Superstar singer Celine Dion is no longer pregnant. In an interview with Canadian paper Journal de Montreal, husband Rene Angelil says: “We are living the reality of the majority of couples who have to use [IVF]. The process can be long and arduous, but today, we are full of confidence. Celine is more determined than ever.” The couple had reported in August that the singer, age 41, was in the early stages of a pregnancy using in vitro fertilization of an embryo that had been frozen for eight years.
What is IVF?
In vitro fertilization (known as IVF) was first used in 1978 when the first “test tube baby,” Louise Brown, was born. It refers to a procedure used in some women with infertility problems. Eggs and sperm are mixed together outside of the body (in vitro) and the resulting fertilized egg, now called a zygote, is implanted into the uterus to continue the pregnancy.
There are five steps in the IVF treatment cycle.
1. Ovarian stimulation. This step involves the use of ovulation, or fertility, drugs. These hormones, taken over a period of eight to 14 days, stimulate a woman’s ovaries to produce several eggs per menstrual cycle instead of one. Successful IVF usually requires the fertilization of multiple eggs — some may not fertilize or develop normally after fertilization.
2. Egg retrieval. Once the eggs are deemed ready for retrieval, the doctor performs a transvaginal ultrasound aspiration. This is a simple surgical procedure that uses a small amount of anesthesia, such as a mild sedative. Once the ultrasound locates the mature follicles in the ovary, the doctor inserts a needle into the follicles and removes the eggs with suction. If the ultrasound can’t find or access the ovaries, doctors might have to perform laparoscopic surgery. This technique — in which doctors cut a small incision in the abdomen and locate the ovaries with a tiny fiber-optic lens — is still simple and short, but it requires stronger anesthesia.
3. Insemination. After retrieval, doctors examine the eggs and decide which of them hold the most potential for a successful pregnancy. They place these eggs in an IVF culture medium to await insemination. Meanwhile, they separate the father’s sperm from his semen. The most motile sperm (the “best swimmers”) are then added to the eggs in the incubator.
4. Fertilization and embryo culture. Usually within a matter of hours, a sperm cell penetrates an egg and fertilizes it. A two- to four-cell embryo appears approximately two days after fertilization. On the third day, a six- to 10-cell embryo is seen. Embryos can be placed in the uterus as early as one day and as late as six days after fertilization. In most cases, they’re observed for two to three days to determine if the development is normal.
5. Embryo transfer. About two to three days after fertilization, the resulting embryo or embryos are transferred to the woman’s uterus. Doctors suspend them in a drop of fluid and draw it into a transfer catheter — a long, thin, flexible tube that has a syringe on one end. They then guide the catheter into the vagina, past the cervix and into the uterus. The patient is encouraged to remain in a resting position for an hour or two to prevent any stress on the body. If the embryo or embryos do attach to the uterine wall, a positive pregnancy test will result.
The success rate, i.e. the chance of having a live birth, varies from infertility center to center, and also varies according to maternal age. The live-birth rate is highest for 27 year-olds, at about 40%, and decreases to about 25% for women at age 37 and older. The main complication of IVF is multiple pregnancy, as more than one embryo is frequently implanted at embryo transfer. Multiple pregnancies have increased risk of pregnancy loss, maternal complications, prematurity and neonatal illness with the potential for long term damage.
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In vitro fertilization