Center for Reproductive Medicine

In Vitro Fertilization (IVF)

About IVF

• What is IVF?
  Under normal circumstances, each month a woman develops a single egg that ovulates (i.e. is released by the ovary) and is captured by one of her Fallopian tubes. In the tube, the egg may be fertilized by a sperm, and the newly formed embryo move down the tube into the uterus where it may implant to establish pregnancy.
  For a woman undergoing In Vitro Fertilization (IVF), each step of this process has been fine-tuned to augment her chance of pregnancy. The IVF process can be considered to involve 4 steps:
  
  • Recruitment of multiple eggs from the ovaries using several different medications
    
  • Collection of the eggs from the ovaries using vaginal ultrasound with the patient under light anesthesia
    
  • The mixing of sperm and egg to facilitate fertilization while in culture; and
    
  • The placement of the embryos into the uterus using a fine catheter.
    

• When is In Vitro Fertilization treatment needed?
  IVF is the most commonly recommended therapy for patients who have been diagnosed with infertility. The treatment was originally designed for women with Fallopian tubes that are either blocked, severely damaged, or absent. In Vitro Fertilization is now also a therapy for patients with endometriosis, immunological infertility, cervical factor infertility and unexplained infertility. In addition, IVF is an excellent choice for couples with mild to moderate male factor infertility. One of the advantages to selecting IVF is that fertilization of the egg can be identified, and embryo quality can be assessed in the IVF laboratory. Such assessment may provide insight regarding possible causes of infertility and the direction of any future treatment.
  
• What are the success rates of In Vitro Fertilization?
  Many factors may influence a couple's chance for success, including the age of the woman, the couple’s diagnosis, the quality of the sperm and the response of the woman's ovaries to medication. In addition, each phase of the IVF cycle may or may not be successful. For example, if the ovaries have a poor response to medication, few or no eggs may develop resulting in cancellation of the cycle. Although exceedingly rare, problems may also arise during the egg retrieval—it may be technically difficult or impossible to retrieve the eggs. There is also a small chance that fertilization may not occur due to either sperm and/or egg defects. Furthermore, eggs may be retrieved and embryos obtained, but the embryos may be of poor quality and lack the ability to develop. Finally, embryo transfer may be technically difficult or impossible (extremely rare). The most common reason for failure in an IVF cycle is failure of the embryo(s) to implant within the uterus.
  
  Most patients want to know the chance of taking home a baby after their IVF treatment. While this is an important statistic, it is also relevant to look at the number of pregnancies that involve triplets or more (high order multiple birth rate). Since these pregnancies involve risks to both the mother and the fetuses, IVF clinics strive to maximize pregnancy rates while minimizing the number of high order multiple pregnancies established. Therefore, when reviewing program statistics, the most important figures to assess are the percent of live-births per treatment cycle and the percentage of pregnancies with triplets or more.
  
  We are a member of the Society for Assisted Reproductive Technology and report our success rates to the Center for Disease Control (CDC) on an annual basis. As a member, we can only publish the most recent statistics available to the CDC (please note: these statistics can also be found on the website: www.cdc.gov/reproductivehealth/art.html
  
  

  IVF
  Age	<35	35-37	38-40	41-42
  % Cycles resulting in a livebirth	40.4	39.6	23.4	17.5
  % Cycles with triplets or more	7.9	14.5	6.9	1.9

  
  

  Frozen-Thawed Embryos
  Age	<35	35-37	38-40	41-42
  % Cycles resulting in a livebirth	34.8	41.0	22.2	33.3

  
  

  Donated Eggs
  	Fresh Embryos	Frozen-thawed Embryos
  % Cycles resulting in a livebirth	40.7	18.8

  
  
• What does IVF cost?

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What Brigham and Women's Offers

• IVF (In Vitro Fertilization)
  Oocytes are retrieved from the patient and inseminated 4 to 6 hours later with sperm. After 16-20 hours, the oocytes are examined to see if fertilization has occurred. If it has, the embryo is cultured for an additional 48 to 96 hours and selected embryos are transferred to the patient's uterus during an embryo transfer procedure either on Day 3 or Day 5 after egg retrieval. During the transfer procedure, a small-bore catheter is passed through the cervical canal into the patient's uterus.
  
  
• GIFT (Gamete Intrafallopian Transfer)
  Eggs are retrieved from the patient and placed into drops of freshly prepared sperm. The eggs and sperm are then loaded from these drops into a sterile catheter that is used to transfer the cells into the Fallopian tube while the patient is under anesthesia. Although no embryo transfer takes place, extra eggs may be placed into culture with sperm to try to obtain embryos for freezing (if good quality embryos develop).
  
  
• Micromanipulaton Technologies
  
  • Intracytoplasmic sperm injection (ICSI)
    ICSI is performed in cases where the number of sperm available is extremely low or there is a past history of failed fertilization. In this procedure, a single sperm is injected directly into the egg, thus "artificially" fertilizing the egg
    
    
  • Assisted hatching (AH)
    AH involves creating a hole in the covering around the embryo, known as the zona pellucida. This procedure is offered to older patients, those with repeat failed implantations, and/or those whose zonae appear thicker than normal. It is thought that by creating a hole in the zona, escapement from the covering is enhanced, and the normal hatching process from the covering is facilitated.
    
    
  • Preimplantation genetic diagnosis (PGD)
    PGD involves the removal of one or two cells from an embryo on Day 3, and genetic analysis of the biopsied cell(s). The PGD procedure is offered to those couples at risk for having eggs with an abnormal number of chromosomes, or who have documented chromosome or single gene defects. Currently, we offer screening for 8 chromosomes, for traceable genetic translocations, and for certain single gene defects such as cystic fibrosis, osteporosis and Tay Sachs.
    
    
• Embryo Freezing and Cryo Embryo Transfer Cycles (CET)
  Extra embryos that appear to be of sufficient quality to survive the freezing process (determined by the embryology staff following the embryo transfer) are frozen if the couple wishes to take advantage of this technology, and are stored for future use in a CET cycle.
  
  There are several advantages to freezing embryos (cryobanking embryos) and undergoing CET cycles. First, the patient does not need to undergo a separate stimulation cycle and egg retrieval when utilizing frozen embryos. In addition, the cost of thawing embryos produced in a prior cycle is significantly lower than that incurred for a fresh IVF cycle and the medication phase of a CET cycle requires less injections and less monitoring. Unfortunately, however, not all patients will have extra embryos of sufficient quality to allow embryo freezing.
  
  
• Surgical Sperm Extraction
  In some instances (i.e. failed vasectomy reversal or congenital absence of the vas deferens) it may be necessary surgically to recover sperm from the testes. Very often, we are able to freeze these sperm extractions for future use in IVF/ICSI cycles.
  
  
• Donor Oocyte
  Ovum Donation provides many couples previously considered "incurably infertile" the chance for a pregnancy. While the most common condition motivating couples to request ovum donation is premature ovarian failure, it can also be used to treat infertility arising from congenitally or surgically absent ovaries, from ovaries which have stopped functioning due to chemotherapy or X-ray therapy, or to treat repeat ART patients who have undergone several "failed" cycles. Additionally, women who carry genetic abnormalities in their own eggs may also be able to become pregnant with eggs donated by women without genetic abnormalities.
  Designated and anonymous egg donation is available. Donors undergo standard IVF treatment using the recipient partner’s sperm and the resulting embryos are transferred into the recipient after her uterus is prepared using hormonal therapy similar to that given the CET patients.
  
  
• Gestational Carriers
  The use of a gestational carrier may be offered to patients with physical disorders that preclude them from becoming pregnant. The patient may choose to bring her own carrier, however, we do provide matching service options. The age limit for gestational carriers is 40. Patients who choose this treatment option undergo standard IVF treatment and the resulting embryos are transferred into the recipient after her uterus is prepared using hormonal therapy similar to that given the CET patients.
  

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Patient Experience and the IVF Process

• Are injections in an IVF cycle painful?
  Although you will be having daily injections, the majority of these injections will be subcutaneous. This means that the needle is very thin and short and causes minimal discomfort. Technique is a very important part of the injection. Discomfort is greatly reduced with proper technique. We are committed to helping you develop proper technique. A nurse will meet with you and your partner to provide private injection teaching. You will be performing a return demonstration injection. The nurse will observe your technique and provide support and reassurance. When you leave the office, you will have the necessary skills and confidence to perform injections properly.
  
  
• Is the IVF procedure painful?
  The IVF procedure (retrieval) is not painful, anesthesia is provided during the procedure and you will be monitored very closely to assure that you are comfortable. As with any surgical procedure, some postoperative discomfort is expected. However, most patients have minimal discomfort following the procedure. The most common complaint is cramping. An anesthesiologist and nurse are present to assess your comfort and provide you with any pain relief you may require.
  
  
• Will hormones cause long-term health risks?
  There is evidence that postmenopausal hormone replacement increases the risk of breast cancer. Since premenopausal women make their own estrogen, there is no evidence at this time that use of fertility medications increases the risk of cancer or other medical illnesses. As the medications used for fertility treatments have been FDA approved since approximately 1970, it is possible that more years of use are required to see long-term problems arise.
  
  
• Can I freeze eggs for the future?
  At this point there is a great deal of ongoing research focusing on methods to freeze both eggs obtained after medical stimulation of the ovaries, and eggs still embedded in ovarian tissue. At this point these protocols are experimental and are not available for widespread use.
  
  
• What is the IVF Process?
  

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