Ovulation Induction

The failure to have any ovulatory cycles or to have very irregular ovulatory cycles is among the most common causes of infertility. In these patients, drugs that induce ovulation, the maturation and release of an egg are used. Ovulation induction involves stimulating the ovary to produce one or more eggs. Throughout the use of ovulation inducing drugs, the patient’s estrogen levels and follicle development are monitored to follow the response of the patient. When the follicles are ready to release their mature egg(s), depending on treatment direction, patients may do either timed intercourse or intrauterine inseminations that coordinate with the release of the egg(s), thus increasing the chance of becoming pregnant.

Intrauterine Insemination

Following intercourse, only a small number of sperm are able to make the long trip from the vaginal entry way to the fallopian tubes where the egg waits to be fertilized. The goal of intrauterine insemination (IUI) is to increase the number of sperm at this site of fertilization.
To accomplish this goal, sperm are first separated from semen and placed in a sterile medium. The sperm are then concentrated in a small volume of medium and are injected directly into the uterus. Because IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract, it is important that tests for male infertility indicate reasonable sperm function and tests of the female patient show adequate ovulation, fallopian tubes, and hormone levels. IUI is often used in conjunction with ovulation induction drugs to enhance the fertilization success rates.

For patients with severe male factor infertility, insemination with donor sperm offers a chance for becoming a parent. Using a licensed and reputable sperm bank, couples can select from a wide variety of carefully screened donors. To meet the wants and needs of their customers, most sperm banks offer a variety of donors from different educational, ethnic, and physical categories. Like IUI with the partner’s sperm, the donor sperm is injected directly into the uterus of the female partner coinciding with her ovulation.

In Vitro Fertilization

In vitro fertilization (IVF) is the process in which sperm and egg are combined in a laboratory setting. This process begins with giving the female patient a series of potent ovulation-inducing drugs to stimulate the .development of numerous eggs. Once the egg-containing follicles are mature, the eggs are removed using a long needle guided by a vaginal ultrasound. The retrieved eggs are then placed in incubators, while the semen sample is collected from the male partner and processed. When the sperm have been prepared and the eggs are mature, the eggs and sperm are placed in petri dishes in the lab to allow for fertilization. If normal fertilization and development occurs, the embryos will be incubated for three to five days and then transferred to the uterus of the female patient. The timing of the transfer and the number of the embryos transferred are determined by the patient’s age, diagnosis, developmental status of the embryos, and in accordance with American Society for Reproductive Medicine guidelines. A pregnancy test can be done 14 days after embryo transfer.

Intracytoplasmic Sperm Injection

Sometimes in IVF, simply mixing the eggs and sperm in a petri dish will not result in fertilization. To by-pass this problem, intracytoplasmic sperm injection (ICSI) can be performed. This procedure involves the direct injection of a single sperm into a mature egg under a high power microscope.Couples with significant decreases in sperm parameters or egg quality may greatly benefit from this procedure.This procedure may also be used in cases where there is a history of previous failed fertilization despite normal sperm testing.

Assisted Hatching

Creating fertilized eggs in the laboratory and then transferring them to the female uterus are only parts of the creation of a successful pregnancy. Once the embryos have been transferred, the developing embryos must be able to hatch out of their shells (zona pellucida) and implant into the uterus. Some eggs, especially those of women ≥ 38 years old, have thicker zona pellucidas and the embryos are unable to hatch out and implant. To assist the developing embryo in its departure from its shell, assisted hatching can be employed. This procedure involves making a small hole in the zona pellucida to allow the embryo to hatch, and therefore have a higher likelihood of implantation. In addition to being used on thick zona pellucidas, assisted hatching can be used with lower-quality embryos that may require assistance in escaping their shells.

Cryopreservation

People who undergo IVF often have more embryos than can be transferred at one time. These embryos can be stored using cryopreservation. The process of cryopreservation involves the freezing and storage of embryos at a very low temperature in liquid nitrogen. While frozen, the embryos remain in a suspended state of development and will not resume development until thawed. When the couple decides to have another chance at pregnancy, the frozen embryos can be thawed and prepared for uterine transfer. While not all embryos survive the freezing and thawing cycle, the majority do survive and can be stored for years before being used.

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Suite 414 Louisville, KY 40207 • 502.897.2144