In vitro fertilization
In vitro fertilization and embryo transfer (IVF-ET) is the most highly evolved procedure available for infertile couples when necessary. It offers hope for some couples who otherwise would hold little or no chance of conception on their own.
IVF-ET was first successfully performed in 1978 in England. The IVF Program at the University of Utah began in 1983. The process was initially devised to bypass damaged or absent fallopian tubes by retrieving eggs directly out of the ovary, fertilizing them with sperm in the laboratory under carefully controlled conditions, and allowing the fertilized eggs (embryos) to develop in culture within the laboratory incubators until they can later be transferred directly into the uterine cavity. This procedure bypasses the need for normal fallopian tubes. Over the years, steady progress in the technologies has led to higher pregnancy rates. Furthermore, it has been learned over the years that tubal factor is not the only condition which can benefit from IVF. By its nature, IVF can help bypass other problems as well (e.g., scar tissue which may physically prevent eggs from leaving the ovaries and/or entering the fallopian tubes, the biochemical abnormalities of endometriosis, the ovulation control difficulties of polycystic ovary syndrome, the motility and fertilization capabilities of abnormal spermatozoa, and uterine cervical abnormalities). When infertility is unexplained in a couple who has undergone extensive evaluation, IVF is often successful because it bypasses the problem(s) within the system, even though those problems may remain unexplained after a successful IVF-ET procedure. In many other circumstances, the explanation for the previously unexplained infertility becomes apparent as each component of the fertilization and embryo development process can be observed closely in the laboratory. Ultimately, embryos can be scored for quality as judged by their appearance through the microscope. The most predictive factor as to whether a pregnancy can be achieved hinges on the embryo quality. IVF-ET is the only way to assess the embryo quality that a given couple is able to achieve. In this light, IVF-ET can be regarded as the world's most expensive laboratory test to assess the capacity for fertility.
The procedure is performed by first suppressing a woman's own reproductive hormone system so that her own hormones will not spontaneously release and interfere with the process of recruiting her eggs. This is done with a daily injection of a medication called a GnRH agonist. Gonadotropins (Follicle stimulating hormone [FSH] and or human menopausal gonadotropins [hMG]) are then administered by injection which directly stimulates the growth of eggs within cysts (called follicles) within the ovary. This process is carefully monitored by serial transvaginal ultrasound examinations and serial examinations of blood estrogen concentrations. When the maximum number of follicles is safely achieved, a quick outpatient procedure under light sedation is performed to collect the eggs. The eggs are fertilized the same day within the state-of-the-art embryo culture facility at the University of Utah, and if necessary, intracytoplasmic sperm injection (ICSI) and assisted embryo hatching (AH) is performed. The best embryos are selected and transferred into the uterus three to five days after collection of the eggs. Additional unused embryos are often cryopreserved for later use. Using program-specific guidelines recommendations are made regarding the number of embryos to transfer. In most cases only two are transferred.
For couples from out of state, much of the background work can be done at home after an initial interview in Salt Lake City. The time spent in Salt Lake City for the IVF-ET procedures is generally 4 to 5 days. After transfer of the embryos, we all wait anxiously for two weeks until a pregnancy test is obtained. The success rates vary depending on the specific diagnosis and indications for IVF. Detailed statistics for various ages and conditions are available during your consultation regarding your specific situation.
