In Vitro Fertilisation (IVF)
Most couples are advised to try in vitro fertilization (IVF). IVF was originally designed for women with absent, blocked or damaged fallopian tubes. However, today it is used for a variety of other fertility problems. Couples see it as a set program of treatment with a conclusion, whereas holistic therapies such as Chinese medicine can be open-ended as the time it takes to work varies from person to person. In addition, IVF offers a solution to treatment without the need to change the couple's lifestyle or diet too much. However, there is a certain amount of illusion to its success, as there is unjustified enthusiasm for treatment on the part of both patients and doctors.
IVF is essential a numbers game. Ideally, an IVF cycle will want to produce around a dozen good quality eggs at retrieval. More than a dozen will dilute the quality of the eggs, as there is only so much of your body's resources to go around, like spreading butter thinly on a large piece of toast. More than a dozen eggs could lead to hyperstimulation (OHSS), which is a
serious problem. Less than a dozen collected generally means a physical deficiency of some type, i.e. blood, yin, jing or qi. The day an egg is put back in can affect the success of the IVF cycle. A fertilized egg is put back in from 1-5 days. Around 30% of eggs on day 3 don't live to day 5, so transferring a day 5 fertilized embryo, a blastocyst, greatly improves success rates, as it's stronger and more likely to be viable.
Generally, each follicle contains one egg. However, in some rare instances a follicle may contain two eggs or none at all. A woman's response to fertility drugs is monitored using ultrasound scans to measure the number and size of the eggs, whilst blood tests are taken to measure oestradiol levels. The rate at which women are checked to see how they are responding varies from clinic to clinic, from everyday to once a week. The frequency of checks depends upon the doctors and the clinic.
During stimulation it is recommended to have acupuncture twice a week to encourage the eggs to grow and be of good quality. Once a dominant follicle reaches between 15-20mm in size, an injection of hCG or LH is given, known as the 'trigger' drug which mimics the natural process of egg maturation making them ready for fertilization.
Some IVF clinics will want women to start taking progesterone from egg collection, whilst other IVF clinics tell women to take it from implantation. Personally, I believe taking progesterone from implantation is better as it allows time for the progesterone to work and send more blood to the uterus lining.
The eggs are collected (harvested) vaginally with assistance of an ultrasound under general or local sedation using an aspiration needle attached to a probe. This part of IVF is the most uncomfortable for a woman. Most clinics will provide pain relief medication. Research has shown that having acupuncture during this process reduces pain levels. Fertilization then takes place in the petra dish with the sperm, which may have been treated according to the sperm condition. It is difficult to predict the number of eggs that will be collected even though ultrasounds may show a certain number of follicles as not all of them can actually be collected.
Day 1 of an embryo's life is the day after the eggs are collected, not the actual day of collection. The number of days left in-vitro depends on the amount of eggs collected. The more the eggs, the longer they will be left in-vitro and the more likely the fertilized embryos will make it to a day 5 blastocyst, which is ideal. Most IVF clinics will not kept them in-vitro for more than 6-7 days. The point at which an IVF clinic will leave them to grow from day 3 to day 5 varies from clinic to clinic.
Some want at least 3 embryos on day 3 to allow them to go onto day 5, whilst other clinics want more than 3 embryos on day 3. A number of eggs will die off, hence the need for numbers. However, it's not just a numbers game, it's also about quality and this is where IVF clinics fall down as they cannot increase the quality of the eggs collected.
The quality of the eggs is based on the woman's underlying health over the last 120 days as this is the time it takes for an egg to grow from start to finish. Improving your health through diet, lifestyle and the taking of Chinese herbs can improve egg quality.
The fertilized embryo is generally transferred from 2-6 days after they were collected. As a general rule, the longer the embryo is left in-vitro and allowed to grow, the better the success of the cycle. Only one out of three embryos collected go on to be transferred back into the woman. If there aren't many fertilized embryos left after day 2-3, i.e. only 2-3, it's best to put them back into the uterus. However, if there are more i.e. 4+ around day 3, then it's best to let them carry on growing until 1 or 2 grow into a blastocyst.
The blastocysts are then selected over the other embryos for transfer. Blastocyst embryos have a much higher success rate of implanting and growing into a fetus than a smaller celled embryo, called a morula. Once the embryo(s) has been transferred, they should implant over the next 1-2 days. The others can then be left to continue growing and if they reach blastocyst they can be frozen for future cycles.
Implantation is broken down into 3 stages; apposition (positioning), adhesion and invasion. It involves a complex sequence of recognition signaling events between the embryo and the primed and receptive uterus wall. This interchange of signaling at the cellular level between the embryo and the womb lining, science is still trying to understand. Implantation only takes place during the limited 'implantation window', a restricted period of endometrial receptivity spanning, between days 20 and 24 of a regular menstrual cycle.
This 'implantation window' can be tested using an endometrial receptibility array (ERA test) test, which is generally offered during a donor or frozen cycle. This test takes a biopsy of the woman's womb lining and tests for a certain gene that may or may not be present. This helps to determine the optimal time for implantation when the lining of the uterus is at its most receptive. This helps to increase implantation and pregnancy rates.
A cytokine, leukemia inhibitory factor (LIF), is vital for implantation. It is produced by the Th2 cytokine IL-4. Women with a lack of LIF cannot facilitate implantation. Acupuncture has been shown to increase the gland development and levels of LIF, thereby improving implantation. Stress has been shown to affect implantation. Stress causes an increase in activated T cells (Natural Killer cells and cytokines), which then prevent successful implantation. Acupuncture has been shown to reduce stress levels, which then regulate levels of activated T cells, thereby benefiting implantation.
To prepare for your embryo transfer, you can warm up your uterus prior to having the transfer using a hot water bottle or heated beany bag. This increases the blood flow to the uterus thereby warming it and thickening the uterus lining ready for implantation. Once you've had your embryos put back in, you should not put any heat on your abdomen or even have a hot bath or go swimming, as being submerged in warm water may cause the embryo to become dislodged from the uterus wall. This is the same principle as Chinese medicine, in that heat (yang) causes things to move.
Please note that I do not offer IVF and this page is for information purposes only. I do however offer acupuncture to assist with the IVF process.