THE STEPS OF ASSISTED REPRODUCTIVE TECHNOLOGY WITH IVF

At our state-of-the-art IVF Denver facility, we offer a wide variety of assisted reproductive technologies (ART) that help clients achieve pregnancy. The most common method is in vitro fertilization (IVF), which is often combined with other techniques, such as intracytoplasmic sperm injection (ICSI), preimplantation genetic diagnosis (PGD), and assisted hatching (AHA).

IVF is a procedure where the woman’s eggs arecombined with the man’s sperm in the laboratory setting. Here is an overview of the steps of IVF at our Colorado fertility clinic.

Step 1 – Controlled Ovarian Hyperstimulation (COH)

Ovarian hyperstimulation is controlled at the start of the IVF process. The most common protocol is use of Lupron (a GnRH-agonist), which suppresses the secretion of gonadotropin hormones in order to prevent premature ovulation. Multiple follicles are then recruited using daily injections of gonadotropins, which helps many eggs form in each ovary.

To assess follicular development, blood testing and ultrasound imaging are done. When follicles reach appropriate size, egg maturation is assisted using administration of human chorionic gonadotropin (hCG). Around 34-36 hours later, the fertility specialist performs egg retrieval.

Step 2 – Egg Retrieval

Egg retrieval is done at the fertility clinic. The woman is given intravenous sedation before the ovarian follicles are aspirated using transvaginal ultrasound guidance. The tiny eggs are inside aspirated follicular fluid, which is examined under the microscope. Using microtools, the eggs are removed from the fluid and place in a petri dish and incubator until insemination.

Step 3 – Fertilization

The man comes into the fertility clinic to give a semen specimen, which is done with masturbation. If sperm parameters were previously deemed normal, around 50,000-100,000 motile sperm are transferred into the petri dish with the eggs.

For sperm with abnormal parameters, ICSI is used to fertilize the mature eggs. This is done using a high-powered microscope where the embryologist picks up a single sperm and injects it into the egg cytoplasm. ICSI can greatly improve the chance that fertilization occurs. Fertilization is assessed around 16 hours after insemination or ICSI.

Step 4 – Embryo Culture

The fertilized eggs (zygotes) develop into embryos in the specially formulated culture medium, which supports their growth and development. On the second or third day following egg retrieval, if sufficient numbers of embryos are present, the embryos may be selected to continue growth to the blastocyst stage. A blastocyst has a higher potential for implantation in the uterus, so fewer embryos are needed. Low numbers of embryos, or poor quality of embryos reduce the chances of blastocyst development.

Step 5 – Embryo Quality

To assess the quality of an embryo, several criteria are used. When choosing which embryos to transfer, the embryos are assessed by the embryologist and Denver fertility specialist. The appearance and development is rated using a grading scale, so high-quality embryos are chosen.

Usually, embryos are transferred between 3-5 days. Day three embryos are in the cleavage stage, and they have 4-8 cells. A single cell is analyzed to assess for fragmentation and symmetry. Day five embryos are in the blastocyst stage, which means they contain more cells with fluid inside.

Step 6 – Embryo Transfer

Embryos are either transferred on day three or day five, depending on the situation and circumstances. Embryo transfer is a simple procedure that does not require anesthesia. Using a small, soft catheter, the embryos are gently placed into the uterus through the cervix.