Assisted Reproductive Program In-Vitro Fertilization (IVF), Direct Sperm Injection (ICSI), G.I.F.T., Cryopreservation

Spectrum Health East’s (formerly Blodgett Memorial Medical Center) program for In-Vitro Fertilization opened in July of 1983 with the addition of the GIFT Program in 1987, and Cryopreservation in 1991. These have been approved by the hospital Board of Trustees and the Intuitional Review Committee. The latter also periodically reviews the ethical standards under which the program functions. The IVF/GIFT team involves a number of qualified people, including physicians, PhD's. nurses, and technicians. The program is under the direction of Douglas C. Daly, MD. who is a board certified specialist in Reproductive Endocrinology. The program is for married couples who have a long-standing problem with infertility which cannot be resolved with the more traditional forms of therapy.

IVF PROTOCOL

IVF is indicated for patients with tubal disease, malefactor infertility, and unexplained infertility. It may also be used for endometriosis and ovulation problems. For a spontaneous pregnancy to occur, an egg (oocyte) has to be released from the ovary (ovulation) and united with the sperm that have been deposited in the vagina and transported up into the tubes. Normally this union (fertilization) occurs inside the fallopian tube within a few hours of the eggs release from the ovary. The fertilized egg (zygote) resides in the tube for about 4 days before being  transported to the uterus. The embryo then hatches and implants into the endometrium.

However, in IVF,  union occurs in the laboratory after the egg and sperm have been collected from the wife and husband. Before the treatment cycle, it is important to ascertain the husband’s fertility. If the sperm function is poor, the couple may benefit from Inter Cytoplasmic Sperm Injection (ICSI) to ensure fertilization.

1. Controlling the female cycle by stimulating and monitoring the development of follicles in the ovary.

2. Collecting ripe eggs (pre-ovulatory oocytes) from follicles in the wife’s ovaries.

3. Collecting and preparing sperm obtained by ejaculation from the husband.

4. Incubating the eggs and sperm together in the laboratory enabling fertilization and embryo growth to occur.

5. Transferring the embryo(s) (pre-implantation embryos) into the wife’s womb (uterus).

Fertility drugs will be prescribed for the woman to control the time of egg release and to increase the chance of collecting more than one egg. Her hormone levels will be checked by periodic blood samples to determine that egg development is progressing satisfactorily. She also will have periodic ultrasound scans of her ovaries to determine follicle number and size. Using the above information, the physician will determine how much medication will be used and when to give the injection of hCG to prepare eggs for collection. Egg retrieval is scheduled approximately 36 hours after the injection of hCG.

Eggs for IVF are retrieved by ultrasound-directed needle aspiration utilizing local anesthetic and IV sedation, The egg in its fluid, is then taken to the laboratory, where the technician removes it and puts it in a specially prepared and tested fluid (culture media). The egg is incubated in the culture media for several hours to allow it to complete its maturation. The husband’s semen, which is obtained by masturbation, is specially prepared to condition the sperm for insemination. The motile sperm are then added to the culture media containing the egg. The sperm and egg are placed in the incubator to allow fertilization to take place. The egg is evaluated at regular intervals to assure that fertilization and cell division (cleavage) have taken place. The egg is now called a "preimplantation embryo" or pre-embryo. If the embryo has developed satisfactorily, it is placed in the woman’s uterus about two days after the retrieval. This procedure is similar to a pelvic exam. A speculum is placed in the vagina to visualize the cervix. A small teflon tube is passed through the cervical canal into the uterus and the pre-embryos are then inserted through the tube. This is usually painless. The patient is then asked to rest for two hours before returning home. The transfer will be followed up by blood tests to see if the embryo has attached to the wall of the uterus (implantation), and if the pregnancy is progressing.

ICSI involves direct injection of sperm into the oocyte and may be indicated when sperm number is low and quality is poor. When the only problem is poor sperm function, IVF with ICSI can achieve a 50% pregnancy rate. ICSI can be done with either fresh or frozen sperm from ejaculated semen or a testicular biopsy.

A delivery rate up to 50% can be obtained in good prognosis patients. Success rate is dependent on the patients age, cause, duration of infertility, and embryo quality. Counseling regarding a patients individual prognosis will be done at the time of your initial consultation. Multiple pregnancies can occur with IVF. It is our program goal to minimize the occurrence of multiple pregnancies.

Many people are astonished to realize that human reproduction is a relatively inefficient process. In normal and healthy couples who are trying to get pregnant, approximately 60 eggs will be fertilized and implanted for every 100 exposed cycles. Of those 60 "pregnancies", approximately 25 will be lost before the first expected menstrual period. Not having a missed or delayed period, the woman does not even realize that an early pregnancy has been lost. Other confirmed pregnancies are lost later as early spontaneous abortions. About 25% of ovulations make it to viability. As a result of this early embryonic loss, under normal circumstances a normal healthy couple has a 1 in 4 chance of having a viable pregnancy each month. It is good to keep these figures in mind as one considers the prognosis for in-vitro fertilization.

G.I.F.T. is a technique developed to achieve pregnancies in couples who have not been able to conceive using standard treatments for infertility. A problem in determining the cause of infertility has been the inability to determine if the sperm and egg meet. It may be that in some cases of unexplained infertility conception does not occur because either the egg or the sperm does not arrive in the fallopian tube.

G.I.F.T. stands for Gamate (sperm and eggs), IntraFallopian Transfer whereby the male’s sperm and female’s eggs are placed separately into a catheter and injected directly into the woman’s Fallopian tubes at the conclusion of the laparoscopic retrieval of the eggs. Fertilization then occurs in the woman’s body, not in the laboratory as with In Vitro Fertilization. The fertilized egg would then continue down the fallopian tube and into the uterus for implantation.

We thank you for your interest in the IVF/GIFT Programs at Spectrum Health East. If you are interested in becoming a patient in this program, please contact Grand Rapids Fertility & P/F, P.C., at (616) 774-2030 or 1-800-695-5941.

Medical insurance that provides coverage for "Infertility Evaluation and/or Treatment" may cover portions of the expenses. The fee schedule enclosed covers costs of the drugs, laboratory, hospital and professional expenses. We will assist you in billing for insurance coverage for reimbursement.

• Payment for the consultation and other necessary services is expected at the time of first visit.

• Any additional infertility screening studies that are needed will be billed at the regular rate.

IVF/GIFT FEES

PRICES EFFECTIVE JANUARY 2007
(Subject to change without notice)

IVF cycle preparation fees (selected insurances may cover these fees)

IVF procedure fees - oocyte retrieval and basic IVF lab