Infertility and Reproductive Endocrinology

Infertility and Reproductive Endocrinology

In Vitro Fertilization (IVF)

The Fertility Institute of Virginia’s In Vitro Fertilization (IVF) is the largest in central Virginia. Since its inception in 1991, we have performed thousands of IVF procedures. We are always available to discuss with you and your partner the medical, emotional, and financial aspects of IVF. It is our greatest hope that your IVF experience with us will be a pleasant and successful one.

IVF is the process in which a woman’s oocytes (eggs) are mixed with your partner’s sperm outside the body. The recommended number and healthiest embryos are transferred back to you usually 3 or 5 days later. While no two IVF cycles are exactly alike, the process generally does involve the same basic steps.

Ovarian stimulation – IVF is a more successful process if the woman can produce multiple oocytes. To achieve this goal, she is placed on a regimen of daily injections of medication (gonadotropins) to stimulate the ovaries to produce oocytes. While on these medications, she will be monitored a number of times in our office with ultrasound to look at the developing egg follicles  and blood work to check hormone levels. When it appears that the egg follicles are an appropriate, mature size, she is given an injection of human chorionic gonadotropin (hCG) to trigger the final maturation of the oocytes and prepare for oocyte retrieval.

Oocyte retrieval – This is the process in which the oocytes are removed for fertilization with your partner’s sperm. The process is done at our outpatient IVF facility. The process is done under conscious sedation anesthesia by a certified anesthetist to ensure your comfort and safety. Under vaginal ultrasound guidance using a special device, your doctor will insert a needle into the egg follicles and remove the eggs. The process generally takes between 30 – 60 minutes.

Fertilization – After removal, the oocytes will be incubated for a period of time and then mixed with your partner’s sperm in the IVF laboratory to achieve fertilization. The day following the oocyte retrieval we will know how many of the oocytes have fertilized normally. The technical laboratory aspects of IVF are complex, and we are fortunate to have a talented embryology staff with decades of IVF experience. (Our laboratory director Dennis Matt, Ph.D., has even been given the responsibility of auditing other programs’ IVF laboratories around the country to make sure they are maintaining high quality.)

Embryo transfer – The transfer of embryos can occur 3 days following the egg retrieval when the embryos are at the 6 – 8 cell stage, or 5 days following the egg retrieval when the embryos are at the more advanced blastocyst stage. If embryos are transferred at day 3 instead of day 5 (or day 5 instead of day 3 for that matter) it only means that your physician believes that this is the best time to do the transfer in your case. You and your physician will discuss the best day to transfer the embryos and the number of embryos to transfer. Except for special circumstances, the number of embryos transferred generally follows the published guidelines of the American Society for Reproductive Medicine.

The embryo transfer almost never requires anesthesia, but you will be given a mild sedative to relax you. You generally are encouraged to have a full bladder for the transfer. A speculum is inserted into the vagina, and using abdominal ultrasound guidance, a soft plastic catheter is inserted through the cervix and the embryos are deposited into the uterus. You will rest at the IVF laboratory for approximately 30 minutes and then take it easy at home for a few days. Progesterone supplementation is given to help improve the lining of the uterus and assist with implantation. Approximately 2 weeks after the oocyte retrieval, you will be instructed about how to get a blood pregnancy test.

Intracytoplasmic Sperm Injection (ICSI) – In certain circumstances it may be determined that simply mixing oocytes and sperm outside the body will not achieve fertilization and creation of embryos. In these instances, ICSI is utilized in which a single sperm is injected into the oocyte using a special needle. The most common indication for ICSI is a sperm issue, but the process may be utilized with unexplained infertility, suspected egg problems, a history of failed fertilization with IVF in the past, or low oocyte number. Nationally, about 70% of IVF procedures are performed with ICSI and this statistic is accurate for our program as well.

Testicular Sperm Extraction (TESE) – In situations where a man has extremely low sperm counts or no sperm in the ejaculate (such as having a vasectomy or failed vasectomy reversal) it may be possible for a urologist to perform a testicular biopsy and to retrieve immature sperm that can be used for IVF with ICSI. At the Fertility Institute of Virginia we work with a number of urologists who can perform the TESE procedure, and our embryology staff is available to work in conjunction to make sure that sperm are present in the biopsy and processed appropriately.

Assisted Hatching – This process is generally performed when embryos are transferred 3 days after retrieval. Hatching is performed by creating a hole in the outer membrane (zona pellucida) of the embryo using an acid solution or laser just prior to transfer. It is theorized that this process helps the growing embryos emerge from their outer covering and implant in the uterus. Many scientific studies have supported the benefits of assisted hatching.

Embryo Cryopreservation – The freezing of embryos has tremendously added to the success of IVF, and we are fortunate to have a very successful embryo cryopreservation program. Since more embryos are often created than will be transferred to the uterus during a fresh cycle, embryo cryopreservation (or freezing) allows couples the opportunity to have multiple embryo transfers following a single retrieval of oocytes. The transfer of previously cryopreserved embryos can occur years following a successful IVF pregnancy or a few menstrual cycles following unsuccessful IVF. A frozen embryo cycle generally requires less medication and monitoring than a fresh IVF cycle does. We are proud that our success rates with frozen embryo transfers are consistently much higher than the national average.

Oocyte Cryopreservation – Unlike embryo cryopreservation which has been performed for decades, the cryopreservation of oocytes (eggs) is a relatively new process. Candidates for oocyte freezing are generally young patients without a partner who need to freeze their eggs because of a medical condition that might affect their eggs in the near future (such a planned radiation or chemotherapy for cancer or some other serious medical condition). While some may consider this process experimental, we have achieved pregnancies and deliveries using oocytes that have previously been cryopreserved.

Oocyte Donation – Many times a couple cannot conceive because the woman is not producing healthy oocytes. As women mature, the quantity and quality of their oocytes decrease. Some women have diminished ovarian reserve and cannot produce healthy oocytes though they are relatively young. Other women have had their ovaries surgically removed or the ovaries are not surgically accessible to retrieve eggs. Some women have had repetitive IVF failure of unknown cause. In these situations donated oocytes may be used to allow a couple to achieve pregnancy.

The donor egg process involves retrieving oocytes from a donor, fertilizing the oocytes with sperm from the recipient’s partner, and transferring embryos to the recipient. It is necessary to synchronize the recipient’s cycle with that of the donor using medication so the recipient’s uterus is receptive to the transferred embryos.

An oocyte donor may be a non-anonymous family member, a friend of the recipient, or an anonymous woman from our egg donor program. Donors are screened using all of the guidelines of the American Society of Reproductive Medicine (ASRM) and the Federal Drug Administration (FDA). Couples review detailed profiles of the donors in making their selection of which donor they wish to utilize.

The success rate of having a live birth following the use of oocyte donation is the highest of all IVF procedures performed.

Embryo Donation – Some couples who have completed their family with IVF and have frozen embryos remaining elect to donate their embryos to another couple. Embryo donation may allow certain couples an opportunity to achieve pregnancy when other methods have been unsuccessful.

Preimplantation Genetic Diagnosis (PGD) – PGD is a process in which embryos are screened for specific genetic diseases or chromosomal abnormalities prior to transfer into the uterus. The process involves removing a single cell from the each embryo, having the cells analyzed for certain defects, and then only transferring embryos that have tested normally using the PGD technique. Candidates for PGD include couples who are genetic carriers for a specific genetic disease, couples who have had a previous child affected with a genetic disease, couples in which one partner has a known chromosomal issue like a balanced translocation, women with a history or recurrent miscarriage, and couples who have experienced multiple IVF failures.

PGD is the most sophisticated and technologically advanced process in the field of assisted reproductive treatments. The Fertility Institute of Virginia is proud to work with the Reproductive Genetics Institute in Chicago, a world leader in this highly sophisticated procedure.

Shared IVF Success Program

The success of IVF has greatly improved over the years and the Fertility Institute of Virginia is proud to have success rates that consistently well exceed the national average. However we do understand that IVF is not successful with every attempt and that the process can be both emotionally and financially stressful.

For these reasons, the Fertility Institute of Virginia and the Virginia IVF and Andrology Center offer a “Shared IVF Success Program.” For a more complete description of this program, please visit the Virginia IVF and Andrology Center.

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Location & Office Hours
10710 Midlothian Turnpike, Suite 331
Richmond, VA 23235
(804) 379-9000