Behind the scenes of in vitro fertilization

IDAHO FALLS -- Individuals and couples in east Idaho are using reproductive technology to start or grow their families. And one of the methods is in vitro fertilization, which is done outside of the body.

Part of the process is intracellular sperm injection, known as ICSI. That's where a sperm is injected into an egg inside a laboratory.

“The embryologist will spend some time looking for the ones that are the perfectly shaped sperm, and they’ll shoot one sperm right into the middle of each egg,” reproductive endocrinologist Dr. Deirdre Conway says.

EastIdahoNews.com was invited to go behind the scenes at the Idaho Fertility Center lab to watch the ICSI process.

Conway says a majority of her patients undergo less aggressive ways than ICSI to achieve pregnancy. ICSI is used in cases of male factor infertility, or as a way to ensure the success of a fertilized egg through placing the sperm directly inside the egg.

"Maybe the sperm numbers or the quality is really low, so we can assist the process and bypass really severe male factor fertility problems," Conway says.

Before the ICSI process begins, a woman's eggs are retrieved while she is under "mini-anesthesia," Conway says. The retrieval process lasts about 20 minutes.

From there, eggs are taken into the lab, and the embryologist begins work immediately.

“I always teach patients that I’m the first babysitter. I’m the first one to hold their babies and give them a little bath so it’s kind of fun thing to share with them,” embryologist Tina Schuermann says.

With an inverted microscope and on a heated stage, Schuermann moves and holds the mature eggs with a sterile glass pipette.

“They enable us to manipulate the little tiny sperm and the egg,” Schuermann says.

The small pipettes that hover over the egg and sperm dish are controlled by manipulators, which look like joysticks. With one of the pipettes she finds the best sperm and hits it -- at least, that what it looks like through the microscope. What she's actually doing is slowing the sperm down while breaking its membrane, or the sperm's tail. Breaking the membrane is crucial to fertilization.

"If you don’t break that membrane, then the sperm can not fertilize the egg," Schuermann says.

After that, the sperm is picked up through the pipette and moved over to the awaiting egg held by the other pipette. It is then injected through the pipette into the middle of the egg.

The sperm cell is one of the smallest cells in a man's body, relatively the size of a red blood cell says Schuermann. An egg is about 30 times wider.

After the single sperm is injected, the egg is placed in a culture dish and then into an incubator. The next day, it is evident if fertilization was achieved or not.

“Approximately 17 hours later, we look for fertilization," Schuermann says. “Once the sperm fertilized the egg there will be two nuclei -- one from the male DNA and one from the female’s DNA."

She says "70 to 80 percent of what is exposed to sperm or injected with sperm, fertilizes."

After a five- to six-day period in an incubator, each cell will have grown and divided until a blastocyst is formed. The blastocyst contains a large cavity in its middle and will contain at least 125 cells.

Next, the fertilized egg is inserted back into the mother in hopes of it forming into a healthy baby. Extra embryos go through vitrification, or a liquid nitrogen flash freezing process, to be preserved.

“It’s fun when they bring their little ones back, and they were just a little ball of cells under the microscope," Schuermann says. "Then a beautiful baby comes to visit us."