Reproductive Treatments

Fertility treatments are options for couples that are unable to conceive or that wish to preserve their fertility potentials. Possible fertility treatments include intrauterine insemination (with or without Clomid or injectable fertility drugs), IVF, egg donation, surrogacy, frozen embryo transfer (FET), ICSI, preimplantation genetic diagnosis, assisted hatching, and cryopreservation of oocytes (eggs), embryos, and sperm.

If you want to learn more about these services, contact us at our Valencia, Beverly Hills, or Burbank office.

During your initial consultation with Dr. Najmabadi the two of you will discuss your case, diagnosis and treatment options available, in detail. Outlined below are various treatment options. To learn more about each, please read on:

Low Tech Reproductive Treatments

Low-tech reproductive treatments include fertility drugs, intrauterine insemination, and ovulation induction.

We will review with you all treatments and testing that will need to be done in preparation for your cycle. Both you and your partner will need to have a few blood tests (HIV 1+2, HTLV I, Hep BsAg, Hep C ab, RPR). The male partner or sperm donor will need to provide a semen sample for analysis (semen analysis). Once the evaluation is complete, you will be able to start your treatment cycle based on your menstrual cycle. We understand that you are anxious to begin treatment and we will make every effort to get you started right away. We will try to simplify the process and walk you through it one step at a time, as it is important that you understand the various steps.

Treatment is initiated with your menstrual period (menses). You are asked to call on the first day of your menses to schedule an ultrasound within the first three days of your period. Prior to starting the treatment cycle, you will meet with the doctor and nurse, they will review the medication schedule to make sure that you are familiar with the drugs and the methods of administration. If there are no significant cysts on your ovaries, you will be able to begin a cycle. Once the treatment is started you will be coming to the office periodically for monitoring of your response to the medications. At each visit you will have an ultrasound and together we will evaluate your progress.

Artificial Insemination

Artificial insemination (AI) involves collecting and processing semen and placing it directly into the woman's vagina, cervical canal, or uterine cavity. Sperm may be from the husband, male partner (AIH), or from a donor (DI). The reasons for using artificial insemination include both male and female factors. Male factors include Abnormal Semen analysis (low count, motility, or % normal morphology), impotence, sexual dysfunction, and retrograde ejaculation. Female factors include hormonal deficiencies, sexual dysfunction and congenital abnormalities of the vagina and cervix.

In most cases, AIH is performed by intrauterine insemination (IUI), where the semen is placed into the uterus through a catheter. In order to increase the number of eggs available, IUI is usually used in combination with controlled ovarian hyperstimulation. AIH can also be performed with cryopreserved sperm that was supplied prior to radiation or chemotherapy for cancer. Sperm is collected and stored in liquid nitrogen and is thawed when the couple is ready for insemination.

In order to ensure safety, sperm should only be used for donor insemination after appropriate testing, cryopreservation, and quarantine.

Donor Insemination

Donor insemination (DI) is most often used for:

• Couples with a severe male factor where other alternatives are not possible or acceptable
• Single women who wish to achieve pregnancy
• Same sex couples that wish to conceive
• Couples that wish to avoid paternal disease transmission

Intrauterine Insemination

If it is decided that an intrauterine insemination (IUI) is appropriate for you and you decide to proceed with treatment, Dr. Najmabadi will help you plan your IUI cycle. There are different types of IUI cycles: an un-medicated IUI, an IUI with the addition of Clomid (CC) and an IUI that utilizes a combination of injectable medications (hMG). There are many steps involved in this process, but try not to become too overwhelmed, that's why we are here. Together, we will discuss what you can expect throughout the treatment process.

Intrauterine insemination (IUI) is a fertility treatment in which washed sperm are placed directly into the uterus. Intrauterine insemination bypasses the cervix and improves the delivery of sperm to the egg, thereby increasing the chances of pregnancy.

A semen sample is provided one to two hours before intrauterine insemination is to be performed. Intrauterine insemination can be performed with the partner's sperm or with donor sperm. The semen is then washed (sperm is separated from the seminal fluid) and the sperm quality is analyzed. Now it is ready to be inseminated, which only takes a few minutes and causes little to no discomfort.

During the intrauterine insemination procedure, a small catheter is inserted into the uterine cavity and the sperm is injected directly into the uterus. The patient should be able to resume normal activity immediately after the intrauterine insemination procedure. If the intrauterine insemination is unsuccessful, it may be repeated during the following cycles.

When is Intrauterine Insemination Recommended?

Intrauterine insemination is often recommended for couples that have been trying to conceive for at least one year with no explanation for their infertility. Intrauterine insemination may also be recommended for any of the following:

• A low sperm count (but no less then 10 million/ml)
• While going through a Clomid cycle (Clomid/IUI)
• When being treated with injectable fertility drugs (hMG or FSH/IUI)
• Bad sperm mobility
• Same sex couples
• Single women
• When donor sperm is used
• The couple has been diagnosed with sexual dysfunction
• Cervix conditions, such as cervical mucus that is too thick

If you believe that intrauterine insemination may be an option for you, contact our Valencia, Beverly Hills, or Burbank office today.

Ovulation Induction

Ovulation induction is frequently used as an adjunct to IUI. Ovulation induction uses medications to stimulate the development of one or more mature follicles in the ovaries. This is a good option for women who do not regularly develop mature follicles, or for patients who do ovulate but want to improve their odds of getting pregnant by releasing more than one mature egg (super ovulation). We use a variety of fertility medications in our offices, including Clomid (CC), hMG, and hCG.

CC/IUI

If Clomid is used for your IUI cycle, you will be asked to start your Clomid pills on day 3-5 of your menstrual cycle and then on a daily basis for 5 days. Clomid allows your ovaries to develop a greater number of eggs, increasing your chances of getting pregnant during each cycle. You will return to the office, usually on the last day of your pills, and then every other day until your IUI is completed. You will have an ultrasound and your progress will be evaluated at each visit.

Once your ultrasound indicates that it is time for us to inseminate (IUI), we will ask you to administer an injection of hCG. This medication will allow a timelier IUI coinciding with the time of eggs being released from the ovaries. This increases the chance of getting pregnant by placing the sperm in the uterus within a two to four hour window of egg release from the ovary. To accomplish this, after the hCG injection, you will be scheduled to return to the office within 34 to 36 hours for an IUI. Your male partner or donor's sperm will be needed on this date.

hMG/IUI

hMG/IUI is very similar to the CC/IUI (see above) however; you will be utilizing an injectable medication (hMG) for your IUI cycle. You will be asked to start your injections on day 3 of your menstrual cycle and continue on a daily basis for 5 days. hMG works in a similar manner to Clomid, but is more aggressive, causing your ovaries to develop a greater number of eggs, thereby increasing your chances of getting pregnant during each cycle. You will be returning to the office every other day until your IUI is completed for an ultrasound and an ongoing evaluation of your progress at each visit.

After your IUI you may be asked to start progesterone supplementation until the confirmatory pregnancy tests are done 10 to 12 days later. If we are blessed with a positive pregnancy test, you will need to continue the progesterone for the first 11 to 12 weeks of pregnancy. The pregnancy test will be done 10 to 12 days after the IUI.

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Reproductive Surgery

Reproductive surgery, such as tubal reversal, hysteroscopy, and laparoscopy, is a method to repair disorders that affect a woman’s reproductive health.

Minimally Invasive Surgery - Diagnostic Laparoscopy

During laparoscopy at our Valencia, Beverly Hills, or Burbank office, a telescope-like instrument is inserted into the abdomen through a small incision so the doctor can visualize the abdominal cavity. During the procedure, the surgeon asks himself several questions, including:

• Do the tubes pass dye easily without becoming swollen?
• Is the tubal wall structure normal?
• Is there evidence of scar tissue?
• Does the tube appear normal, and does it make contact with the ovary?
• Are there adhesions between the tube and the ovary?
• Is there evidence of endometriosis?

Tubal Reversal

Tubal ligation, or “tube tying,” is a common form of contraception; however, life circumstances change, and many women wish to become pregnant again. Fortunately, tubal reversal surgery can help a woman regain her fertility and gives her the chance of achieving the pregnancy she desires.

Tubal reversal can be performed through laparoscopy (placing a small scope through the naval) or through a small incision (mini-laparotomy) just above the pubic bone. In most cases, a laparoscopy is done first to evaluate the tubes’ reversibility. If the conditions of the tubes are appropriate, the tubal reversal will be performed by laparoscopy. If not, a small incision is made just above the bikini line and the separated ends of the fallopian tubes are rejoined with fine suture material. The tubal reversal procedure takes two to three hours and can performed under general anesthesia. Most patients are able to return to normal activities within two weeks of the tubal reversal procedure.

There are several factors that determine the success of the tubal reversal surgery, including the length and health of the fallopian tube sections to be rejoined, the woman’s age at the time of tubal reversal, and pelvic scar tissue.

There are risks associated with every surgery, and tubal reversal is no exception. Complications of the tubal reversal surgery include bleeding, infection, or damage to surrounding organs. However, these risks are extremely rare, and most patients are satisfied with the procedure. In addition, it is important to note that the risk of ectopic pregnancy, or tubal pregnancy, increases from 1 in 100 to 5 in 100 pregnancies after tubal reversal.

If you have had tubal ligation and now wish to become pregnant again, contact us in Beverly Hills, Valencia, or Burbank today to learn more about tubal reversal and how it can help you.

Tubal Cannulation

Tubal canalization offers a realistic chance of pregnancy for women who have proximal blockage, especially if the rest of the tube is normal.

During tubal canalization at our Valencia, Beverly Hills, and Burbank offices, a small guide wire and catheter are passed through the uterus into the fallopian tubes to eliminate blockages. Anti-inflammatory medications, such as Motrin or Naproxen, are taken prior to the procedure to reduce cramping and discomfort, and antibiotics are taken to minimize the chance of infection.

Ultrasound Procedures

Ultrasounds are diagnostic tools that use sound waves to generate images of internal body structures. High frequency sound waves are used during the ultrasound procedure, so no radiation is involved. We offer two different ultrasound methods at our Beverly Hills, Valencia, and Burbank offices: abdominal and transvaginal.

Abdominal Ultrasound

During the abdominal ultrasound, a special probe is covered with a water-soluble jelly and rolled over the patient's abdomen. The abdominal ultrasound method provides a good view of the pelvis, but structures deep inside the pelvis, such as the ovarian follicles and the endometrium, are difficult to evaluate accurately. The abdominal ultrasound procedure might involve minor discomfort because you need to have a full bladder during the examination.

Transvaginal Ultrasound

During the transvaginal ultrasound, a specially designed ultrasound transducer is inserted into the vagina. Transvaginal ultrasound offers a clearer image and a more accurate picture of the ovaries and uterine lining because the transducer is closer to the pelvic structures. In general, this technique is the method of choice for evaluating the pelvis because it offers better accuracy and is usually more comfortable than the abdominal technique because the bladder can be empty.

Ultrasounds have several uses in infertility and reproductive endocrinology, including:

• Viewing the uterus. When the bladder is empty, the uterus is the largest structure visible in the pelvis. Abnormalities, such as fibroids, can be identified, and the endometrium can be evaluated.
• Viewing the fallopian tubes and ovaries. Ultrasounds can identify abnormal cysts on the ovaries, which may indicate endometriosis or polycystic ovarian disease. In general, normal functioning fallopian tubes are not visible.
• Menstrual cycle monitoring. Ultrasounds can monitor changes in both the ovaries and the endometrium throughout the menstrual cycle. The egg itself is not visible on the ultrasound, but the surrounding follicle is easily seen. In addition, changes in the endometrium can be measured throughout your menstrual cycle.
• Ovulation monitoring and egg retrieval. Ultrasounds can monitor your response to medication during ovulation induction by following the growth and maturation of egg-bearing follicles. Eggs (oocytes) can then be retrieved using an ultrasound-guided needle.
• Monitoring the pregnancy. The presence of a gestational sac can be confirmed within the uterus 18 to 25 days following oocyte retrieval or ovulation, and fetal heart motion can be seen approximately 28 to 32 days post ovulation. In addition, multiple pregnancies can be identified with ultrasound, and ectopic pregnancies can be detected early so we can effectively and safely provide the appropriate treatment.

High Tech Reproductive Treatment - Assisted Reproductive Technology (ART)

High tech reproductive treatments include, but are not limited to, IVF, egg donation, and surrogacy. Learn more below.

IVF- In vitro fertilization

In vitro fertilization (IVF) is a method of assisted reproductive technology (ART) in which the woman’s egg (oocyte) is removed and joined with a man's sperm in a laboratory test tube, where fertilization occurs. The resulting embryo is implanted into the woman’s uterus to develop naturally.

Learn more about IVF at our Beverly Hills, Valencia, and Burbank offices by visiting the IVF page of our website.

ICSI - Intracytoplasmic sperm injection

Intracytoplasmic sperm injection ( ICSI) is a micromanipulation procedure that has revolutionized the treatment of male factor infertility. ICSI can be used to treat a variety of male infertility disorders, such as low sperm counts (oligospermia), low sperm motility (asthenospermia), or abnormally-shaped sperm (teratospermia).

Learn more about intracytoplasmic sperm injection ( ICSI) at our Beverly Hills, Valencia, and Burbank offices, by visiting the IVF page of our website.

Preimplantation Genetic Diagnosis (PDG)

Preimplantation genetic diagnosis (PGD) is a procedure that can identify some genetic defects within an embryo before it is transferred into the uterus. The preimplantation genetic diagnosis procedure begins with the normal IVF process.

Learn more about preimplantation genetic diagnosis (PGD) at our Beverly Hills, Valencia, and Burbank offices, by visiting the IVF page of our website.

Assisted Hatching

Assisted hatching is a procedure in which a hole is made in the zona pellucida to help improve the chances of implantation. The assisted hatching procedure is performed chemically, with a microscopic needle, or with a laser. During the assisted hatching procedure, either a small hole is made in the zona, or the zona is thinned using a micromanipulation method. The embryos are then transferred into the uterus.

Learn more about assisted hatching at our Beverly Hills, Valencia, and Burbank offices, by visiting the IVF page of our website.

Blastocyst Transfer

Embryos are usually transferred to the uterus on the third day after follicle aspiration, when the fertilized eggs that have divided are between six and eight cells. At this stage we would transfer between three to five embryos, based on the patient's age, rate of cell division, and egg quality.

In the past few years, the standard of care is moving toward transferring embryos on day five, with the embryos at more than 130 cells. This is the called the blastocyst stage. A blastocyst is an embryo that has developed for five days after fertilization and has divided into two different cell types. The embryos that survive to day five of development are usually strong and healthy, and typically offer a greater chance of implantation into the uterine wall. At the blastocyst stage (day five), we usually transfer two embryos, which leads to a lower multiple pregnancy rate (if there are more than two embryos, remaining blastocysts may be cryopreserved for future use). Blastocyst transfers can also improve pregnancy rates in specific cases, but not all cases.

Frozen Embryo Transfer

When more eggs are retrieved than needed, we can freeze them for future use (cryopreservation). Embryos can be frozen at any stage between day one and day six after egg retrieval and can be stored for up to five years. We offer frozen embryo transfer at our Valencia, Beverly Hills, and Burbank offices to allow you the chance of conception when the time is right for you.

The frozen embryo transfer process is less invasive than standard egg collection. Frozen embryo transfer can be done during your natural cycle, or we may need to control your cycle with medication depending on whether we can monitor the time of your natural ovulation. The embryos are placed into your uterus at the time of ovulation and the when the thickness of the endometrium (lining of your uterus) is right.

Before the frozen embryo transfer can be performed, your embryos will need to be thawed so the age of the embryos corresponds to the age of your uterine lining. The timing of frozen embryo transfer usually depends on the stage at which the embryos were frozen.

Not all embryos survive the cryopreservation process. Before the frozen embryo transfer, we will evaluate your embryos to make sure they are ready for transfer. If they are, then the frozen embryo transfer can go forward.

The embryo transfer is usually performed two days after ovulation. During the procedure a catheter is inserted through the cervix and the embryos are placed injected into the uterus. The frozen embryo transfer usually takes about 15 minutes.

The success rate of frozen embryo transfer is almost as successful as standard IVF. Success depends on several factors, including the number and quality of embryos, your age, and the cause of infertility.

If you are considering fertility treatments and want to learn more about frozen embryo transfer, contact us in Valencia, Beverly Hills, or Burbank today.

Cryopreservation

Cryopreservation is a common addition to IVF. The aim of cryopreservation is to preserve fertilized dividing embryos or unfertilized eggs (oocytes) for use in the future.

Learn more about cryopreservation at our Beverly Hills, Valencia, and Burbank offices, by visiting the IVF page of our website.

Egg Donation

Egg donation is a process by which eggs (oocytes) from another person (usually between the ages of 20-30) are fertilized with sperm and transferred into the uterus of the patient who is trying to conceive. This is usually done for women over the age of 40 or patients with poor ovarian reserve.

Learn more about egg donation at our Beverly Hills, Valencia, and Burbank offices, by visiting the egg donation page of our website.

Surrogacy

Surrogacy is an option for couples that are unable to conceive on their own because of congenital absence of a uterus (patient born without a uterus), or someone who has lost her uterus to cancer, abnormal bleeding, fibroids or endometriosis. Others may not be able to carry a child because of an anatomical problem with the uterus, incompetent cervix, or a medical condition which puts the life and health of the mother at risk. There are two types of surrogacy -traditional surrogacy and gestational surrogacy.

Traditional Surrogacy

With traditional surrogacy, the surrogate provides the egg and the intended father provides the sperm. Therefore, the child is genetically related to both the surrogate mother and the intended father or anonymous donor. The surrogate then carries the pregnancy to term. and hands the baby over after it is born. When the baby is born, the surrogate turns the baby over to the intended parent or parents and signs away all parental rights.

Gestational Surrogacy

Gestational surrogacy is a good option for women who do not have a functional uterus or who are unable to carry a pregnancy. Gestational surrogacy is distinguished from traditional surrogacy by the fact that the surrogate has no biological relationship to the child.

The first step in the gestational surrogacy process is to undergo in vitro fertilization (IVF) to produce an embryo that is biologically yours (you can also use donated eggs, sperm, or embryos if you are unable to produce an embryo). The embryo is placed in the uterus of the gestational carrier, who will carry the baby to term. When the baby is born, the gestational carrier turns the baby over to you the intended parent or parents and signs away all parental rights.

The gestational carrier can be a friend or relative, or she can be anonymous. All gestational carrier candidates are thoroughly screened with physical examinations, psychological testing, family medical history, physical examination, and review of past medical, gynecological, and obstetrical records.

Surrogacy can be a very emotional and possibly complicated process; however, the potential outcome is the baby you have always dreamed of. If you are unable to conceive and want to learn more about our surrogacy program, contact our Beverly Hills, Valencia, or Burbank office to schedule an appointment.

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