In Vitro Fertilization

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

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 (from the vagina)
- 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)

What Types of Infertility Might Be Helped by IVF? 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. Unexplained infertility that has not responded to other treatments. Infertility secondary to sperm antibodies. Due to the high success of IVF and intrauterine embryo transfer, GIFT (Gamete Intra Fallopian Transfer) and ZIFT (Zygote Intrafallopian Transfer) techniques are rarely used in current practice. Intracytoplasmic Sperm Injection (ICSI) is a relatively new micromanipulation technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous in vitro fertilization attempt. The technique involves very precise maneuvers to pick up a single live sperm and inject it directly into the center of a human egg. The procedure overcomes many of the barriers to fertilization and allows couples with little hope to achieve a successful pregnancy. At Yale the ICSI procedure was first used in 1994 and the first successful birth was achieved in 1995.

The ICSI Process

ICSI is a tool available in the IVF laboratory to achieve fertilization. The initial steps in preparation for ICSI are the same as for IVF:
- Stimulation of the ovary to produce several fertilizable oocytes (eggs)
- Retrieval of the oocytes from the ovary (through the vagina
- Fertilization of mature oocytes with ICSI
- Placement of the embryos into the uterus for implantation (embryo transfer or ET)

Fertilization by ICSI means that the micromanipulation specialist picks up the single live sperm in a glass needle and injects it directly into the egg.