In vitro fertilization (IVF) and gamete intrafallopian
transfer (GIFT) are technical and complex procedures used
in the treatment of infertility. Each procedure has its
advantages and disadvantages, which are discussed in detail
during the course of each patient's evaluation.
IVF is now used as a first line treatment for
many conditions including moderate to severe damage
of the fallopian tubes, cases of advanced female age,
and moderate to severe male factor. Even though IVF is a
first line treatment, it will be required by less than 10%
of patients.
GIFT is rarely used because it requires placement
of the gametes (egg and sperm) in the end of the fallopian
tube, which requires a laparoscopy. This makes GIFT a more
expensive procedure and the success rates are no better.
GIFT is used when a couples religious values dictate that
fertilization must occur "inside the body".
Patients undergoing assisted reproductive technology
(ART) procedures receive daily injections of follicle
stimulating hormone (FSH) to stimulate the growth of
many follicles each of which contains an egg. More eggs
are needed because some are invariably damaged when handled
during the ART procedure.
 Patients
usually administer FSH subcutaneously at home.
Lupron is also administered to prevent premature
ovulation, which could result in the "loss" of
a stimulation cycle. It is necessary to come to our office
during the stimulation for ultrasound
and estradiol measurements. Dosage adjustments are made
based upon the results for these tests.
Once the eggs are mature, an injection of hCG
is given to complete maturation of the egg (s). The body
does not differentiate between hCG and luteinizing hormone
(LH). LH is the hormone that stimulates ovulation in a normal
menstrual cycle.
Sometimes a woman's eggs will not mature and
fertilize due to factors such as reduced ovarian reserve
due to age or other conditions. These patients are candidates
for our donor egg program, which is discussed in the "Donor
Egg" section of our Web site.
Approximately 36 hours after the hCG injection,
the eggs will be retrieved, usually by transvaginal guided
needle aspiration, or rarely by laparoscopic retrieval.
With GIFT, the eggs and sperm will be transferred into the
fallopian tube, and any extra eggs could be fertilized for
embryo cryopreservation (freezing) for use in a future cycle.
In an IVF cycle, the eggs are fertilized and
placed in an incubator until mature and ready for transfer,
usually three to five days. Again, extra embryos could be cryopreserved
for future use.
Sometimes micromanipulation procedures such
as intracytoplasmic
sperm injection (ICSI) are need, especially in cases
of moderate to severe male factor infertility. If ICSI is
performed, a single sperm will be injected into each egg
prior to placing them in the incubator.
Assisted Hatching is another procedure that
can be used for previous failure of fertilization, advanced
maternal age, or in other select groups of patients. In
assisted hatching, a small "hole" is made in the
membrane surrounding the embryo using acid Tyrode's solution,
a small needle, or a laser. This does not harm the embryos
and sometimes helps them "break out of their shell"
and attach to the uterine lining.
 After
the embryo transfer patients' activities are restricted
for a period of time. There will be restrictions on activities
such as intercourse, aerobics, and strenuous activities.
All ART patients receive in depth education
on their procedures from our nursing staff and Dr. Cooper.
We do this using reading material, consultations, and personal
contact with the staff.
IVF patients coming from other programs
should send their records from previous physicians. It is
best if we receive these records prior to the first visit.
However, patients are seen without these records but it
sometimes delays the treatment process.
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