Understanding the IVF Process

Summary

Dr. Leo Doherty explains the in vitro fertilization (IVF) process at Reproductive Medicine Associates of New Jersey, detailing how eggs and sperm are combined outside the body, using either ICSI or conventional insemination. He discusses ovarian stimulation, egg retrieval, and the revolutionary impact of pre-implantation genetic testing for aneuploidy (PGT-A), which allows for the selection of chromosomally normal embryos, improving IVF success rates. The process of embryo transfer is also described, emphasizing the strategy of maximizing egg growth safely and debunking the myth that IVF accelerates menopause.

Takeaways

• 🧪 In vitro fertilization (IVF) involves eggs and sperm meeting outside the human body, with sperm injected via ICSI or allowed to fertilize through conventional insemination.
• 🛌 The IVF laboratory serves as an artificial fallopian tube environment, mimicking natural interactions that would occur within the body.
• 💉 Ovarian stimulation for IVF involves administering hormones FSH and LH in higher concentrations to promote the growth of multiple eggs.
• 🥚 Egg retrieval is performed just before the eggs would naturally ovulate, under anesthesia, to collect them from the ovaries.
• 🧬 Pre-implantation genetic testing for aneuploidy (PGT-A) is a significant advancement, allowing the selection of embryos with the correct number of chromosomes for transfer.
• 📈 PGT-A has improved success rates by enabling the transfer of fewer, chromosomally normal embryos, enhancing the chances of implantation and pregnancy.
• 🔬 The IVF process typically aims to create as many embryos as safely possible and then select the chromosomally normal ones for transfer.
• 🌡 Patients are assessed for their IVF protocol based on the quantity of eggs and the number of follicles determined through blood tests and ultrasound.
• 🚫 A common misconception is that IVF uses eggs destined for future ovulation, potentially leading to early menopause; however, IVF rescues eggs destined for reabsorption.
• 💧 During embryo transfer in IVF, the embryo is inserted into the uterine cavity through the cervix using a catheter, with the process monitored via ultrasound.
• 👶 The embryo transfer aims to place the embryo in the uterine cavity where it may implant and develop into a pregnancy over the following weeks.

Q & A

What is the basic concept of in vitro fertilization (IVF)?

In vitro fertilization is a process where an egg and sperm meet outside the human body. It involves the removal of eggs from the ovaries and the introduction of sperm either through ICSI (intracytoplasmic sperm injection) or conventional insemination, allowing fertilization to occur in a laboratory setting.

How does the natural process of fertilization differ from IVF?

In the natural process, the sperm finds its way and unites with an egg in the woman's fallopian tube. In contrast, IVF bypasses this by taking the eggs out and combining them with sperm in a controlled environment.

What is the role of the laboratory in IVF?

The laboratory serves as an artificial fallopian tube environment, where the interactions that normally happen in the fallopian tube take place, facilitating fertilization and early embryonic development.

How does ovarian stimulation work in the context of IVF?

Ovarian stimulation involves administering hormones FSH and LH in higher concentrations than naturally produced by the body to promote the growth of multiple eggs, as opposed to the one egg typically developed in a natural menstrual cycle.

What is the purpose of egg retrieval in IVF?

Egg retrieval is a procedure performed just before the eggs would naturally ovulate, where eggs are withdrawn from the woman's ovaries under anesthesia to be fertilized in the laboratory.

What is pre-implantation genetic testing for aneuploidy (PGT-A) and how does it impact IVF success rates?

PGT-A is an embryo biopsy performed in the lab to determine the chromosomal normality of embryos, identifying those with 46 chromosomes. This has revolutionized IVF by allowing for the selection of chromosomally normal embryos, improving success rates and reducing the number of embryos needed for transfer.

How has the strategy of making and selecting multiple embryos changed the IVF field?

The strategy of creating as many embryos as safely possible and then selecting chromosomally normal embryos for transfer has revolutionized IVF. It has led to improved success rates and the ability to transfer fewer embryos than historically needed.

What is the process of embryo transfer in IVF?

During embryo transfer, the embryo is passed into the uterine cavity through the woman's cervix using a catheter, as opposed to the natural process where the embryo travels through the fallopian tube.

Why is it recommended for patients to have a full bladder during embryo transfer?

A full bladder allows the use of a trans-abdominal ultrasound probe to carefully guide the catheter through the cervix into the endometrial cavity, providing a clear view of the procedure.

How does the IVF process affect a woman's egg reserve and the potential for early menopause?

Contrary to a common misconception, IVF does not cause early menopause by using eggs destined for future ovulation. Instead, it rescues eggs that would have been reabsorbed, giving them a chance to grow and be fertilized.

How do physicians assess individual patients for their IVF protocol?

Physicians assess patients based on the quantity of eggs within their ovaries each month, using blood tests and ultrasound to determine the number of follicles and decide on the appropriate dosage of FSH and LH medications.

Outlines

00:00

🧪 In Vitro Fertilization Process and Techniques

Dr. Leo Doherty, a physician at Reproductive Medicine Associates of New Jersey, explains the in vitro fertilization (IVF) process, which involves eggs and sperm meeting outside the human body. He describes two methods of fertilization: intracytoplasmic sperm injection (ICSI) and conventional insemination. The IVF laboratory is likened to an artificial fallopian tube environment. Ovarian stimulation is discussed, where hormones FSH and LH are used in higher concentrations to grow multiple eggs, followed by an egg retrieval procedure. The introduction of pre-implantation genetic testing for aneuploidy (PGT-A) is highlighted as a significant advancement in the field, allowing for the selection of chromosomally normal embryos, thereby improving success rates across all ages.

📈 Enhancing IVF Success with Embryo Selection

The general IVF strategy is to create as many embryos as safely possible and then select those that are chromosomally normal for transfer, revolutionizing the field. The process of embryo transfer in IVF is described, where the embryo is inserted into the uterine cavity through the cervix, using a catheter guided by trans-abdominal ultrasound. The importance of a full bladder during this procedure is noted to facilitate the transfer. The selection of individual IVF protocols for patients is based on the quantity of eggs within their ovaries, with the potential for growth and development assessed through blood tests and ultrasound.

🚫 Debunking Misconceptions about IVF and Egg Usage

A common misconception about IVF is addressed, where patients fear that using eggs for IVF will lead to early menopause. Dr. Doherty clarifies that the IVF process rescues eggs that would have otherwise been reabsorbed, giving them a chance to grow. He explains the natural monthly 'race for ovulation' where a group of eggs is destined to either ovulate or disintegrate, and how IVF stimulation allows these eggs to be utilized, thus not depleting the overall egg reserve.

Keywords

💡In vitro fertilization (IVF)

In vitro fertilization, commonly known as IVF, is a process where eggs are fertilized by sperm outside the body, in a laboratory setting. It is a key theme of the video, as it is the main reproductive technology discussed. The script explains that IVF involves the retrieval of eggs and their subsequent fertilization with sperm either through ICSI or conventional insemination, highlighting the artificial environment that mimics the natural fallopian tube.

💡Ovarian stimulation

Ovarian stimulation is the process of using hormones to encourage the growth of multiple eggs within the ovaries, which is a critical step in the IVF process. The script describes how, normally, only one egg is stimulated to mature each month, but in IVF, higher concentrations of hormones are used to promote the growth of multiple eggs suitable for retrieval and fertilization.

💡Follicle stimulating hormone (FSH)

FSH, or follicle stimulating hormone, is one of the hormones produced by the pituitary gland that plays a vital role in the development of ovarian follicles and subsequent egg maturation. The script mentions FSH in the context of ovarian stimulation for IVF, where it is administered in higher quantities than in a natural menstrual cycle to encourage the growth of multiple eggs.

💡Luteinizing hormone (LH)

LH, or luteinizing hormone, is another hormone involved in the menstrual cycle and is essential for triggering ovulation. In the context of the video, LH is also part of the hormone treatment used during ovarian stimulation for IVF to support the development and maturation of eggs.

💡Egg retrieval

Egg retrieval is a medical procedure performed to extract mature eggs from a woman's ovaries, which is a necessary step before the eggs can be fertilized in an IVF setting. The script describes this process as being done just before the eggs would naturally ovulate and under anesthesia.

💡Intracytoplasmic sperm injection (ICSI)

ICSI is a technique used in IVF where a single sperm is injected directly into an egg to facilitate fertilization. The script mentions ICSI as an alternative to conventional insemination, allowing for the fertilization of eggs in cases where natural fertilization might be less successful.

💡Conventional insemination

Conventional insemination is the process where sperm are placed around an egg to allow fertilization to occur naturally in an IVF setting. The script contrasts this method with ICSI, explaining that it involves allowing the sperm to fertilize the egg without direct injection.

💡Pre-implantation genetic testing for aneuploidy (PGT-A)

PGT-A is a technique used to screen embryos for chromosomal abnormalities before they are implanted in the uterus. The script highlights PGT-A as a game-changer in the field of IVF, allowing for the selection of embryos with the correct number of chromosomes, thereby improving success rates and reducing the number of embryos needed for transfer.

💡Embryo transfer

Embryo transfer is the final step in the IVF process where selected embryos are placed into the uterus with the aim of establishing a pregnancy. The script describes the procedure as being done through the cervix using a catheter and mentions the use of a trans-abdominal ultrasound to guide the process.

💡Menopause

Menopause is the natural cessation of a woman's menstrual cycles and reproductive capabilities. The script addresses a common misconception about IVF, clarifying that the process does not cause early menopause by using eggs destined for future ovulation cycles. Instead, IVF rescues eggs that would otherwise be reabsorbed.

💡Follicles

Follicles are the fluid-filled sacs in the ovaries that contain eggs. The script discusses the use of blood tests and ultrasound to monitor the number of follicles, which is important for determining the dosage of FSH and LH medications during ovarian stimulation for IVF.

Highlights

Dr. Leo Doherty explains in vitro fertilization (IVF) as a process where egg and sperm meet outside the human body.

Traditional fertilization occurs in vivo, with sperm naturally finding and uniting with an egg in the fallopian tube.

In IVF, eggs are removed and sperm is injected via ICSI or allowed to fertilize through conventional insemination.

The IVF laboratory serves as an artificial fallopian tube environment for fertilization to occur.

Ovarian stimulation for IVF involves higher concentrations of FSH and LH hormones to grow multiple eggs.

Egg retrieval is performed just before the eggs would naturally ovulate.

Pre-implantation genetic testing for aneuploidy (PGT-A) has revolutionized the IVF field by allowing the selection of chromosomally normal embryos.

PGT-A improves success rates by enabling the transfer of fewer, chromosomally competent embryos.

The IVF strategy is to create and select chromosomally normal embryos for transfer, enhancing pregnancy chances.

Embryo transfer in IVF is performed by inserting the embryo through the cervix into the uterine cavity.

Patients are instructed to have a full bladder for ultrasound-guided embryo transfer.

The ultrasound can visualize the moment the embryo is transferred into the uterine cavity.

IVF protocols are personalized based on the quantity of eggs and the number of follicles.

Blood tests and ultrasound determine the appropriate medication dosage for ovarian stimulation.

A common misconception is that IVF uses eggs destined for future ovulation, potentially causing early menopause.

IVF actually rescues eggs destined for reabsorption, giving them a chance to grow and be fertilized.

The number of 'runners in the race' for ovulation decreases with age, affecting the potential for natural conception.

IVF stimulation maximizes the growth of eggs that would otherwise be lost in the natural cycle.

Transcripts

I'm Dr Leo Doherty a physician here of

Reproductive Medicine Associates of New

Jersey I see patients in the Somerset

and Freehold locations

in vitro fertilization is the process by

which an egg and a sperm meet outside of

the human body in Vivo sort of the

old-fashioned way the sperm will find

its way and Unite with an egg in the

woman's fallopian tube in vitro

fertilization is the process by which

the eggs are removed from the ovaries

and then sperm is either injected

through a process called ixy or

intracytoplasmic sperm injection or

allowed to fertilize through what's

called conventional insemination where

we put a certain number of sperm around

each egg and allow fertilization to take

place in the laboratory environment

essentially the in vitro laboratory is a

very fancy artificial fallopian tube

environment so the interactions that

normally happen in the fallopian tube

happen within the in vitro fertilization

Laboratory

ovarian stimulation typically occurs

every month in a woman's normal

menstrual cycle where the brain tells

the pituitary gland to make two hormones

called FSH follicle stimulating hormone

and LH luteinizing hormone in quantities

that are sufficient to make one egg

develop within the ovary ovulate and be

available for potential fertilization

the ovarian stimulation that we do for

in vitro fertilization involves giving

the same hormones but in higher

concentrations to promote the growth of

multiple eggs once the eggs reach a

certain size just before they would

normally ovulate we do an egg retrieval

procedure to withdraw them from the

women's ovaries under anesthesia

there are methods to improve embryo

selection and one of the one of the

biggest game changers in the field has

been pre-implantation genetic testing

for anupility or pgta that is an embryo

biopsy performed in the laboratory that

allows us to know which embryos do and

do not have the correct number of

chromosomes which is 46 chromosomes this

is revolutionized the field this is

something that we utilize heavily at

Reproductive Medicine Associates of New

Jersey and it has allowed us to have

excellent success rates transferring

less embryos than was historically

needed to achieve good success rates so

by knowing which embryos are

chromosomally normal and and therefore

competent to have a chance to implant

and develop into a pregnancy we can

better select which embryo to transfer

and improve success rates across all

ages the general strategy of IVF which

is make as many embryos as you can

safely and then select the individual

chromosomal normal embryos that are

competent to produce a pregnancy and

transfer those has revolutionized the

field

typically an embryo transfers itself

into the uterus from above through the

fallopian tube when we do an embryo

transfer in the in vitro fertilization

process the embryo is passed in a

catheter through the woman's cervix into

the uterine cavity from below so instead

of coming in from above through the

fallopian tube it's inserted through the

cervix using a catheter so we typically

instruct our patients to arrive with a

full bladder to allow us to use a

trans-abdominal ultrasound probe to

watch the catheter be carefully guided

through the cervix into the endometrial

cavity and then it's actually a very

cool process you can see when we push

the plunger to to eject the embryo into

the uterine cavity we can see a little

flash of fluid on the ultrasound screen

you can see right where the embryo will

hopefully set up shop for the next 38

weeks

we assess individual patients for their

IVF protocol based on the quantity of

eggs within their ovaries each month

women's born with a fixed number of eggs

and gradually over time as she gets uh

less young or older there are less

runners in the race monthly for

ovulation so every month there is a

group of eggs out of the thousands that

are present and the ovaries that could

potentially grow and develop

we are able using blood tests and

ultrasound to determine the number of

follicles in the monthly race for

ovulation and then decide how much of

the FSH and LH medications to use to

maximize the growth in a safe way

one of the most common misconceptions I

hear from patients is that by doing IVF

they're going to use eggs that were

destined for ovulation sometime in the

future and they they may go into

menopause earlier as a result

I always like to talk about the number

of runners in the race for ovulation

each month every month there is a group

of eggs that are destined to either

ovulate or get

reabsorbed and

essentially disintegrate so what we do

in the IVF stimulation process is rescue

the eggs that were destined for

reabsorption and give them a chance to

grow so every month you're going to

either use or lose the runners in the

race and by stimulating the additional

runners in the race that we're not going

to get selected by the women's own

hormones we give them a chance to grow

as well