SUCCESS RATES MONITOR
Clinical Pregnancy* Rates 2013(First quarter)
IVF/PGD(<35 yrs): 70%
DONOR EGG IVF: 100%
*Presence of Gestational Sac
IVF is a “first line” treatment for many of the conditions that cause infertility. It is an accepted medical procedure and thousands of healthy babies have been born as a result of in vitro fertilization. Before IVF came into routine clinical use, many couples, especially those with male factor infertility or tubal disease, had no hope of creating a genetically related child.
To control the timing of egg maturation, and to increase the chance of collecting more than one egg, fertility drugs are commonly used in in vitro fertilization cycles. The use of fertility drugs is not mandatory as techniques are available to collect only one or two eggs from a natural cycle (no medications). However, it is known that with increased numbers of eggs being collected, there is a greater chance of ultimate success. Natural cycles typically produce lower pregnancy rates than stimulated cycles. The major benefit of natural cycles is reduced cost.
Fertility drugs used in In Vitro Fertilization
The fertility drugs commonly used for the in vitro fertilization process include one or more of the following:
After successful super ovulation, and the administration of hCG, the eggs are collected from the ovaries using a procedure called ultrasound-guided transvaginal oocyte retrieval. This is performed in the operating room of the Washington Center for Reproductive Medicine IVF Center infertility clinic under conscious sedation. The anesthesiologist starts an IV line and pain medication is administered to make the patient comfortable.
A minor surgical procedure is performed where an ultrasound probe is inserted into the vagina and by the use of a needle the follicles are aspirated. Our PhD embryologist receives the eggs in the follicular fluid and identifies and separates the oocytes.
During the surgical portion of the procedure, we strive to make patients experiences as pleasant as possible. Usually patients leave the office within one to two hours following egg retrieval and are prescribed pain medicine to deal with the mild discomfort associated with the egg retrieval process. Postoperatively, we keep in telephone contact with patients to make sure they are doing well. Dr. Kustin is available by telephone on a 24-hour basis should patients need his advice postoperatively.
The male will be asked to abstain from ejaculation for two to three days before the egg retrieval so that we might obtain an optimal specimen. Before initiating an in vitro fertilization cycle, the sperm is thoroughly analyzed. Many tests of sperm function are performed to analyze the likelihood that the sperm will be able to fertilize eggs.
In cases where there is a question about the ability of the sperm to fertilize eggs (such as severe male infertility), we offer intracytoplasmic sperm injection (ICSI). By the use of this technique, one sperm is injected directly into the egg, providing normal embryonic development. (Please see the section on ICSI.) We have a very comfortable facility (the Marilyn Monroe Room) where the male provides a fresh specimen on the day of his partner's egg retrieval.
In conventional IVF, the eggs and sperm are placed together in a special culture fluid and kept incubated in our laboratory to allow fertilization to occur. We maintain an extremely rigorous quality assurance program in our laboratory so that the appropriate conditions to facilitate fertilization and cell division are always present. After cell division, the fertilized eggs are known as embryos. In cases of male infertility, one sperm may be injected directly into each egg (ICSI).
Embryology is an exacting science and we constantly strive to use state of the art techniques. Our IVF laboratory is classified as a "clean room". Advanced air filtration techniques are used so that air borne toxins such as automobile emissions and other fumes that inhibit the growth of the embryo are extracted. With circulating air of the highest quality we are able to ensure the highest success rates for our patients. We were the first clinic in the Northwest to invest in this technology and to offer it to our patients. We are committed to constantly strive to offer the latest developments.
We also understand that the latest technology is only as good as the people who work with it. A highly experienced PhD embryologist, with many years experience in IVF and ICSI, runs our IVF laboratory. The staff is meticulous in their work and is committed to providing the best results possible for our patients. They realize that patients are concerned about the welfare of their embryos and, together with the clinical staff, will keep you abreast of day-to-day progress in the laboratory.
After several days of culturing embryos in the laboratory, normally developing embryos are transferred into the uterus using a small catheter inserted through the cervix. Embryos are usually transferred on the third day after egg retrieval when they are at approximately the 8-cell stage. In some cases, the embryos are biopsied at this stage with removal of one cell for analysis by preimplantation genetic diagnosis (PGD). This enables the embryos sex to be determined as well as the presence of certain chromosomal or genetic problems.
In certain cases, if the embryo quality on the third day is excellent, we may recommend that the embryos be cultured for a further two to three days until they develop into a blastocyst. The benefits of blastocyst transfer has a higher pregnancy rate because only the best embryos survive to the blastocyst stage. Apart from the higher pregnancy rate, the benefits of blastocyst transfer lie in the fact that fewer embryos need to be transferred, therefore, diminishing the risk of multiple pregnancies.
Embryo transfer remains the most crucial part of the IVF process and it is Dr. Kustin's philosophy that this process must be undertaken with the utmost care. The patient is prescribed a mild sedative and is asked to attend the clinic with a full bladder so that an abdominal ultrasound can be used to visualize the correct placement of the embryos in the uterus, thus facilitating the highest pregnancy rate.
At the time of embryo transfer, it is usual to transfer up to three embryos (this depends upon several factors such as patient age and diagnosis), while saving other embryos for cryopreservation (freezing). Following embryo transfer, the patient is asked to rest in our comfortable recovery area for two hours and then asked to return home for three days of bed rest.
The number of cryopreserved IVF cycles that can be attempted in the future is determined by the number of embryos resulting from the stimulated cycle. The woman's "hormonal cycle" is synced to match the events that occur in a normal pregnancy cycle using medications, such as Progesterone. This insures that the endometrium thickens and becomes more vascular enabling it to accept and support a developing embryo. In general, success rates using cryopreserved embryos are lower than when using "fresh" embryos.
Following embryo transfer, support of the initial growth of the embryos is paramount and hormonal treatment with Progesterone, either by injection or vaginal cream, is mandatory. Estrogen may also be prescribed via a patch. Twelve days after embryo transfer, the patient is asked to attend the clinic for a pregnancy test.
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