Some of the awesome photos I have taken over the years can now be seen on Instagram!
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Infertility is a horrible thing that many of my loved ones have had to deal with. After months and months and sometimes years of trying the old fashion way, couples begin to explore different options to get pregnant including fertility drugs, insemination and if all else fails IVF. IVF or in vitro fertilization is the process of fertilization by manually combining an egg and sperm in a laboratory dish. When the IVF procedure is successful, the process is combined with a procedure known as embryo transfer, which involves physically placing the embryo in the uterus. There are five basic steps in the IVF and embryo transfer process.
1. First the woman takes fertility meds. They are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman’s cycles. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries.
2. Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity. The eggs are removed from the ovaries using the needle.
3. Sperm, usually obtained by ejaculation is prepared for combining with the eggs.
4. The sperm and eggs are placed in incubators located in the laboratory. The incubators enable fertilization to occur. Sometimes it is difficult for fertilization to occur and intracytoplasmic sperm injection may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
5. The embryos are usually transferred into the woman’s uterus from one to six days later, but in most cases the transfer occurs between two to three days following egg retrieval. At this stage, the fertilized egg has developed into a two-to-four cell embryo. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb. This process is often guided by ultrasound.
A blood test and potentially an ultrasound will be used to determine if successful implantation and pregnancy have occurred.
The number of embryos that should be created or transferred during any single IVF cycle is subject to debate. Some medical literature states that transferring no more than four embryos per IVF cycle will yield optimal results. Transferring more than four is believed to result in excess numbers of multiple pregnancies, increasing the possibility of additional complications.
Transferring four embryos instead of only one or two increases the probability that pregnancy will occur. However, it is important to realize that all four embryos could implant. This would cause the mother to be pregnant with quadruplets. Suddenly a mother goes from having no baby to having too many babies. Some woman find a quadruplet pregnancy is not possible for them for multiple reasons including socioeconomic costs, medical complications and simply not being able to care for so many babies. In this case the woman would have a procedure called selective reduction or multifetal pregnancy reduction. Multifetal pregnancy reduction (MFPR) is a procedure used to reduce the number of fetuses in a multiple pregnancy, usually to two. When a pregnancy involves three or more fetuses, the risks of miscarriage, stillbirth, and lifelong disability increase with each additional fetus. Because MFPR is a type of abortion, it remains controversial.
The most common method of fetal reduction is transabdominal MFPR. For this procedure, the doctor uses ultrasound as a guide and inserts a needle through the woman’s abdomen and into the uterus to the selected fetus. The doctor injects the fetus with a potassium chloride solution (KCL injection), which stops the fetal heart from beating.
Because it is very small during the first trimester, the dead fetus is usually absorbed by the mother’s body so it is not removed from the womb after the MFPR procedure. This procedure is usually done between 9-12 weeks of pregnancy.
Like any medical procedure, there are risks involved with multifetal pregnancy reduction. One risk of multifetal pregnancy reduction is a miscarriage of the remaining fetuses. Of pregnancies with three, four, or five fetuses, about 5% of pregnancies miscarry after being reduced to twins.But overall the risk of a fetal death is higher for a triplet-or-more pregnancy than after having MFPR.
This is an unfortunate case of the 5% that miscarry after having MFPR. In a case like this, the mother had an IVF procedure transferring 4 embryos. All 4 embryos implanted and the mother was pregnant with quadruplets. The decision was made to have MFPR at 10 weeks to reduce from a quadruplet to a twin pregnancy. A KCL injection was given to 2 fetuses at 10 weeks (first 2 tan-grey smaller babies in photo). These babies died in utero at 10 weeks and remained in the placenta with the 2 remaining live babies. Unfortunately at 18 weeks the remaining twins (last 2 red-pink bigger babies in photo) were miscarried. No baby, too many babies, no babies. Sad story.
Check out this new app for Apple products called Figure 1. This is a great free app with gross photos. Many of my gross images are used in the app. Enjoy!!!
This will be my second year participating in the Philadelphia Science Festival. This year I am doing 2 events, Murder at the Mutter this Friday night, April 26th (http://www.philasciencefestival.org/event/58-murder-at-the-mutter-outbreak) and Discovery Day: Be the Detective this Saturday afternoon, April 27th (http://www.philasciencefestival.org/event/22-discovery-day-be-the-detective). I’m the autopsy expert Come support science and check it out!!!
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