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Medical Edge Newspaper Column from Mayo Clinic

HOW TO PICK AN IN VITRO FERTILIZATION CLINIC

DEAR MAYO CLINIC: Is in vitro fertilization considered experimental? Is it regulated? How can a couple know which centers do the best job? — Detroit

ANSWER: No, IVF is not experimental. It has been successfully used for more than 20 years. And yes, it is regulated — and you are wise to seek out centers that have excellent compliance records with federal regulations.

Couples evaluating IVF programs should ask doctors the questions below. Answers to these questions are public information required by the 1992 Fertility and Clinic Success Rate and Certification Act. Data from the estimated 370 U.S. fertility clinics are reported to the Centers for Disease Control, and can be viewed online at www.cdc.gov/nccdphp/drh/art.htm.

Are the physicians board certified?
Who is the IVF laboratory director, and what are his or her qualifications?
Is the IVF laboratory certified?
What are your pregnancy and delivery rates?
How many embryos do you implant to get that rate?
What is your multiple-pregnancy rate?
What is your success rate when using frozen embryos?

Briefly, here are the steps involved in in-vitro fertilization:

Superovulation: The woman is prescribed fertility drugs for nine to 12 days, causing her ovary to prepare more than one egg-bearing follicle. Once the follicles reach the proper size, the woman is given a hormone injection that will start the release of the mature eggs.
Egg retrieval: Thirty-six to 38 hours after the hormone injection, the eggs are retrieved through a minor transvaginal procedure. They are carefully sucked into a special tube, examined under the microscope and put into an incubator. On the average, 10 to 12 eggs are collected.
Semen collection. The man provides the sperm-containing semen the same day the woman’s eggs are retrieved. The semen is then analyzed.
Fertilization. In standard insemination, a prescribed quantity of sperm is added — usually 100,000 sperm per milliliter — to a Petri dish containing eggs, and they “swim” together. Over the next 18 hours, fertilization occurs to create embryos.
Incubated embryo growth. The embryos grow by cell division for the next 48 to 72 hours in the incubator. When an embryo is four to eight cells in size, it’s ready to be transferred into the mother’s body.
Embryo transfer. This is usually done two or three days following egg retrieval, on an outpatient basis. Using a tube, doctors insert and deposit the embryos in the uterus.
Finally, there is a wait of 12 to 14 days before blood tests can confirm a pregnancy.

— Anita Singh, M.D., reproductive endocrinologist, Mayo Clinic, Scottsdale, Ariz.

Additional Resources:
Treatment of Infertility
Appointment Information
Infertility Information

DEAR MAYO CLINIC: My doctor says I should be evaluated for coronary artery blockages. What does that mean, and what sort of tests should I have? — Montana

ANSWER: Coronary arteries are small blood vessels that encircle the heart like a crown — hence the name “coronary” (Latin for “crown”). When they are blocked, the heart is “starved” of oxygen. It has to pump harder to meet the body’s demand for oxygen. Under this stress, the heart cannot keep up with the demand. If the narrowing completely blocks blood flow, a heart attack may result.

Tests such as an electrocardiogram (EKG) and an exercise tolerance test can help diagnose coronary artery disease. The EKG records the electrical activity in the heart, and can therefore show if there has been heart damage. The exercise test measures the heart’s ability to meet the body’s demand for oxygen. Sometimes a chemical is used to stress the heart instead of exercise.

An angiogram is essential in pinpointing blockages. During an angiogram, a catheter — a tiny hose — is placed in the femoral artery in the groin and guided up to the heart. Then contrast dye is injected into the coronary arteries so that they will show up on X-ray pictures. In patients with coronary artery disease, the angiogram shows a narrowed “tube.” This is the diseased artery.

— David Holmes, M.D., Cardiovascular Diseases; Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Coronary Artery Disease
Appointment Information
More Information on Coronary Artery Disease

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.