Ultrasound Guided Egg Retrieval
When blood hormones reach the desired levels and/or the ultrasound shows ovarian follicles to be the desired size and number, hCG hormone is administered and egg retrieval is scheduled thirty-six hours later. With the help of ultrasound images, a needle is passed through the back of the vagina and into ovarian follicles. The eggs are drawn out of the follicles with gentle suction. Approximately 70 percent of all follicles contain a retrievable egg. Usually intravenous (IV) medication is used for sedation and to maintain comfort. Spinal anesthesia is another option for keeping you comfortable during retrieval.
Microsurgical Sperm Retrieval
Sperm may be obtained from the epididymis or directly from the testicle. Microsurgical sperm retrieval is used for men who have an obstruction that cannot be repaired, such as absence of the vas deferens, congenital obstruction, or failed vasectomy reversal and for men who have untreatable testicular failure.
In an embryo transfer procedure, the ovaries are stimulated to produce multiple eggs. The eggs are retrieved and inseminated in a culture dish in the laboratory. If fertilization is confirmed the next day, the resulting embryos are incubated for an additional two to four days. Embryos are then selected for non-surgical transfer.
The non-surgical embryo transfer is accomplished by loading the embryos into a small catheter, threading the catheter through the cervical canal, and depositing the embryos into the uterus. No anesthetic is required for the transfer.
Single Embryo Transfer
We have developed a program of mandatory single embryo transfer (SET) for patients who have a good prognosis for IVF treatment success (less than age 38, no history of failed IVF cycles at our program, and the development of at least one good quality blastocyst). Starting at their initial clinic visit, patients are educated about risks of multiple gestations and expected outcomes after SET. We have found that selectively applying single embryo transfer to good prognosis patient’s results in immediate pregnancy rates equal to those for patients having two embryos transferred. We strive for one healthy baby at a time.
Although pregnancy rates improve to a point with transfer of multiple oocytes or embryos, IVF carries a risk of multiple gestations (twins, triplets, etc) associated with the number of embryos transferred. Multiple pregnancies are high-risk pregnancies. The best way to prevent multiple pregnancies is to limit the number of embryos transferred. Our program guidelines for embryo transfer are shown below:
Upper Limits for Number of Embryos Transferred At UI Hospitals and Clinics
|Age of Woman||Day 3||Day 5|
|37 and less||2||1 or 2|
|39 and above||4||2|
|Age of Woman||Day 3||Day 5|
|37 and less||2||2|
|39 and above||4||2|
In situations when more than the desired number of eggs to be transferred fertilize, many couples opt to cryopreserve their non-transferred embryos for future transfers. For a variety of reasons couples may ultimately choose not to transfer their cryopreserved embryos. Our embryo donation program gives couples an alternative to discarding these embryos. Embryo donors are evaluated for psychological, medical and genetic health and are tested for sexually transmitted diseases. Couples receiving anonymously donated embryos are prioritized based on need for donor gametes, previous childbearing, and previous infertility therapy.
The clinical staff at the UI for Advanced Reproductive Care will assist couples with preparation of the documents required for the purchase of anonymously donated sperm from a commercial sperm bank. Once the sperm arrives, the Reproductive Testing Laboratory will store the specimens in liquid nitrogen until the time of your procedure. Our program also will facilitate the testing and sperm cryopreservation for directed sperm donors.
Embryo Cryopreservation (Freezing)
The use of cryopreservation technology for preservation of early human embryos has been shown to enhance the efficiency and cost-effectiveness of establishing pregnancy through in vitro fertilization. When in vitro fertilization yields more good quality embryos than the desired number to be transferred, the excess, quality embryos may be cryopreserved.
Advantages of embryo cryopreservation include:
- The elimination of the pressure to transfer a greater number of embryos that increases the risk of multiple pregnancy
- It gives patients the option to attempt to conceive in a frozen embryo transfer cycle at approximately one-fifth the cost of a fresh in vitro fertilization cycle
Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection (ICSI) helps fertilization for couples with male-factor infertility unresponsive to other forms of treatment. The procedure involves injecting a single, live sperm directly into a mature oocyte, or egg. ICSI is recommended for couples who have no or very low rates of fertilization during previous treatment cycles or when the number of normal motile sperm available is less than that required for traditional in vitro insemination.
Preimplantation Genetic Diagnosis
Preimplantation genetic diagnosis (PGD) involves the removal of a single cell from a three-day-old embryo and testing the cell for certain inherited diseases (such as cystic fibrosis and muscular dystrophy). This service is available for couples at risk for passing on a genetic disease to their children.