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Glossary of In Vitro Terms

Ovarian Suppression and Stimulation

Key elements of the IVF procedure are techniques designed to suppress and stimulate the ovaries so eggs (oocytes) can be retrieved before they are spontaneously released during natural ovulation. Administered with daily injections by the patient at home, medications control ovarian activity, stimulate the production of multiple eggs and increase the lining of the uterus to support pregnancy. Multiple eggs increase the potential availability of embryos (fertilized eggs) for transfer and possible cryopreservation.

Monitoring

The physician closely monitors each patient with frequent ultrasound and blood tests. Vaginal ultrasound is used to watch the development of follicles (the sacs of fluid within the ovaries which contain eggs) and determine how well a patient is responding to the medication. The follicle size gives an idea of the number and maturity of eggs (oocytes). The thickness and pattern of the uterine lining is also evaluated to ensure adequate lining to sustain a pregnancy. Frequent blood tests are used to measure hormone levels which indicate a patient’s response to the medication.

Oocyte (Egg) Retrieval

When monitoring by the physician determines the eggs are ready for oocyte retrieval, a procedure is performed under light intravenous sedation administered by an anesthesiologist. Using a ultrasound probe, a needle is guided through the vaginal wall and fluid is aspirated from each follicle, immediately taken to the laboratory where eggs are identified, counted and each egg moved to an individual dish of nutrient media stored in an incubator. Egg retrieval is not painful and recovery is brief.

Insemination and Fertilization

During the retrieval the spouse will provide a semen specimen to be used for fertilization. The semen is processed so that the strongest are selected and placed in the dishes from insemination. About 50 thousand sperm are placed in each dish and left to incubate together with in the carefully controlled lab environment. Fertilization will be frequently monitored over the next several days.

Intracytoplasmic Sperm Injection (ICSI)

If not enough active normal sperm are available, a process called ICSI is used where an embryologist injects a single sperm into the egg to fertilize it. This painstaking process is performed under a special microscope using a micro-suction instrument to hold the egg while one sperm in a fine glass needle is injected into it. ICSI requires great skill and expertise, but allows couples to overcome the barriers of low sperm count, motility, morphology and sperm maturity.

Embryo Transfer and Implantation

Three or five days after retrieval (based on cell growth), the embryos will be transferred into the uterus in a non-surgical procedure in our special procedure room. Usually taking only 15-20 minutes, patients can resume normal activity the following day. The number of embryos transferred will depend on patient age, quality of the embryo and patient medical history. Implantation will occur over the next two to five days. Cryopreservation can be performed on remaining embryos not transferred if quality shows it can sustain the freeze and thaw procedures.

Successful implantation is verified by a series of chemical pregnancy tests two weeks after the egg retrieval. If implantation has not occurred, the patient will have a menstrual period soon after stopping the medication.

Cyropreservation

Cyropreservation is the process of freezing and storing embryos for later use. Freezing of extra embryos gives a couple the opportunity to attempt another IVF cycle without going through a stimulation and egg retrieval procedure.

The freezing process is controlled and employs a special solution to protect the fertilized eggs from damage. Unfortunately there is not a satisfactory method for egg freezing and thawing at this time. Only embryos (fertilized eggs) and sperm are suitable to freeze.

Not all embryos are suitable to freezing. Based on the quality and rate of growth of the embryo, the embryologist will determine which, if any, embryos are suitable to freezing. Embryos can remain frozen for years without compromising the quality at which they were frozen. However, there is no guarantee the embryos will survive the freezing and thawing process.

Donor Egg Cycle

If eggs are not available from the patient, an egg donor can be used. In this therapy, eggs from another woman are fertilized with the patient’s partner’s sperm. The resulting embryos are transferred to the patient.

The donor may be known to the couple or anonymous. If anonymous, an agency will coordinate the procedure.

Preimplantation Genetic Diagnosis

Preimplantation Genetic Diagnosis (PGD) is a technique that can be used during in vitro fertilization procedures to test embryos for genetic disorders prior to their transfer to the uterus. PGD makes it possible for couples or individuals with serious inherited disorders to decrease the risk of having a child who is affected by the same problem. This technique is controversial and raises issues of sex selection and genetic engineering. At present, PGD is only offered in a few centers, usually under the supervision of an institutional ethics review board, but its use may become more widespread in the near future. For more information on PGD, please read www.asrm.org/patients/factsheets/pgd-fact.pdf.