In vitro fertilization: Helping couples achieve the greatest gift of all
It's science that almost seems like science fiction. A couple wants a child yet they are unable to conceive in the conventional way. They go to a highly specialized physician, a reproductive endocrinologist, who is able to harvest the woman's eggs and fertilize them in the laboratory with her partner's sperm. The doctor then implants the embryos into the woman's uterus where, hopefully, one will develop into a beautiful child.
This amazing scientific feat is called in vitro fertilization (IVF), literally meaning fertilization that takes place in glass (in vitro). When the procedure was introduced over 20 years ago, it was called a "test tube baby" because of where the fertilization occurred. "We are lucky to be living in these times," says
George Taliadourous, MD, Virtua reproductive endocrinologist. "Thanks to IVF, thousands of couples can realize the dream of creating their own child."
Infertility is not uncommon
A sophisticated series of procedures
The main event
The waiting game
Infertility is not uncommon
At least 15% of all couples experience infertility at some point. Infertility is defined as the inability to become pregnant while having unprotected intercourse for a year.
Robert A. Skaf, MD, chief of reproductive endocrinology, Virtua West Jersey Hospitals notes: "Some people believe that there is an increase in infertility today. That is not the case. What has increased are couples over 35 wanting children, just about the age when fertility starts to decrease."
Dr. Skaf explains: "Candidates for IVF include patients with a fallopian tube blockage, women who have failed therapy such as ovulation induction with drugs like Clomid, and older women with less chance of becoming pregnant. Once a couple decide on IVF, we do a complete medical history and clinical evaluation before starting."
What can a couple hope for in terms of success? According to Dr. Skaf in the year 2000: "For women age 35 and under, the per IVF cycle pregnancy rate is approximately 40 percent. For women 35 to 39, it's approximately 44 percent. But by age 39 and over, achieving a viable pregnancy with IVF drops sharply to just 10 percent because the quality of the eggs diminishes with time.
A sophisticated series of procedures
IVF is a complex and extremely time-sensitive process. It starts with the woman taking a daily hormone injection to stimulate the development of eggs. According to Dr. Taliadouros: "Optimally, we want to produce about 15 eggs, being careful not to under stimulate or over stimulate production." Every two to three days, the woman visits her physician for an ultrasound and a blood test to watch for follicle growth. When the follicles (eggs) reach maturity, they are vaginally retrieved, a procedure done under light sedation guided by ultrasound. Women over age 42 often use donor eggs.
The main event
The day the eggs are retrieved, they are fertilized "in vitro" with the partner's sperm and then placed in the incubator, which provides an environment that perfectly mimics the body.
David Forstein, DO, Virtua reproductive endocrinologist explains: "For men with a low sperm count or low sperm motility, intracytoplasmic sperm injection (ICSI) can be performed. This recently developed high-tech procedure is where a single sperm is actually injected into a single egg to make sure fertilization occurs." Three to five days after fertilization, two to four developing embryos are implanted in the uterus. Now the really hard part begins.
The waiting game
For the next 12 days, the couple will ride a roller coaster of emotion as they wait to see if the embryo has properly imbedded itself in the lining of the uterus resulting in pregnancy. At about two weeks, a pregnancy blood test can determine if the IVF cycle was successful and a baby is on the way.
Even if a first IVF cycle does not "take," it's important to know that many couples go through two or three IVF cycles before a pregnancy is produced. "IVF success rates are rising every year," says Dr. Forstein. "The technology and techniques are getting more sophisticated." All of which translates into help and hope for couples who want to create a new life. It's also good to know that Virtua Health delivers over 7,000 babies a year, with services that include everything from obstetrics to comprehensive neonatal intensive care.