In Vitro fertilization (IVF)

This procedure is generally used after several failed IUIs, because of blocked fallopian tubes, advanced age or any other infertility causes.

IVF refers to a laboratory technique in which mature oocytes are exposed to sperm outside of the human body in order to produce embryos. First of all, both oocytes and sperm must be obtained from each partner and cleaned of any unwanted material. The sperm is then washed and brought to the ideal concentration for the fertilization of eggs. Once this is achieved, both the eggs and sperm are mixed in small droplets of specialized media in a small Petri dish. The dish is then placed in an incubator under controlled conditions to allow fertilization to occur. After about 18 hours, the embryologist will be able to assess the fertilization.

However, an IVF fertility treatment (IVF cycle) refers to a complete process involving several steps:

Step 1

All clients need to complete all investigations and standard infectious disease screening.

Step 2

A MOCK (simulation) transfer has to be performed in order to assure that, once we have good embryos, it will be possible and easy to transfer them into the uterine cavity (a full bladder is necessary for this procedure).

Step 3

Ovarian Hyperstimulation (by fertility drugs, mostly hormones administrated by subcutaneous injections) will be prepared, monitored and controlled with the objective to collect many mature oocytes.

Step 4

Retrieval of the oocytes (vaginal surgery) by harvesting them with an ultrasound-guided needle.

Step 5

Fertilization of the harvested eggs in vitro done at the fertility laboratory in a Petri dish

Step 6

Culture of embryos in the laboratory occurs for three to five days

Step 7

Transfer of one to two embryos (blastocysts) into the uterus (full bladder is necessary for this procedure).

Step 8

Cryopreservation (freezing) of surplus high-quality embryos, if possible.

Step 9

To support the luteal phase, progesterone supplementation is prescribed. Vaginal suppositories or intramuscular injections are required.

Oocyte retrieval is a procedure in which mature oocytes are collected from the ovaries. Oocyte retrieval is conducted when the patients’ hormonal stimulation has concluded and the ovarian follicles are likely to contain an increased number of mature oocytes. The patient is placed under intravenous sedation and a transvaginal ultrasound guided needle is used to puncture the ovary by going through the wall of the vagina. Once inserted, a controlled vacuum is applied to the needle and the follicular fluid is aspirated from the ovary.

ivf eggretreival

At this point, the embryologist searches for oocytes from each follicle. Oocytes are very small and can only be seen under microscope. After the retrieval, all oocytes are transferred to a special culture media and placed in an incubator prior to being fertilized with the sperm.

Embryo culture and development begins directly after fertilization of the egg. ivf mature egg fr

Over a three to five day period, embryos are placed in a specialized embryo media that provides nutrients which help the embryo grow and develop. Every day or two, the embryos are transferred to a new type of media because as they develop, their nutritional requirements change. This is also partly because embryos should not be kept in contact with their metabolic waste for extended periods of time. Embryos undergoing culture are kept in an incubator that has a precisely controlled atmosphere that keeps temperature, gas concentrations, and humidity constant.

Day 1, following the retrieval, oocytes are first observed to determine if they have been fertilized. The fertilization can be confirmed by the presence of 2 pronuclei (PN) inside the oocytes, attesting both set of 23 chromosomes;

Following this, all fertilized eggs are tracked individually through embryo development on days 1, 2, 3, and 5 post-fertilization. It is important to observe embryos on these days because it allows the embryologist to assess which embryos are developing in an optimal manner and may be candidates for transfer. Embryos are evaluated on their morphological characteristics (appearance), their number of cells, their percentage of fragmentation (debris), etc. These observations are very important and should coincide with the 'timing' of embryo development.

ivf day3 1

A day 2 embryo should ideally have cleaved and be composed of four cells, and on day 3, be composed of eight cells.

If we have too few embryos and/or if the quality is insufficient, a transfer is usually recommended on day 3. It is preferable to do it on this day rather than risk the embryos stop developing before their transfer. However, if several good quality embryos are available, we will probably recommend that they be left two more days to grow. Embryos that reach the blastocyst stage on day 5 are more likely to lead to a pregnancy; nevertheless, there is a possibility that none of them survive the additional culture. But if several reach this stage, we will have a better selection for the transfer (having monitored their development for five days).
ivf blastocyst 1

A day 5 embryo is called a blastocyst; this embryo is then composed of more than 64 cells.

Embryo transfer takes place after a short period of embryo culture, generally three to five days. Once adequately developed, the embryo has a greater chance of survival and implanting on the uterine lining. On the day of transfer, the highest quality embryo(s) are loaded into a specialized flexible catheter. Using ultrasound, the catheter is guided into the uterus where the embryo(s) are expelled. This procedure is relatively simple and not painful.

The maximum number of embryos that are available for transf

er is governed by Conceptia policies and varies depending upon many factors, including the health status of the female patient, the quality of embryos, the recommendation of the embryologist/attending physician and your choice in regards to the possibility of a multiple pregnancy.

The Intracytoplasmic Sperm Injection (or ICSI) is a micromanipulation technique that allows the embryologist to inject a single sperm into a mature oocyte. By doing so, he or she ensures that the embryo is penetrated by a sperm, leaving nothing to chance.

Firstly, both the oocyte and sperm are prepared by removing any unwanted material. Once cleaned, the oocyte is placed within a holding dish separate from the washed sperm. The embryologist then assorts the good sperm according to their motility (movement) and morphology (appearance) into a fine glass needle. The oocyte is then held in place a pipette through suction, and the sperm is carefully injected into the centre of the oocyte. After the injections are finished, oocytes are placed back in culture media and incubated.
ivf injection02 1

ICSI is utilized in cases where patients are presented with an abnormally low sperm count, when surgical techniques are required to obtain sperm or when there are very few oocytes that have the potential to be fertilized.

Depending on both the stage and quality of a developing embryo, it is sometimes advantageous to use laser assisted hatching to help the embryo hatch from the zona pellucida (shell). The developing embryo has a finite energy reserve for growth and development; thus, it is believed that AH helps to reduce the burden of 'hatching' on the early embryo, improving its potential to be successfully implanted and to produce a viable foetus.

For some patients, their infertility may be caused by thickening of the zona pellucida, making embryo hatching and implantation very difficult. Assisted hatching is a micromanipulation technique performed in the laboratory just prior to transfer. This technique, performed by laser, creates an opening in the zona pellucida and allows its hatching. The purpose of the laser-assisted hatching is to help the embryo to exit its zona pellucida, to implant itself in the uterine wall, and thus increase the chances of success of the patient.

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Oocyte Retrieval

Embryo Culture and Development

Embryo Transfer

Intracytoplasmic Sperm Injection (ICSI)

Assisted Hatching (AH)

1 in 6

Above Average

800

> 50

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