In Vitro Fertilization (IVF) is a procedure in which oocytes (eggs) are surgically retrieved from a woman's ovaries and fertilized in the laboratory. The fertilized eggs are then allowed to grow into pre-embryos and then transferred to the woman's uterus through the cervix. The term Assisted Reproductive Technologies (ART) is also frequently used and simply refers to all fertility treatments in which both egg and sperm are handled. The types of ART are IVF, GIFT (gamete intrafallopian transfer), and ZIFT (zygote intrafallopian transfer). IVF is the most common ART procedure that is used in the United States, as GIFT and ZIFT do not increase pregnancy rates, but require a second procedure (laparoscopy). We do offer GIFT for couples with specific religious (cannot have fertilization outside of the body) or medical (severe cervical scarring preventing normal embryo transfer) reasons.
All IVF procedures involve egg retrieval and embryo transfer. Depending upon the individual case, specialized procedures are offered: 1) Assisted Hatching (AH) - treatment of the embryo prior to transfer to improve the chance of implantation) 2) Blastocyst Culture - growing embryos 2-3 additional days in the lab prior to transfer, 3) Intracytoplasmic Sperm Injection (ICSI) - injecting a single sperm into the egg, 4) Preimplantation Genetic Diagnosis (PGD) - biopsy of an embryo prior to embryo transfer to minimize the risk of genetic disorders or pregnancy loss. We also work closely with urologists who specialize in male infertility and can perform procedures such as micro epididymal sperm aspiration (MESA). In cases where there is little or no ejaculated sperm, the urologists can aspirate sperm from the male reproductive tract, which is then frozen by our Andrology Laboratory for future use. We are also experienced in cryopreservation (freezing) of pre-embryos. Some of the procedures that we are involved with IVF treatment are described below.
Egg retrieval - Injectable medications are used to stimulate the woman's ovaries to produce eggs. Patients are closely monitored through ultrasound and blood tests in order to optimize follicular development while minimizing the incidence of hyperstimulation of the ovaries. Eggs are then surgically retrieved during a brief outpatient procedure in which the woman is sedated using medicines given through an intravenous (IV) line.
Micromanipulation - This term refers to the microscopic procedures using the sperm, eggs, and/or embryos that are designed to improve fertilization, implantation, or reduce the risk of genetic disease or recurrent pregnancy loss. There are three types of micromanipulation offered:
Intracytoplasmic Sperm Injection (ICSI) - This procedure involves direct injection of a single sperm into a mature egg. This procedure is selectively used in cases involving significant decreases in sperm counts, motility, or morphology. This procedure may also be used in cases where there is a history of previous failed fertilization despite normal sperm testing.
Assisted Hatching (AH) - This procedure involves making a small hole in the zona pellucida (sugar-protein membrane) that surrounds the pre embryo at the 6-8 cell stage approximately 1 hour prior to embryo transfer. As the embryo continues to grow, the hole becomes larger, making it easier for the embryo to "hatch" out of its shell, which is necessary for implantation to occur. This procedure is performed in patients with a thickened zona pellucida, as well as in patients  35 y/o.
Preimplantation Genetic Diagnosis (PGD) - A small hole is made in the membrane surrounding a 6-8 cell embryo (similar to assisted hatching). A single cell is aspirated from each embryo and is evaluated for various genetic abnormality. Abnormal embryos are not transferred, thus reducing the risk of genetic disease, recurrent pregnancy loss, or implantation failure.
Microepididymal Sperm Aspiration (MESA)/Testicular Sperm Extraction (TESE) - This is a procedure in which sperm are aspirated or extracted from the male reproductive tract (testes or epididymis), sometimes requiring the use of a microscope. The retrieved sperm are immediately taken by an experienced andrology/embryology technician and then frozen. This procedure should be performed by a urologist with specialized training in male infertility
Embryo Transfer - Embryos are transferred to the uterus by passing a small catheter through the cervix to a distance approximately 1-1.5 cm from the top of the uterus. A trial embryo transfer is usually performed prior to the actual embryo transfer to measure the distance from the outside of the cervix to the top of the uterus for proper placement. This procedure is very similar to an IUI in that it usually takes less than 5 minutes to perform, and requires no anesthesia. In our program, ultrasound-guided placement of embryos is routinely performed.
Cryopreservation of Embryos - Excess embryos may be cryopreserved (frozen) for transfer in a subsequent cycle. We recommend freezing at either the fertilized egg stage, or the blastocyst stage. Frozen embryo transfer (FET) cycles require less medication, minimal monitoring and are much less expensive than a fresh cycle, while still providing good pregnancy rates.
Egg Donor Program - Donor eggs may be used in IVF in women who are unable to achieve a pregnancy with their own eggs and come from a known or an anonymous donor. Donor eggs are then fertilized with the sperm of the recipient partner (or with donor sperm as indicated), with subsequent embryos transferred to the recipient's uterus. For anonymous egg donation (recipient couple does not know the identity of the egg donor), our Center provides a list of donors to choose from which match the recipient couple's desired characteristics. All donors undergo thorough medical, genetic, psychological, and laboratory screening prior to donation.
For potential egg donors:
The Center for Reproductive Health (CRH) has a very successful egg donor program and invites women who are between 20-32 years of age to enroll in its egg donor screening and qualification process by contacting Judy Eckert, RNC at 513-585-0752. In addition to having the satisfaction of helping an infertile couple to have a baby, egg donors receive monetary compensation for their time and effort (all medical expenses involved in the egg donation process are billed to the recipient couple).
Gestational Carriers - The Center also works with couples that provide their own gestational carrier (a woman who carries the pregnancy for the couple but has no genetic link to the child). This procedure is generally used for patients who have severe damage to their uterine cavity or who have had their uterus removed.
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