Increasing the Odds of a Successful in Vitro Fertilization (IVF)

Technology to help infertility is so advanced now that chances of successful IVF pregnancy are extremely good. Our twins were born of IVF 15 years ago and technology has since improved to a new level.

Blastocyst culture is the most advance infertility treatment which involves in vitro fertilization and embryo culture for 5 to 6 days until it reaches the blastocyst stage - a final stage of embryo that is ready to implant in the uterine wall to impregnate. The best embryos are selected and transfer into the uterine cavity after they have been analyzed for abnormal chromosome. The treatments would help tubal blockage, severe pelvic adhesion, endometriosis, male factor and unexplained infertility cases.

Traditional IVF is to implant embryo after rearing only 2-3 days externally into the intrauterine at the cleaving stage of only 4-8 cells. Blastocyst is a 5 days old embryo that is formed after the conception of egg and sperm. The embryo size before being embedded is 120-150 cells. It is made possible by the advanced environmental control in prolonging external embryo rearing. Embryo at Blastocyst stage can be implanted directly into the intrauterine, which gives a better chance of pregnancy.

IVF can be performed together with Testicular Sperm Extraction (TESE) and Intra Cytoplasmic Sperm Injection (ICSI) to achieve a higher pregnancy rate.

TESE is method where the semen is extracted from the testicles for cases where man is unable to produce sperm. The semen tube may be clogged or partially cut off (sterile). TESE is a minor and uncomplicated operation. A part of the testicle tissue is clipped off and needle is inserted to extract sperm. Local anesthetic or anti-suppressant is used for this simple operation.

Sperm is injected into the egg by ICSI process. ICSI is a direct injection of a single sperm into each egg. This is one way of conception for patients who have a few sperm or has no sufficient amount of sperms to penetrate the egg.

A typical IVF process would be as follow:

1. Drugs are given to cause "Super Ovulation" to produce multiple eggs.

2. Eggs are retrieved using a vaginal ultrasound probe to guide a needle into the ovaries. The procedure does not require general anesthesia and is performed with just simple intravenous sedation. An anesthesiologist is on site to administer the sedation for safety and comfort.

3. Extracted or ejaculated sperms are capacitated (a biochemical and structural change in the laboratory), to isolate motile and healthy sperms prior to fertilization process.

4. Removed follicular fluid from the ovaries is examined in the laboratory for eggs. Eggs are isolated and placed in culture media where they are allowed to further mature. A few hours later, portions of the processed sperms are placed around each egg. Only 50 to 100 thousand sperms are needed for each egg. The eggs and sperms are left to incubate together in a carefully controlled environment. Approximately 18 to 24 hours following insemination, the eggs are inspected under the microscope to determine how many have been successfully fertilized. These embryos will be cultured in the laboratory as they continue to grow and develop until they reach Blastocyst stage.

5.Two healthy embryos are transferred via a thin, soft plastic catheter through the cervix into the uterine cavity. They are then deposited in the upper part of the uterus and the catheter is withdrawn. This is generally a painless procedure and the patient remains in bed for 2 hours before being discharged home. As implantation will take place in the following two or three days, patient is advised to stay home for sufficient rest.

6. Patient will administer daily vaginal suppository of progesterone to enhance implantation. Ten to twelve days after the embryo transfer, blood pregnancy test is performed. Rising blood levels of the pregnancy hormone, "hCG", indicates that implantation has occurred. Approximately 10 days after the first hCG lift, ultrasound is performed to confirm pregnancy. Fetal pole and fetal heart beating indicate the beginning of a new life.