In vitro fertilization
Candidates for vitro fertilization (IVF) are women with disease of the oviducts, unexplained infertility, or endometriosis (occurrence of endometrial tissue outside the endometrial cavity, a condition that reduces fertility), and those whose male partners are infertile (e.g., low sperm count). Follicular development is induced with one or a combination of GnRH analogs, clomiphene, recombinant FSH, and Menopausal gonadotropins (a combination of LH and FSH). Follicular growth is monitored by measuring serum estradiol concentration and by ultrasound imaging of the developing follicles. When the leading follicle is 16 to 17 mm in diameter and/or the estradiol level is greater the 300 pn/mL, hCG is injected to mimic an LH surge and induced final follicular maturation, including maturation of the oocyte. Approximately, 34 to 36 hours later, oocytes are retrieved from the larger follicles by aspiration using laparoscopy or a transvaginal approach. Oocyte maturity is judged from the morphology of the cumulus (granulose) cells and the presence of the germinal vesicle and first polar body. The mature oocytes are then placed culture media.
The donor’s sperm are prepared by washing, centrifuging, and collecting those that are most motile. About 1000,000 spermatozoa are added for each oocyte. After 24 hours, the eggs are examined for the presence of two pronuclei (male and female). Embryos are grown to the four-to eight- cell stage; about 60 to 70 hours after their retrieval form the follicles. Approximately three embryos are often deposited in the uterine lumen in order to increase the chance for a successful pregnancy. To ensure a receptive endometrium, daily progesterone administrations begin on the day of retrieval. A successful pregnancy rate of 15 to 25% has been reported by many groups, which compares favorably with that of natural human pregnancy.
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