In Vitro Fertilization ( IVF )

In vitro fertilization is an accepted medical treatment for many causes of infertility.  IVF is considered a “first line” therapy for conditions such as fallopian tube disease, moderate to severe male infertility, older women, in those who have failed other treatments, such as IUI, and other cases as deemed appropriate by Dr. Shaykh.

“In vitro” literally means “outside of the body” which is where fertilization occurs in IVF.  IVF involves many steps, the first of which is the production of numerous eggs.

A women undergoing IVF receives follicle stimulating hormone (FSH; Gonal-F, Follistim, Bravelle, etc.) by subcutaneous injection during the first phases of her menstrual cycle. FSH stimulates the development of the ovarian follicles, each of which contains an egg, a process termed ovulation induction. Many eggs are needed for the IVF processes as some are unavoidably damaged during handling and sometimes not all eggs will fertilize.

While undergoing ovulation induction, the patient must regularly come to our office for monitoring.  Monitoring consists of estradiol hormone measurements and vaginal probe ultrasound.  The physician can visualize the follicles, ovaries, and endometrium using ultrasound.  Estradiol levels confirm healthy follicular development and help avoid potential drug side effects.

Once the follicles are judged mature, an injection of hCG is given and the egg retrieval is scheduled.  Egg retrieval is conducted under general anesthesia as an outpatient using transvaginal guided ultrasound retrieval.  A small “needle” is used to withdraw the eggs from the follicles.

After the eggs are withdrawn, they are immediately passed to the embryologist where they are separated from the follicular fluid and prepared for fertilization with the husbands, or donor’s sperm.

Intracytoplasmic Sperm Injection ( ICSI ) More Information

Sometimes intracytoplasmic sperm injection (ICSI) will be performed to improve the chances of fertilization.  ICSI is used in cases of male infertility, where the sperm count is low or quality is poor, in older women, in cases of previously failed fertilization, and others as judged necessary by Dr. Shaykh. Using ICSI, a single sperm is injected directly into the egg.

After fertilization, the embryos are transferred to incubators where they will remain until mature and ready for uterine transfer.  Incubation usually requires three to five days.  Dependant upon the number of viable embryos at day three, culture may be continued to day 5 or longer until the embryos have differentiated into blastocysts.  Blastocysts are typically heartier and more likely to implant and develop.

During the IVF procedures, the endometrium (lining of the uterus) must thicken and become more vascular to support the developing embryos.  Drugs such as Lupron or Antagon interfere with endometrial development so progesterone is normally administered in stimulated cycles.

The patient comes to our clinic for uterine transfer once the embryos are mature.  This is a painless procedure usually requiring less than fifteen minutes.

Embryo Freezing (cryopreservation)

Following embryo transfer, surplus embryos can be frozen. The advantage of freezing embryos is that they can be replaced in a future cycle without the patient having to repeat drug treatment and surgery. We recommend embryo freezing if two or more embryos of good quality are available. The final decision, however, remains with the couple concerned.

Frozen embryo transfer has been practiced since 1987 and there appears to be no increased incidence of fetal abnormality in babies born following this procedure. About 70 percent of all frozen embryos survive the thawing process. Although some couples may have all of their embryos survive in good condition, others may not have any that survive. Embryos are frozen in batches of two or three and are thawed as a group, not individually.

Replacement of frozen embryos is relatively simple. The woman’s natural cycle is monitored using an ultrasound scan and ovulation predictor kits to time ovulation. Following ovulation, the embryos are thawed and transferred back to the uterus. If the woman’s cycle is irregular, we may recommend HRT, giving us control over the time of transfer. At our center, embryos can be frozen for up to one year, at which time the embryos may be donated to another couple, thawed in a culture and allowed to degenerate, or transferred to a long-term storage facility.

IVF provides hope to thousands of couples who otherwise would not be able to have genetically related children. This is especially true in cases of moderate to severe male infertility where once donor sperm was the only option.  Using ICSI, pregnancy can be achieved as long as a single sperm can be obtained.  In some cases, the sperm are withdrawn directly from the testicles or reproductive tract.

Participation in Our IVF Program

Dr. Shaykh has offered a successful IVF program to patients in Florida and Virginia for many years.  He does not limit participation in his program to a certain patient profile. For example, some programs will not treat older women or those who fail the clomiphene challenge test because of concerns over their overall IVF success rates. Dr. Shaykh clearly explains the chances of successful conception to each couple but does not refuse treatment to those who choose to attempt IVF. Review our IVF patient brochure.