One of the more common and successful forms of assisted reproductive technology is In Vitro Fertilization. This is a multistep process that begins with controlled ovarian stimulation using fertility drugs to increase follicular egg production.
Once the follicles containing the eggs reach an appropriate stage, the eggs are retrieved in an outpatient minimally invasive ultrasound procedure and then immediately transferred to the IVF laboratory. The laboratory will inseminate the eggs using sperm prepared for this moment. From the eggs that fertilize, the laboratory will care for your embryos until they reach a stage for either transfer back to the uterus or cryopreservation.
IVF may be needed because of severe male infertility and female infertility related to tubal factor, endometriosis, anovulation, failure to achieve a pregnancy with ovulation induction in unexplained infertility cases if initial treatment fails. Some important predictors of the IVF process is female age, ovarian reserve, condition of the uterine cavity, severity of male issues and male age, the presence of tubal disease and prior IVF attempt outcomes.
Our program is a leading model for IVF centers in the US, offering preimplantation genetic diagnosis (PGD). With PGD we are capable of determining whether an embryo is free of certain genetic diseases. Women over age 35 can have a PGD performed on embryos to check for aneuploidy (an incorrect number of chromosomes) in chromosomes 13, 18, 21, X and Y. Also, couples who are at risk for Cystic Fibrosis, Tay-Sachs, Duchenne’s Muscular Dystrophy, Spinal Muscular Atrophy and other diseases are candidates for PGD.
While participating in our program, each couple receives personal counseling and education. We offer a committed staff of specialists, dedicated counselors and carefully maintained facilities.
Assisted reproductive technology procedures
- In vitro fertilization (IVF): In vitro fertilization (IVF): General concept of IVF includes controlled ovarian stimulation to obtain multiple eggs from the ovaries, and combining those eggs with sperm in a culture dish.
- Intracytoplasmic sperm injection (ICSI): This procedure is used to assist fertilization in cases of limited sperm numbers, motility or normal shape. In simple terms, instead of culturing sperm cells in proximity to the egg, a normal appearing sperm is injected into a single egg under the microscope by using an operating microscope and a micro pipette. It is also utilized in cases of prior low or abnormal fertilization in IVF, frozen oocytes or if preimplantation genetic diagnosis is planned.
- Assisted Hatching (AH): The most frustrating problem in IVF is the fact that sometimes good looking embryos in the culture dish on the day of embryo transfer do not always implant and result in pregnancy. Although there may be many potential explanation of this unfortunate occurrence, it has been suggested that precise laser manipulation of the outer capsule of the egg (zona pellucida) can be applied to improve embryo implantation in selected cases. At our center, the procedure is performed in a minimally invasive manner on day 3 stage embryos.
- Embryo cryopreservation and frozen-thawed embryo transfer (FET): • Embryo cryopreservation and frozen-thawed embryo transfer (FET): Embryo cryopreservation can be considered for any ART treatment cycle. At UF Health, healthy excess embryos are frozen (cryopreserved) on day 5 which maximizes their survival on thaw and provides excellent pregnancy rates on FET similar to initial fresh cycle transfers. A frozen-thawed embryo transfer cycle does not require ovarian stimulation medications or an egg retrieval unlike the preceding IVF attempt. For FET treatment preparation, combined birth control pills and Lupron may be utilized in patients with normal ovarian function for suppression. Treatment with estrogen administered in incremental doses is started to develop endometrial lining. Several days before the scheduled transfer progesterone based on the stage of the embryo to be transferred is added to the treatment regimen. Thawed embryo transfer is performed using pelvic ultrasound guidance identical to IVF.
- Embryo Biopsy and Preimplantation Genetic Diagnosis (PGD): This procedure involves the removal of several cells from day 5 stage embryos to perform genetic testing. This procedure can be performed to avoid inherited single gene genetic disorders if the specific DNA mutation is known in the couple. Our IVF lab staff at UF Health performs embryo biopsies on site. The biopsied cells are then shipped to an approved reference laboratory for a specific diagnosis for each embryo. After the biopsies, the embryos are frozen while the results are pending. Later, a FET cycle is scheduled to transfer the desired healthy embryo(s).
- Embryo Donation: We do not have an internal embryo donation program or frozen embryo bank at UF Health. However, we will gladly perform frozen-thawed embryo transfers to interested patients if the third party embryos are donated to the patient. All FDA regulations, guidelines and program requirements will be strictly followed for this procedure.
- Gestational Surrogacy: Sometimes a uterus may be absent or may not be healthy enough to carry a pregnancy for many reasons. In these unique situations, a gestational surrogate could allow a couple to have a biologically related child by using a surrogate as the carrier for the couple’s embryo(s). UF Health fertility physicians and our specialized nurses can provide further information on this process.
Pre-treatment assessment before IVF
Minimal requirements for testing before an IVF cycle include an ovarian reserve assessment, recent semen analysis, sexually transmitted infection screening, blood type and antibody screen, evaluation of the uterine lining (by saline infusion sonogram or hysteroscopy as needed), psychological evaluation, and financial counseling. Then, the IVF consent will be signed by the couples in the presence of our UF Health Reproductive Medicine physicians. At this session, final decisions for the treatment protocol and recommended IVF lab procedures will be made. Our IVF consent form is a detailed document modified from the text prepared by The Society for Assisted Reproductive Technology (SART) of which UF Health Reproductive Medicine is a member. The IVF Consent Form will take you to this document where you can review the details of treatments including the benefits and potential concerns and complications associated with IVF or ICSI.
