization.

Sometimes, despite a battery of tests and a thorough investigation, doctors cannot find a cause for a couple's infertility. IVF is very helpful after other treatment methods have failed.

The IVF Process

IVF is a multistep treatment method that requires precision and efficiency at every stage. Our IVF team, in coordination with the woman's doctor, uses the latest techniques in hormone therapy, egg collection and embryo transfer to increase a couple's chance of having a baby.

There are four steps to the IVF process:

1. Hormone Therapy: Ovulation—the release of a mature egg from an ovary—is a prerequisite for pregnancy, either naturally or through IVF. Normally the body's own hormones stimulate one egg to ripen and release each month. This egg, if fertilized by a sperm, will potentially develop into a pregnancy. Research has shown IVF is more successful when several eggs are obtained from the ovary just before ovulation occurs. This increases the chance that at least one egg will be fertilized during the IVF process. One way to induce or stimulate several eggs to develop is to give the woman injections of hormonal medications for about 10 days. The woman's physician will monitor egg development through ultrasound scans and blood tests. These tests help to determine the precise dosage of hormone medication to administer and predict when the eggs will be ready to retrieve.
2. Egg Collection: Through a procedure called transvaginal egg retrieval, eggs are retrieved from a woman's ovary using a thin needle that is guided by ultrasound. The needle is inserted into the vaginal wall, where the ovaries are easily accessed, and the eggs and their surrounding cells are collected. This is an outpatient surgical procedure requiring intravenous sedation.
3. Insemination: The eggs are placed in a small dish filled with special nutrients. The IVF team mixes the sperm with the eggs and incubates them for 24 hours. If fertilization occurs, the fertilized eggs (embryos) will be monitored to see if they continue dividing normally.
4. Embryo Transfer: In approximately two to five days after retrieving the eggs, the embryos are transferred to the woman's uterus. This is a nonsurgical procedure that takes only a few minutes. A thin tube, or catheter, is inserted via the cervix. The embryos, contained in a drop of fluid, are deposited in the uterus.

IVF Options

IVF with Donor Eggs

The use of donor eggs is an IVF option for women who can't produce their own eggs. In IVF with donor eggs, the recipient undergoes hormonal treatment to prepare her uterus for potential implantation. Once donor eggs are available, they are fertilized with the recipient's partner's sperm and placed in her uterus at the optimal time for implantation. Ideally the donor's and recipient's cycles are synchronized, but if this is not possible, the embryos may be frozen (cryopreserved) until the recipient can be hormonally prepared for embryo replacement.

According to the American Society of Reproductive Medicine guidelines for egg donation, all egg donors are required to have psychological and clinical screenings. Careful genetic, family and social histories of the donor are also required. Donors are between the ages of 21 and 34 and need to give their informed consent after acceptance by the IVF team. Total anonymity is maintained for the donor as well as the recipient, except when the egg donor and recipient are known to each other, as with a relative or friend.

The Center for Reproductive Medicine works with all egg donors once arrangements are made by the patient's physician.

IVF with Gestational Carrier

This is an option for women who have no uterus (due to either surgical removal or congenital absence), impaired uterine function (due to scarring or damage) or a medical condition that precludes carrying a pregnancy.

A gestational carrier is a woman who voluntarily contracts to become pregnant with an embryo derived from the egg and sperm of a couple in whom pregnancy is medically impossible or ill advised for the woman. Unlike a surrogate mother, the carrier has no genetic relationship to the child.

The genetic mother undergoes the ovulation induction and egg retrieval phases of the IVF process, and her eggs are inseminated with her partner's sperm in the laboratory. Once fertilization and early embryo development have occurred, the embryos are placed into the uterus of the carrier. Every attempt is made to synchronize the genetic mother's and carrier's cycles, but if this cannot be accomplished, the embryos may be cryopreserved and then thawed at the appropriate time.

The Center for Reproductive Medicine works with gestational carriers once arrangements have been made by the patient's physician.

Related Technologies

Embryo Cryopreservation

More embryos than recommended for transfer into the uterus may result from the egg retrieval procedure. Researchers have shown that transferring high numbers of embryos does not improve a woman's chance of becoming pregnant; it only increases her chance of a multiple gestation. Therefore, the couple must decide what to do with the remaining embryos. The Center offers couples the option of freezing and saving excess embryos, a procedure called cryopreservation. These embryos can be thawed and transferred to the woman's uterus in a later cycle if an earlier IVF attempt fails or if the couple wants a second child. Cryopreservation potentially reduces the cost and eliminates the egg collection step in subsequent cycles.

ICSI

Intracytoplasmic sperm injection (ICSI) is an advanced micromanipulation technique in which a single sperm is injected directly into the egg using a microscopic glass needle. ICSI has revolutionized the treatment of male infertility by overcoming barriers to sperm entry into egg. Fertilization is possible even in cases with low sperm count or compromised sperm function.

Assisted Hatching

Assisted hatching is a technique for improving the implantation of embryos obtained through IVF. With assisted hatching, a notch is made into the zona pellucida, which is the protein layer surrounding the egg. This aids the escape of the growing embryo, which helps in the implantation process.

GIFT

Gamete intrafallopian transfer (GIFT) is a surgical procedure that uses a laparoscope to retrieve eggs from the ovaries and transfer them into the fallopian tubes with sperm, so that fertilization can occur naturally within the woman's body. With GIFT, the physician can determine the woman's pelvic condition and treat most abnormalities, such as scar tissue or endometriosis, at the same time. Healthy fallopian tubes and adequate sperm are necessary for GIFT.