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Embryo Development: What Happens After My Egg Retrieval?

Day 0 – FIRM physicians refer to retrieval day as day O of embryo development. Before leaving the recovery area, your FIRM doctor will give you the final egg count. Several hours later an embryologist in the IVF lab will inseminate the eggs. Insemination can be accomplished by standard insemination or by ICSI (shown below). Standard insemination involves placing washed sperm with an egg into the culture dish. ICSI, a more involved process, requires that the embryologist insert the sperm into the egg using a specialized needle and a microscope. After insemination, the eggs are placed back into the incubator to allow time for fertilization to occur. Your FIRM doctor will review with you the method to be used for insemination prior to your IVF cycle. However, on occasion, the results of the semen analysis on the day of the retrieval may necessitate ICSI be done, which your FIRM physician would discuss with you in that event. Continue reading

Understanding Miscarriages

Miscarriages are pregnancies that stop developing. Development stops at different times and for different reasons. The great majority of miscarriages are early occurring before 10 weeks due to a genetically/chromosomally abnormal conceptus – the result of an abnormal egg or sperm fertilization.  Most often it is an abnormal egg because the egg is much older than sperm.  Women are born with a certain number of eggs, they never make any more eggs their entire life.  Eggs accumulate genetic/chromosomal errors as a function of time.  Continue reading

Egg Freezing for Fertility Preservation

Fertility preservation offers couples or individuals the opportunity to preserve their ability to have children in the future. For some women a medical reason, such as cancer treatment, may lead them to seek fertility preservation. For others, the reason is personal such as to defer childbearing or to pursue a chosen career path.  Continue reading

The Menstrual Cycle

Throughout recorded history, there have been many superstitious beliefs with regards to menstruation. If a woman does not have a regular, monthly period there are typically a handful of reasons why. The focus of this blog is to help patients understand the normal menstrual cycle.

A normal menstrual cycle typically occurs every 24-35 days. It is divided into two phases, the follicular phase when an egg grows inside a follicle and the luteal phase when the follicle becomes a corpus luteum and makes progesterone. The end of the follicular phase and beginning of the luteal phase is marked by ovulation. Continue reading

Embryo Adoption – made simple

There are thousands of cryopreserved embryos being stored at IVF clinics throughout the world.  These embryos are for the most part leftover from successful cycles. Couples may come back to use these embryos, continue to store them, discard them or put them up for adoption.  At the Florida Institute for Reproductive Medicine we strongly encourage couples who have completed their family to consider adoption.  Embryo adoption is an ideal option for many couples, particularly those with severe egg or sperm factors.  Costs to do donor embryo IVF are typically much less than donor egg in vitro fertilization and can be comparable to donor sperm insemination given the differences in fecundity. Continue reading

Stimulation protocols for low response patients rationale

Women are born with a certain number of eggs, they never make any more eggs their entire life.  At the time of puberty when women start menstruating they have lost over 90% of their eggs having a few hundred thousand remaining.  Each month with menses a group of eggs start to develop, only one of which goes on to ovulate.  If multiple eggs develop a multiple pregnancy can occur. The remaining eggs that do not mature form scars in the ovary.  The whole cohort of eggs is lost each month.  Being on birth control pills does not prevent this programmed loss of eggs.  As the eggs get older they accumulate genetic/chromosomal errors in response to different environmental insults, i.e., free radicals, alcohol, caffeine, tobacco, chemotherapeutic drugs and other toxins.  As a result of the decreased number and quality of eggs fertility rates decrease over time.  At age 35 fertility rates drop significantly, by age 40 rates drop drastically.  The great majority of women older than 42 will require donor eggs to achieve healthy ongoing pregnancies.

Since the very first IVF pregnancy there have been countless different stimulation protocols to try and get women to produce more and better quality eggs.  In my reproductive medicine career spanning almost 30 years, I have reviewed at least 30 different protocols none of which have ever been shown to significantly improve the number and quality of eggs.  The only medication that has some evidence supporting a benefit to egg quality has been growth hormone, and this is questionable.  Because we have not been able to significantly improve egg number and quality in the low response patient, the stimulation strategy has changed over the last several years to stimulating patients with the least costly option, i.e. low dose gonadotropin protocols or even oral medications.  While there is a cost rational for this, in these patients it is critical to get as many eggs as possible. For that reason, in most cases, I will stimulate the patient with a high dose protocol to try and get every egg that is coming along to develop.  In the case of repeated IVF failures in the low response patient, the only real solution is that of either donor egg or donor embryo IVF whereby younger, healthier eggs are used.

Kevin L. Winslow, M.D.
Director for Florida Institute for Reproductive Medicine

Evaluating the infertility patient’s uterus

In terms of evaluating the endometrial cavity, the site of embryo implantation, direct inspection via a hysteroscope offers the most precise information.  It also allows us to treat any pathology, i.e., adhesions, polyps, fibroids or a uterine septum.  Hysteroscopy gives us information regarding the opening of the fallopian tubes, but does not give us any information regarding the remainder of the tubes.

Hysterosalpingogram (HSG) performed by the injection of a contrast dye into the uterine cavity will detect filling defects, but does not tell us what the pathology is.  Hysterosalpingogram also allows us to assess whether the fallopian tubes are patent, as contrast dye can be seen filling and exiting the tubes.  By examining the course of the fallopian tube we can get an idea as to whether there may be paratubal adhesions, i.e. the tube is often convoluted with poor dispersion of the dye throughout the pelvis.  When the fallopian tube is not a concern sono-hysterosalpingogram can be performed, an office procedure whereby sterile saline is injected into the endometrial cavity and an ultrasound is performed.  This technique is more sensitive in detecting endometrial pathology than a regular hysterosalpingogram, but again does not tell us what the pathology is and does not allow for corrections.  Sono-HSG is often the screening procedure of choice when the fallopian tubes are known to be patent or have been removed.  Will all three diagnostic procedures there is a low chance of infection.  The risk of this is significantly higher if the fallopian tubes are blocked.  Prophylactic antibiotics are often recommended if tube status is unknown.

Kevin L. Winslow, M.D.
Director for Florida Institute for Reproductive Medicine

The 4 commonly asked questions about IVF

Q: Am I going to go through menopause early?

A: No. Each month when you get a period a group of eggs starts to develop. The brain only makes enough fertility hormones that one (rarely two or three, eggs develop hence twins and triplets), but you still lose that whole cohort of eggs coming along that month.

Q: Is there an increased risk of birth defects associated with in vitro fertilization?

A: For the most part, no. We are not changing the wife’s eggs, we are not changing the husband’s sperm, we are simply allowing sperm and egg to unite. So, in general, there is not an increased risk of genetic/congenital anomalies. The exception to this is in cases of very severe male factor (typically counts 2 million or less), i.e., some of these males will have a genetic reason why their counts are so low and pass these genes on. There is a slightly increased risk of congenital anomalies associated with babies born from IVF, this is felt largely due to the increased incidence of multiple pregnancies as a result of transferring more than one embryo.

Q: What to do with our remaining cryopreserved embryos?

A: There are three or potentially four options for embryo disposition.

You can continue to store the embryos and use these to establish another pregnancy. Frequently couples change their mind after 2-3 years and come back wanting another child. The great majority of couples end up using all of their cryopreserved embryos.

Embryos can be donated to the donor embryo adoption program. There are many couples who embryo adoption is an ideal way to start their family. The Florida Institute for Reproductive Medicine has one of the busiest donor embryo programs in the country.

Embryos can be thawed and discarded.

Some couples have opted to donate embryos for stem cell research.

Q: Is IVF painful?

A: IVF fertility shots are given by subcutaneous injections, (very small needle), they are usually described as painful. As eggs develop the capsule of the ovary gets more and more distended, some individuals feel this, they usually describe this as a pressure sensation.  Egg retrieval is done under IV sedation, liquid valium makes you very sleepy, you are given a narcotic so that you do not feel pain. If the patient was feeling pain, they would be moving and we would not be able to retrieve their eggs.

What is Vitrification for egg and embryo freezing?

Vitrification also known as the instant freezing technique has replaced the old slow freeze technology for both egg and embryo freezing. Vitrification has greatly improved egg/embryo thaw survival rates as well as increased embryo implantation rates. Vitrification has been so advantageous that most programs now are freezing all day 5/day 6 embryos and transferring them in a subsequent cryo cycle where estrogen and progesterone levels mimic those of nature. This technique has been associated with higher pregnancy rates, higher birth weights (almost a pound) and a lower incidence of ovarian hyperstimulation syndrome. If you are considering an IVF program make sure they are using the vitrification freezing technique for both eggs and embryos.

Kevin L. Winslow, M.D.
Director for Florida Institute for Reproductive Medicine

FIRM is one of the few programs in the country providing IVF care throughout the year

The Florida Institute for Reproductive Medicine is one of the few programs in the country providing IVF care throughout the year. Most programs batch their IVF cycles in series for program convenience – patients often have work and vacation conflicts with these cycles.   Spreading out our IVF cycles throughout the year not only facilitates patient convenience, but also allows our embryologists to spend more time on each case. When embryologists have several cases to do in a single day there is an increased chance for mistakes. The Florida Institute for Reproductive Medicine has five board certified reproductive medicine specialists, five doctoral level embryologists and a team of ten IVF nurses that allow us to provide IVF care throughout the year on your schedule.

Kevin L. Winslow, M.D.
Director for Florida Institute for Reproductive Medicine

Florida Institute for Reproductive Medicine proudly serving patients in North Florida and South Georgia including Savannah, Columbus, Jacksonville, Jacksonville Beach, Orange Park, St. Marys, Palm Coast, St. Augustine, Palatka, Lake City, Tallahassee, Daytona, Ponte Vedra, Gainesville, Orlando, Melbourne, Ormond Beach, New Smyrna, Port Orange, Brunswick, St. Simons Island, Thomasville, Tifton, Albany, Brunswick, Valdosta and Dothan Alabama.

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