IVF was originally developed in the early 1970s to treat infertility caused by blocked or damaged fallopian tubes. By 1978, the first IVF baby, Louise Brown, was born in the United Kingdom. Since then, the number of IVF procedures performed each year has increased and the success rate has improved significantly. IVF involves several different treatment stages:

Stage One:

Ovarian Stimulation and Monitoring: In order to maximize the patient’s chances for successful fertilization, a patient undergoing IVF usually take hormones in the form of injections to increase the number of eggs produced in a given month. Monitoring is performed to continuously follow a woman’s ovarian response, allowing the physician to adjust and time medication dosage appropriately.

Stage Two:

Ovum Retrieval: With the patient sedated and comfortable, the ova or eggs are retrieved through the vagina under ultrasound guidance.

Stage Three:

Culture and Fertilization: The oocytes are fertilized with sperm from the male partner. At times, the sperm are put down on top of the oocyte. In other cases, especially when there are less than one million living sperm, ICSI or intracytoplasmic sperm injection is used catch a single sperm and inject it directly into the oocyte.

Stage Four:

Embryo Transfer: Either three or four of the best embryos are transferred directly into the uterus and allowed to implant. The remaining healthy embryos may be cryopreserved (frozen) The pregnancy test is performed 11 days after embryo transfer. In a good program with a high quality laboratory, a woman under the age of 40 should become pregnant approximately 50% of the time.

Over the first two decades of experience with in vitro fertilization (IVF), embryos were routinely cultured for two to three days in the laboratory, and then transferred to the uterus. This is quite different than when embryos normally enter the uterus (day 5 or 6). After two or three days of growth inside the body embryos are found in the fallopian tubes and may not be ready to enter the uterus. Recently, laboratory culture conditions have been improved so that embryos can develop to the blastocyst stage in the laboratory, and therefore be replaced into the uterus at the more “natural” time, Day 5 or 6 after fertilization.

The additional benefit of waiting longer to transfer embryos is reducing the number of embryos needed to be transferred to result in a viable pregnancy. By culturing embryos to the blastocyst stage we have more opportunity to choose the healthiest ones for transfer. So, optimal pregnancies rates may be obtained by transferring fewer embryos and reducing multiple pregnancy rates.

The technique of PGD involves the removal and analysis of a limited number of cells from a developing embryo. The analysis of these cells may be performed by fluorescent in situ hybridization (FISH) or polymerase chain reaction (PCR), which allows a geneticist to provide information on the individual embryo’s chromosomal make-up. PGD cases require extended embryo culture (see Blastocyst transfer and culture) to allow for enough time for genetic analysis to be performed. In consultation with the patient’s physician and embryology laboratory, the decision of which embryo(s) and how many embryos to transfer will be made.

Patients requiring egg donation at Manhattan Fertility Center are entered into Reproductive Medicine Associates of New York’s Egg Donation Program. Potential donors are rigorously screened for medical and psychological conditions; because of the stringent eligibility criteria, only a very small percentage of applicants actually qualify to become a donor. Though the process is anonymous and the identity of the donor is never revealed, the egg donation team matches the donor to the recipient with the specific attributes requested by the recipient. Once the donor is matched and is cleared to commence the donation process, she will start her cycle of IVF medication so that several of her eggs mature. The recipient will take separate medication in order to increase the lining of her uterus to help the implantation process. When the eggs of the donor mature, they are aspirated from the sedated donor and taken into the embryology laboratory, where skilled embryologists combine the eggs with the sperm of the partner or a sperm donor. If healthy embryos result, typically one or two are transferred back into the uterus of the recipient several days later while any residual healthy embryos can be frozen for a future IVF cycle.  The recipient then waits 10-14 days to determine if the procedure is successful and she is pregnant.

• who anticipate having children after the age of 35
• who are about to go under medical therapies (i.e. radiation treatment or chemo therapy) and are putting their reproductive abilities at risk, or
• who have a family history of endometriosis, premature ovarian failure, or early menopause.

Oocyte cryopreservation is the process by which a woman’s unfertilized eggs are extracted from her uterus and are frozen at a very low temperature. When the woman becomes ready to attempt pregnancy, a fertility specialist team will slowly thaw her eggs and they will attempt to fertilize it through in vitro fertilization.

RMA of New York announced a breakthrough in a multi-site study sponsored by Extend Fertility whereby it successfully achieved 3 out of 4 pregnancies- a 75% success rate.

Clomiphene is usually prescribed for five days each cycle, usually beginning on day three or five. Of all women treated with clomiphene 60% to 80% will ovulate normally. Nearly 10% of women treated with Clomiphene may experience side mild side effects, including hot flashes, blurred vision, nausea, bloating sensation, and headaches. Serious side effects are rarely seen with clomiphene therapy. The frequency of twins occurring in women who conceive while taking clomiphene has been reported to be as high as 10%. In addition, new studies suggest that long-term use of clomiphene for more than 12 cycles may place patients at an increased risk of developing ovarian cancer.

A number of studies have confirmed a significantly improved pregnancy rate with injectable medications that stimulate “superovulation”. This improvement in pregnancy rate is due primarily to the increased number of eggs produced. “Fertility drugs,” including Pergonal, Humegon, Metrodin, Gonal-F, and Follistim are administered beginning on the second or third cycle day and given for six to nine consecutive days. Response to these drugs is monitored by frequent vaginal ultrasounds and blood estrogen determinations. At a time in the cycle when the ovarian follicles reach a designated size, and estrogen levels are appropriate, an injection of the hormone HCG is given to trigger ovulation. Ovulation usually occurs 36-48 hours after the HCG injection. Thus, intercourse or insemination should be timed accordingly.

Performing intrauterine insemination may result in an increase in the number of sperm at the site of fertilization in the fallopian tube. Generally only 1 of 2000 sperm ejaculated into the vagina make can later be found in the fallopian tube. Therefore, adding insemination to stimulated cycles may further improve the pregnancy rate. A possible side effect of the injectable fertility drugs is ovarian hyperstimulation, a condition in which the ovaries are tender and enlarged. In severe cases, a woman may have swelling from retaining excessive amounts of body fluid in the tissues. Fortunately, severe hyperstimulation is rare, occurring in less than one percent of treatment cycles.