In Vitro Fertilization (IVF) In vitro fertilization (IVF) is utilized in more difficult infertility cases involving severe endometriosis, pelvic adhesions, or problems that cannot be corrected with other treatments. It is also the best treatment if both fallopian tubes are blocked. The IVF process is complex and consists of several steps, including: ovulation induction, egg retrieval, fertilization of the eggs and embryo culture, embryo grading, and embryo transfer. Ovulation Induction Hormone injections are given to stimulate multiple egg production. This stimulation process usually requires the initial use of Lupron to suppress the ovary to prevent ovulation or the use of Antagon or Cetrotide during the stimulation cycle until the desired time. Daily gonadotropin injections are then added to stimulate the development of the eggs. These are usually given subcutaneously (under the skin) and are much less uncomfortable than the previous generations of medication. We then monitor the progress of ovulation induction with ultrasounds and blood estrogen levels over several days. Egg Retrieval An egg retrieval is performed by placing a special needle into the ovarian follicle and removing the fluid that contains the egg. This is a relatively minor procedure and is performed by visualizing the follicles with a vaginal ultrasound probe. A needle is directed alongside the probe, through the vaginal wall, and into the ovary. To avoid any discomfort, strong, short acting intravenous sedation is provided. Fertilization of the eggs and Embryo Culture Once the follicular fluid is removed from the follicle, the eggs are identified by the embryologist and placed into an incubator. The eggs are fertilized with sperm later that day by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI). During conventional insemination approximately 50, 000 sperm are placed with each egg in a culture dish and left together overnight to undergo the fertilization process. The ICSI technique is used to fertilize mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle. Intracytoplasmic sperm injection (ICSI) ICSI allows couples with very low sperm counts or poor quality sperm to achieve fertilization and pregnancy rates equal to traditional IVF. It is also recommended for couples who have not achieved fertilization in prior IVF attempts or if a low number of eggs are retrieved (< 5). The eggs will be checked the following day to document fertilization and again the next day to evaluate for early cell division. After fertilization they are called embryos and are placed in a solution called media to promote growth. Embryos are routinely cultured for three days and then transferred to the uterus and/or cryopreserved (frozen). We now have the ability to grow the embryos for five days until they reach the blastocyst stage. Transferring blastocyst embryos offers a lower risk of multiple birth while providing a high chance of pregnancy.In Vitro Fertilization/Embryo Replacement On day two or three after fertilization, the embryos will be evaluated for blastocyst culture. If there is a sufficient number of dividing embryos they will be placed in special blastocyst media and grown for two or three additional days. Embryo Transfer Embryos may be transferred on day 2, 3, or 5 after egg retrieval. Transfer performed on day 5 is called a blastocyst transfer. They are placed through the cervix into the uterine cavity using a small, soft catheter. This procedure usually requires no anesthesia. Blastocyst Transfer A blastocyst is an embryo that has developed for at least five days after fertilization — the point at which, during natural conception, embryos arrive in the uterus. BlastocystPrior to developments in IVF over the last decade, embryos were routinely transferred back to the uterus just three days after fertilization in the embryology lab. But in a natural conception, the embryos arrive in the uterus approximately two to three days later. It was not until recent years that advancements in laboratory techniques allowed embryologists to mature the embryos further. By delaying the blastocyst transfer a few extra days, fertility specialists are much better able to select the embryos which have the best chance for survival. In turn, by growing embryos to a more advanced stage, fertility physicians are able to transfer fewer embryos without decreasing the chance for pregnancy. This advancement maintains a high pregnancy rate while decreasing the risk of conceiving a high-order multiple pregnancy – helping avoid serious risks to both the mother and baby. After the embryo transfer Progesterone is routinely given to support the uterine lining and could be given by an injection or vaginal application. This is continued until 10 – 12 weeks of pregnancy. At that time the placenta should be competent to make its own progesterone to maintain the pregnancy. In those patients who did not have an optimal response or if the embryology is poor we give estrogen in a pill form to enhance implantation. A blood test is performed 12 days after the embryo transfer to confirm a pregnancy. Best Fertility Care Centre , Advanced Fertility Care Centre , Maternal & Child Health Care Centre , Ashwini Hospital Moondrumavadi K.Pudur Madurai-07