IVF Procedures

Preimplantation genetic testing (PGT) is the general term for genetic testing performed on embryos produced by in vitro fertilization (IVF) before the embryos are transferred to the uterus. The purpose of PGT is to improve the chances of having a successful embryo transfer.

Genetic testing does not impact or change the genetics of an embryo, but it does give doctors and prospective parents more information and may help them select the most viable embryos for transfer.  

There are three types of PGT: PGT for monogenic disorders (PGT-M), PGT for structural chromosomal rearrangements (PGT-SR), and PGT for aneuploidy (PGT-A). PGT-A is the most routine type performed and as such should be understood by prospective parents.

An embryo transfer is usually the final step in the process of in vitro fertilization (IVF), where the embryo is transferred to the patient’s uterus. The embryos used in this procedure may either be fresh or thawed (after being frozen).

During IVF, mature eggs are fertilized, either by conventional IVF (insemination) or intracytoplasmic sperm injection (ICSI), after which the resulting embryos are grown in an incubator in the embryology laboratory. An embryo transfer is the procedure whereby one or more of the embryos that has been grown in the lab setting is then transferred from culture media into the patient’s uterus, in the hopes of initiating a pregnancy.  

Fresh embryo transfers are those in which the embryo was fertilized after the ovarian hyperstimulation and egg retrieval process, then transferred in the same cycle. As such, the embryo has never been frozen.ⁱ

Alternatively, embryos can be frozen and preserved by a process called cryopreservation, and then stored to be transferred in a subsequent cycle. This is known as a frozen embryo transfer (FET) and requires the cryopreserved embryo to be thawed before transferring into the uterus.ⁱⁱ

There has been a significant increase in the number of frozen embryo transfer cycles being performed in the last decade due to better cryopreservation techniques, improvement in embryo culture media, providers choosing the “freeze-all” strategy to avoid ovarian hyperstimulation syndrome, more patients undergoing embryo banking for fertility preservation or family planning, and advancements in preimplantation genetic testing.ⁱⁱⁱ

Menopause is a natural process all women will eventually go through as they reach middle age. During menopause, the ovaries stop releasing eggs, menstrual periods become less frequent and eventually cease, and hormones such as estrogen and progesterone decrease. While menopause marks the end of fertility, there is still a chance to become pregnant during menopause - either naturally or through fertility treatments.

After an egg retrieval for a fresh cycle, or when contemplating a frozen embryo transfer, women often wonder how many embryos should be placed into the uterus. Usually, single embryo transfer (SET) is promoted, especially if an embryo is genetically tested (undergoes pre-implantation genetic testing, PGT). However, there are cases where a patient may want to transfer two or more embryos. Examining the pros and cons of multiple embryo transfer can help women make an informed decision.

Individuals who are transgender or transitioning face unique issues regarding fertility, family building, and fertility preservation. The term transgender describes individuals who do not identify with the sex they were assigned at birth. Gender identity is complex and exists on a spectrum. While some transgender people identify with a gender different than the sex they were assigned at birth (often referred to as genetic or biological sex), others do not identify as either of the traditional binary genders.  

Transgender men are individuals who were assigned female sex at birth but identify as male, while transgender women are those who were assigned male sex at birth and identify as female. Some transgender individuals prefer to be identified only as men/male or women/female, dropping the term transgender. Others prefer the terms trans man or trans woman. In this article we will discuss options for creating a family as a transgender individual as well as for those who are undergoing gender transition, and will use trans or transgender terminology for conciseness even as we recognize the differences in preferred language. We will also discuss pregnancy, the delivery process, and aspects of the postpartum course for these individuals.  

Transgender parenthood is fairly common. According to the U.S. Transgender Population Health Survey, 19 percent of transgender respondents were parents.ⁱ

Chromosomes are made up of DNA and genes that determine multiple aspects of a human’s makeup. Chromosome analyses are often performed in an attempt to give a healthcare provider more insight into a range of issues, from potential genetic conditions to what may be causing recurrent miscarriage. Embryonic and fetal genetic testing may be recommended or pursued for a variety of reasons. Sometimes, individuals or couples have genetic conditions that run in their families, in which case in vitro fertilization (IVF) with preimplantation genetic testing (PGT) can help select embryos that do not carry this condition. In other cases, those attempting to conceive or who have had multiple pregnancy losses may pursue genetic testing of an embryo to help ascertain a cause. Genetic testing can also give an early glimpse into the sex of the fetus as well as whether the fetus has extra/missing chromosomes that could cause conditions such as Down or Turner Syndromes.

This article focuses on sperm retrieval procedures, which are procedures that remove sperm from the testicles for the purpose of fertilizing an oocyte (egg). This may be used for men with no sperm in the ejaculate (azoospermia), but that still produce sperm in the testes.

There are two main types of techniques for surgical sperm retrieval: aspiration and extraction. Sperm aspiration involves using a needle to remove (aspirate) sperm from the epididymis or the testes. Sperm extraction takes a sample of the tissue, known as a biopsy, to collect the sperm. There are also different variations or subtypes of these procedures, as well as non-surgical approaches for those with ejaculation limitations.

For clients going through in vitro fertilization (IVF) or any type of fertility treatment, the associated clinic will build a comprehensive plan to examine all risk factors, health conditions, and reproductive issues that may interfere with the ability to conceive. Much of what is assessed will be associated with the physiological form and function of the reproductive system. The uterine lining is one component of the reproductive system that will be assessed.  

The endometrial lining changes in thickness and appearance in response to the changing hormone levels throughout the menstrual cycle and therefore is used as part of the assessment for how a patient is responding to treatment; as such, it is an important aspect to examine as one part of the reproductive system as a whole.  

In vitro fertilization (IVF) is an assisted reproductive technique where sperm and eggs are combined outside the body, and the resulting embryo or embryos are transferred into a uterus (embryo transfer). Performed at a fertility clinic, IVF can help women conceive if they are having trouble doing so, often after completing other, less invasive fertility interventions. It can also be an option for those without fertility issues, including single women, same-sex couples, and those with certain medical conditions such as cancer.  

IVF can be performed using a woman’s own eggs and her partner’s sperm, or with donor eggs or donor sperm. Embryos from IVF, whether donor embryos or created from a woman’s own eggs and partner’s sperm, may be transferred to either the intended parent’s uterus or into a gestational carrier’s (colloquially referred to as a “surrogate”) uterus.  Sometimes the term “IVF” is used to refer to the process of freezing eggs (oocyte cryopreservation) even if fertilization and creation of embryos does not take place.

With regard to in vitro fertilization (IVF), potential success is highly dependent on being able to retrieve enough high-quality eggs that may subsequently go on to produce healthy embryos. Part of that process involves ovarian stimulation. In some cases, fertility doctors will suggest priming protocols. As patients seeking pregnancy review the various IVF protocols suggested, it is important to understand what priming protocol may be best for them. This includes knowing how these protocols can impact reproductive health, what the protocols are used for, what drugs will be required, and what the success rates are.

Preimplantation genetic testing (PGT) is the general term for genetic testing performed on embryos produced by in vitro fertilization (IVF) before the embryos are transferred to the uterus. The purpose of PGT is to improve the chances of having a successful embryo transfer.

Genetic testing does not impact or change the genetics of an embryo, but it does give doctors and prospective parents more information and may help them select the most viable embryos for transfer.  

There are three types of PGT: PGT for monogenic disorders (PGT-M), PGT for structural chromosomal rearrangements (PGT-SR), and PGT for aneuploidy (PGT-A). PGT-A is the most routine type performed and as such should be understood by prospective parents.

Sperm donation is a process in which a fertile male donates semen (ejaculatory fluid containing sperm) that can be used by an individual or couple wanting to have a baby. An understanding of how sperm donation works, what its success rates are, and why people might opt to use sperm donation are helpful in determining what that type of fertility journey might look like.

Egg donation is a process in which a fertile woman donates her eggs (oocytes) to another individual or couple who want to conceive a baby. There are a number of steps involved in not only the decision to use donor eggs, but then to move forward once that decision has been made. For anyone considering using donor eggs, it is important to understand the details around how egg donation works, how to find an egg donor, and what success looks like in this type of fertility journey.

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Mitochondrial replacement therapy (MRT) is a highly controversial type of therapy used to either prevent genetic disease or support in vitro fertilization (IVF) success when advanced maternal age may be an issue. The therapy is not currently practiced or legal in many countries, including in the United States or Canada, as the practice is considered a very experimental form of genetic modification. Mitochondrial replacement therapy often comes up during online research related to the concept of a “three-person baby.” Several terms are misused in attempting to define mitochondrial replacement, and the procedure itself is often misunderstood. This leads to questions about the idea of a three-person baby, which is technically not an accurate description of mitochondrial replacement therapy.

Conceiving through in vitro fertilization (IVF), or other assisted reproductive technology, is a multifaceted process that involves several steps. Once eggs have been retrieved, successfully fertilized, and the embryos have developed, the embryo transfer procedure is planned by the reproductive endocrinologist (REI, also called RE). IVF embryo transfer processes vary depending on factors that include whether fresh or frozen embryos are used and how many embryos are planned for transfer. Successful embryo implantation into the uterine cavity requires careful planning before the actual transfer procedure itself, and possibly a few lifestyle adjustments for the woman during the weeks immediately following the procedure.

In order to increase the chances of a successful pregnancy, embryo grading is completed by an embryologist during an in vitro fertilization (IVF) cycle. Assessing embryos for quality at specific stages of embryo development can be a valuable tool in reproductive medicine to help the doctor decide which embryo to transfer first (when there is more than one embryo available for transfer). Understanding what takes place during embryo grading is important, in that it can help patients determine what their next steps in the IVF process might be.

Preimplantation genetic testing (PGT) is the general term for genetic testing performed on embryos produced by women undergoing in vitro fertilization (IVF) before transfer to the uterus. PGT aims to improve the chances of having a successful ongoing pregnancy after embryo transfer. While genetic testing does not impact or change the genetics of an embryo, it gives doctors and prospective parents more information and may help them select the most viable embryos for transfer.

A physician may recommend medicated ovulation induction, timed intercourse, intrauterine insemination (IUI), therapeutic donor insemination (TDI), and/or in vitro fertilization (IVF) to assist in becoming pregnant as part of a reproductive medical treatment plan. During treatment, a reproductive endocrinologist (RE) may prescribe ovarian stimulation in order to maximize the number of eggs produced.

Difficulty with conception can at times be traced to issues within the structure of the reproductive tract, such as the shape of the uterus or blocked fallopian tubes. If a doctor suspects that to be the case, a hysterosalpingogram may be recommended. The hysterosalpingogram is a relatively common diagnostic procedure in reproductive medicine, which gives doctors the ability to see how the uterus and fallopian tubes are shaped.