IVF Laboratory

Assisted Reproductive Technologies (ART) refers collectively to the various procedures and techniques involving the laboratory handling of human oocytes (eggs), sperm, and/or embryos. ART offers new hope to infertile couples who may have been considered untreatable, or for those who have not responded to traditional medical treatment.

Infertility treatment is rapidly evolving, nowhere more so than here in the Stanford Fertility and Reproductive Medicine Center or SFRMC. Although ART procedures generally follow the steps described below, no single approach is exactly the same for each person. Your health care team will discuss every option and every step with you in great detail. They will also discuss current success rates as may apply to your specific situation.

In general, ART procedures include these steps:

1. Ovarian stimulation
2. Egg retrieval
3. Fertilization
4. Transfer

Ovarian Stimulation and Egg Retrieval

Women with normal ovarian function usually produce one egg per month. To increase the number of mature eggs available for fertilization, the ovaries are stimulated with carefully regulated hormone doses, administered by injection. Your physician will monitor your response to these hormonal preparations and track follicular development through ultrasound scans and blood tests.

Ovulation is triggered with hormone injections. Once the follicles mature, your physician will retrieve as many eggs as possible. With the patient under conscious sedation or light anesthesia, the physician uses vaginal ultrasound to direct a needle through the vaginal wall to aspirate mature follicles from the ovary.

Fertilization and Transfer

The fertilization of eggs and transfer of embryos can be accomplished by several means. The following descriptions are complete as of the publishing of this Web page.

In vitro fertilization (IVF) involves ovarian stimulation and egg retrieval. Shortly before egg retrieval, a semen sample is collected. The retrieved eggs are placed in a laboratory dish with the motile sperm, where fertilization takes place. The fertilized eggs develop from 3 to 5 days in a special culture medium in a controlled environment, and are then transferred to the woman's uterus for potential implantation and embryo development.

Intracytoplasmic sperm injection (ICSI) is an effective treatment for male infertility. Following egg retrieval, a single sperm is injected into each egg. It is also possible to aspirate sperm directly from the epididymus or testicles, thereby making ICSI an option for men who have had vasectomies or men with congenital absence of the vas deferens.

Assisted hatching involves laboratory manipulation of the embryo to create an opening in its outer covering (zona pellucida). This technique may increase the chance of implantation, especially in reproductively older women.

Blastocyst transfer (BT) is a technique introduced here at Stanford in 1998 by our embryologists and physicians. As with IVF, the eggs are retrieved from stimulated ovaries, fertilized, and allowed to develop for 2-3 days in cleavage medium. The embryos are then transferred to blastocyst medium for 2 additional days before being transferred to the woman's uterus.

During those crucial days, the embryos undergo key developmental changes that help to determine which are most likely to survive. The extra days also allow for further enrichment of the uterine lining, increasing the chances for successful implantation. Physicians transfer fewer embryos, called blastocysts at this stage, thereby reducing the chance for multiple births. Success rates for blastocyst transfer are encouraging.

Cryopreservation allows surplus embryos to be stored for later use. In addition, if the uterine lining is not suitable for implantation in a stimulated cycle, cryopreservation allows transfer during a different menstrual cycle. Women facing medical procedures affecting fertility can also use cryopreservation to bank embryos for the future.

The donor oocyte (egg) program offers hope for women with difficulty in egg production or whose eggs carry a genetic defect. Click here to access information about our egg donation program, as well as our Oocyte Donor Personal History form.

Preimplantation Genetic Diagnosis (PGD) is designed for patients requiring genetic screening of embryos. It can be used to detect whole chromosome abnormalities such as those leading to Down's Syndrome or recurrent miscarriage. PGD can also be used to detect single gene disorders, for example: cystic fibrosis, thalassemia, anemias, etc. Specific applications should be discussed with your physician and genetic counselor. Click here for links to several genetics laboratories.  Click here to see our list of genetics laboratories.

Our laboratory is accredited by the College of American Pathologists and the American Association of Bioanalysts. We have a California tissue bank license and are registered with the Food and Drug Administration.
 

Standard IVF Lab Procedures

	Oocyte immediately after retrieval
	Fertilized oocytes showing two nuclei
	Day-2 embryo at the four cell stage
	Day-3 embryo at the eight cell stage
	Day-5 blastocyst
	Blastocyst  hatching in preparation for implantation
	Fully hatched blastocyst

ICSI and PGD

	Metaphase II oocyte prepared for ICSI
	Injection of a Metaphase II oocyte
	Biopsy of a Day-3 embryo for PGD