What
is in vitro fertilization?
In
vitro fertilization (IVF) is a procedure
used to induce pregnancy that has
been practiced for over twenty years.
During IVF, a woman’s eggs are
removed from the body, fertilized
with sperm in a laboratory, and then
placed in the woman’s uterus
as embryos several days later. Between
15 and 25 percent of in vitro fertilization
patients produce healthy babies. Success
is much higher for younger women,
and it is also much higher for some
types of infertility
than for others.
Who
is a candidate for IVF?
Common
problems that lead couples to in vitro
fertilization include:
- Nonfunctional fallopian tubes
that cannot be repaired by surgery
- Endometriosis in the female
- Low sperm counts in the male
However,
there are also patients for which
in vitro fertilization may be a very
inappropriate procedure. If, for instance,
smoking has contributed to the couple’s
infertility, the procedure is unlikely
to be successful. The procedure may
also be unsuitable for a woman with
a genetic disorder that the child
could inherit. It is best to consult
with a reputable IVF doctor to help
with the decision.
How
is the IVF procedure performed?
The
IVF specialist helps the woman prepare
for surgery beginning a few weeks
ahead of time. Blood tests and ultrasound
scans are taken to determine the best
ovular retrieval time. The woman is
given hormonal fertility
drugs to increase the production
of eggs and to assist in retrieval.
She and her partner are both typically
advised to avoid hot tubs, saunas,
alcohol, smoking, and most medications
in the weeks leading up to surgery.
Maintaining a consistent pattern of
diet and exercise is also recommended.
Finally, the couple should abstain
from sexual intercourse for at least
a few days prior to surgery.
If
the eggs are to be fertilized with
sperm from the woman’s partner,
then he provides the sperm sample
a few hours before the eggs are extracted.
The sperm is most commonly obtained
through ejaculation; however, if the
male has a reproductive impairment,
the surgeon can obtain the sample
microsurgically from either the epididymis
or the testes.
In
IVF, the eggs are usually extracted
in one of two ways. The first is laparoscopy,
a procedure that uses very small incisions
to access the ovaries through the
abdomen. An instrument with a lighted
tip called a laparoscope is used to
view the region while other surgical
instruments are inserted to remove
the eggs. Then the incisions are sewed
up.
An
even less intrusive and less risky
method involves a needle guided by
sonogram. The ovaries are viewed on
a sonogram image, and the needle is
inserted through the vaginal wall
to retrieve the eggs. This procedure
is said to cause discomfort comparable
to a pap smear.
Once
the eggs are ready to be fertilized,
they are placed with the sperm sample
in a laboratory dish. Preembryos begin
to form, and they are placed in a
nutrient solution that mimics the
environment in the fallopian tubes.
After
a few days, the embryos are inserted
into the uterus using a special catheter.
The doctor will time the insertion
to coincide with the point at which
naturally fertilized zygotes would
be entering the uterus. After insertion,
the woman will only need to lie still
for about an hour, after which time
she can go home.
The
two primary risks of in vitro fertilization
are ovarian hyperstimulation syndrome
and multiple pregnancy. Ovarian hyperstimulation
syndrome can result in anything from
moderate fluid collection in the abdomen
to damaged internal organs. Multiple
pregnancy carries with it numerous
risks to both the mother and fetuses.
These can include miscarriage, gestation
diabetes, anemia, and urinary tract
infections.
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