A process where a woman undergoes multiple egg development through the use of injectable medications under sedation through ultrasound guidance, a needle is placed through the vagina into the ovaries to extract the eggs. The eggs and sperm are then combined in our state-of-the-art IVF laboratory. Once fertilization has occurred, embryos are transferred directly into the uterus..
- Intracytoplasmic Sperm Injection (ICSI)
- Performing in vitro fertilization requires a significant amount of sperm. In cases where the male partner has a low sperm count, poor sperm mobility, or sperm structure concerns, ICSI can be of extreme value, facilitating fertilization with just a few sperm.ICSI is accomplished with the use of specialized micromanipulation equipment in our state-of-the-art lab. An egg is immobilized under the microscope using special glass tubing, and a single sperm is injected into the egg. Sixteen to 24 hours later, the egg can be evaluated to see if normal fertilization has occurred.
- Assisted zona hatching (AZH)
When an embryo is ready to implant in the lining of the uterus, it first must hatch out of its outer layer, called the zona pellucida. There is some evidence that suggests the zona may become abnormally thickened in some individuals as a result of the IVF process, making it more difficult for the embryo to hatch out at the appropriate time.AZH is another micromanipulation technique performed in the lab. Delicate instrumentation is used to stabilize the embryo and create a small slit in the embryo prior to transfer.
Basic Steps of IVF
- Ovarian stimulation and egg development
Prior to beginning your IVF treatment cycle, you will be started on a medication to suppress the ovaries. Once the ovaries are suppressed, hormones are prescribed to be injected daily or twice daily in order to stimulate the ovaries to develop multiple eggs.
- Egg retrieval and evaluation
After tests indicate that eggs have reached maturity, you’ll be prescribed another hormone, HCG, to finalize the maturation process. Egg retrieval is scheduled for 35 to 36 hours later.Egg retrieval is a brief procedure that is typically performed in the early morning. Guided by the images from a transvaginal ultrasound, the doctor inserts the tip of a small needle through the vaginal wall, into the ovary, and into the egg sac (follicle). The contents of each follicle are evaluated under a microscope by our embryologist.
- Egg fertilization and transfer
Eggs that are determined to be mature thereby having the greatest chance of fertilization or producing a pregnancy are ready to be introduced to sperm four to six hours after egg retrieval. Fertilized eggs are incubated for three to five days, until ready for transfer to the patient.
- Pregnancy test
A pregnancy test is typically performed two weeks after transfer. We’ll provide you with specific instructions as to when to return to the office and what testing will occur.
Infertility is complex and different for every couple. Sometimes, the factors causing infertility aren’t solved by following a textbook approach. In these cases, more advanced options need to be considered.
Dr. Miller is committed to taking a closer look at innovations that could help a couple achieve a successful pregnancy. Our physicians believe in exhausting every possible diagnostic and treatment angle for each couple. Dr. Miller and team are trained in the latest innovations to help a couple fulfill their dreams of starting a family. Learn about the newest procedures that have helped our patients become parents.
- Transvaginal Ultrasound Guided Embryo Transfers
- Blastocyst Transfers
- Preimplantation Genetic Diagnosis (PGD)
Infertility patients concerned about their risk of having multiples may benefit from blastocyst transfer. This unique process allows a reproductive endocrinologist to transfer fewer embryos that have the best probability for resulting in a successful pregnancy.
Typically, embryos are transferred on day three. After this point, about half of the embryos stop developing and degenerate, reducing the likelihood of a pregnancy. To have the same chances at attaining a pregnancy, it is necessary to transfer more embryos. This carries an increased risk of having multiples.
In a blastocyst transfer, the embryos are grown to day five or six. This is the stage in which an embryo begins to expand again, and it becomes possible to discern the embryos with the best quality.
However, growing an embryo past day three must be done very carefully. The conditions and nutrients required by embryos change, affecting the enriched fluids that house the embryos. Without proper laboratory conditions, an embryo is less likely to implant and may even die.
Dr. Miller has a state-of-the-art lab with precise controls in place to maintain embryos beyond day three.
For couples with a smaller number of healthy embryos, this approach may not be beneficial. Many women have infertility due to aging ovaries, and the blastocyst approach is not ideal for them. The patient that has the most to benefit is a couple where the female is young, especially in her 20s.
During an Embryo Transfer Process, the embryos are placed inside the uterus. The thriving embryos will ultimately implant into the endometrial lining. This step takes only ten minutes, but it can significantly affect a woman’s chances for a successful outcome.
There are many delicate steps in this process. For example, the uterine lining may not be scratched or damaged by the catheter while it is within the uterine canal. The location along the uterine canal where the embryos are placed can also impact the chances of success.
Although some centers utilize nurses for embryo transfer, Dr. Miller completes the embryo transfer process.
During the process, the physician cleans the cervix to remove a thick mucus that is secreted in the cervical canal because of hormones. In order to locate and remove this mucous, the physician uses a powerful lighting system within the opening of the cervical canal. If the mucous isn’t completely removed, the embryos can be caught within the cervix.
While virtually every center performs trans-abdominal ultrasound with a full bladder, Dr. Miller performs Embryo Transfers with trans-vaginal ultrasound. This allows the procedure to be completed without a full uncomfortable bladder. Moreover, visualization is superior.
Our Embryo transfer technique is modified for success. Dr. Miller uses a two-catheter technique. A dummy catheter finds the precise location for placement, then a second catheter is used to actually transfer the embryos. “This allows the embryos to spend less time in the unstable environment of the catheter,” said Dr. Miller, director of in vitro fertilization. “The entire procedure takes less than 10 minutes with embryos transferred in mere seconds, but it’s a critical time for the fragile embryos.”
The increased risks of miscarriage and genetic disorders faced by older women who are trying to have a baby can be avoided by use of an innovative technique available through Dr. Miller.
Preimplantation genetic diagnosis (PGD) is a procedure that tests embryos for genetic disorders before placement in the uterus. It is performed in conjunction with IVF and should be considered for women over the age of 37, women with a history of recurrent miscarriages, and families with a history of genetic diseases.
PGD is conducted by analyzing the DNA within one of the cells of each embryo formed during a routine IVF cycle. (There are eight interchangeable cells in a healthy embryo. Removing one cell is not harmful to the development of the baby.) This DNA analysis helps to identify genetic disorders, such as Down’s syndrome and Turner’s syndrome, and to determine which embryo to implant.
Dr. Miller has created a tightly-controlled environment for the delicate science of IVF. Air purity, temperature, oxygen level and other details are in place for the most “embryo-friendly” atmosphere.