In Vitro Fertilization (IVF)

In vitro fertilization (IVF) involves fertilization outside the body in an artificial environment. This procedure was first successfully used for infertility in humans in 1977 at Bourne Hall in Cambridge, England. To date, tens of thousands of babies have been delivered worldwide as a result of IVF treatment. Over the years, the procedures to achieve IVF pregnancy have become increasingly simpler, safer and more successful.

To accomplish pregnancy as a result of IVF, several steps are involved:

• Stimulation of the ovary to produce several fertilizable oocytes (eggs)
• Retrieval of the oocytes from the ovary
• Fertilization of the oocytes and culture of the embryos in the IVF Laboratory.
• Placement of the embryos into the uterus for implantation (embryo transfer or ET)

When IVF Might Be An Option

Some of the types of fertility that might be helped with IVF include:

• Absent fallopian tubes or tubal disease that cannot be treated successfully by surgery
• Endometriosis that has not responded to surgical or medical treatment
• A male factor contributing to infertility, in which sperm counts or motility are low but there are enough active sperm to allow fertilization in the laboratory
• Severe male factor in which sperm must be obtained surgically
• Unexplained infertility that has not responded to other treatments
• Infertility secondary to sperm antibodies
• Genetic diseases that result in miscarriage or abnormal births

The UCSF Center for Reproductive Health offers the following procedures in conjunction with IVF:

• Assisted Hatching
• Blastocyst Culturing
• Embryo Co-Culturing
• ICSI

Assisted Hatching

Assisted hatching involves the use of mechanical or chemical thinning of the zone pellucida (outer shell) of the fertilized egg, prior to transfer into the uterus. It is believed that this outer shell becomes thicker and hardened with aging of the oocyte. As such, women of advanced age, or with an elevated FSH level on day 3, may have decreased chance for embryo implantation. The embryos of women with endometriosis and poor quality embryos may also have this problem. The technique of assisted hatching was introduced to enhance the embryos ability to hatch, and thus implant, after transfer.

The technique of assisted hatching involves measuring the thickness of the zona pellucida in embryos that are candidates for the procedure. If an embryo has not initiated the thinning process naturally, a small "window" is created chemically in the wall of the protein coat, using a dilute acidic solution pulsed onto the embryo surface through an extremely fine glass micromanipulation needle. The embryos are then implanted normally into the uterine cavity.

The most extensive experience with assisted hatching has been reported from Cornell University where implantation rates of 25% per embryo are reported, as compared to 18% per embryo with regular IVF in non-assisted cycles.

You may be a candidate for assisted hatching if you are 38 years of age or older, have an elevated basal FSH level, or if you have previously had one or more IVF cycles with failure of your embryos to implant despite otherwise good results.