In-vitro Fertilization (IVF)

Infertility affects 6.1 million American women and their partners (American Society of Reproductive Medicine). That comes to about 10 percent of the reproductive age population! Luckily, treatments such as in vitro fertilization (IVF) have opened the door for couples that have failed to conceive with conventional methods. IVF is a fertility treatment that can help make the dream of a family a reality. Since its development, IVF has assisted in the creation of countless families across the world.

What Is IVF?

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.

In vitro fertilization was successfully used for the first time in the United States in 1981. Since then, more than 100,000 babies in the United States have been born as a result of IVF (American Society of Reproductive Medicine). If you want to learn more about IVF, contact us in Beverly Hills, Valencia, or Burbank to schedule an appointment.

Am I a Candidate for IVF?

IVF was originally designed to help women with tubal disease that could not conceive naturally. Today, IVF is the treatment of choice for various types of infertility for couples that have not had success with less invasive treatments.

If you have any of the following conditions, you may be a good candidate for IVF:

• Ovulatory dysfunction
• Male factor infertility
• Blocked, diseased, or absent fallopian tubes
• Pelvic inflammatory disease
• Unexplained infertility
• Failed conventional fertility methods with Clomid, injectable drugs, and/or intrauterine insemination (IUI)
• Endometriosis
• PCOS
• Uterine factors or cervical mucus problems

If you have been trying to conceive without success and have one or more of these problems, we might be able to help. Contact us at our Beverly Hills, Valencia, or Burbank office today.

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IVF Process

There are many steps involved in the IVF process, but try not to become too overwhelmed by the process – that’s why we are here. Together, we will discuss what you can expect throughout the treatment process, review all of the medications, and learn about the testing that will be done. Although the IVF process is complex, one of our board certified fertility specialists will try to simplify it for you and walk you through it one step at a time.

During our initial consultation, one of our board certified fertility specialists will meet with you and discuss your case, diagnosis, and possible treatment options in detail. If IVF is appropriate for you and you decide to proceed with your treatment, they will review the various tests that will be required in preparation for your cycle and identify and review the dates of your cycle.

In preparation for your cycle, both partners will need to have a few blood tests (HIV 1+2, HTLV I & II, Hep BsAg, Hep C ab, RPR). The male partner or sperm donor will need to provide a semen sample for analysis. A sperm sample may be frozen to serve as a back up for the actual procedure. Once the evaluation is complete, you will be able to start your treatment cycle based on available schedule and your menstrual cycle. We understand that you are anxious to begin treatment as soon as possible and we make every effort to get you started right away.

Prior to starting the cycle, our IVF coordinator will meet with you again, review the medication schedule, and make sure that you are familiar with the drugs and the methods of administration. Once the treatment is in progress, you will be coming to the office periodically ( typically on day five, seven, and nine of your injections) for monitoring of your response to the medications. This usually includes a blood test (Estrogen, E2 level) and an ultrasound on each visit. With each visit we will notify you of your progress and make sure that you know what will happen next.

Once your ultrasound and blood test results indicate that it is time for us to retrieve your eggs, we will ask you to stop all fertility drugs and take a medication called hCG. This medication will allow one of our board certified fertility specialists to retrieve your eggs in a timely manner. The retrieval (aspiration) is done under ultrasound guidance in a procedure room in our Beverly Hills office. You will be receiving medication to put you to sleep for a period of 10 to 30 minutes under the supervision of an anesthesiologist. Your male partner or sperm donor's sperm will be needed on this date.

Following the egg retrieval procedure, you will be contacted and will receive an update of the status of your embryos. The day after the aspiration (24 hours) you will find out how many eggs have fertilized. On day two (48 hours after aspiration) you will be asked to start vaginal progesterone that evening, and you will be informed of how many fertilized eggs (zygotes) are dividing and the number of normal appearing zygotes. We will contact you to schedule the embryo transfer date. The options are a day three transfer or a day five transfer (blastocyst transfer). The final decision is made on day three (72 hours) when we will make an assessment together as to the best option for you with respect to an embryo transfer date (day three versus day five).

After the embryo transfer you will be asked to go home and stay home at bed rest for three days. You will be asked to continue your 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.

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IVF Techniques

Since IVF was first developed, there have been several advances and improvements in the techniques involved in egg retrieval, embryo transfer, and ovulation induction.

Below are some of the IVF options we offer at our Beverly Hills, Valencia, and Burbank offices

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 years. We offer frozen embryo transfer at our 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.

During the procedure a catheter is inserted through the cervix and the embryos are placed 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 here at our Valencia, Beverly Hills, and Burbank offices. The aim of cryopreservation is to preserve fertilized dividing embryos or unfertilized eggs (oocytes) for use in the future. This is helpful in many ways. There are those who conceive with a fresh cycle and return years later to attempt another pregnancy with their frozen embryos. Others who have not been successful in their fresh IVF cycle can try to conceive through a frozen embryo transfer (FET) cycle. This allows for a second or third attempt at conception without exposure to fertility drugs and the high cost of a fresh IVF cycle . We can also freeze a patient’s eggs for future use when someone is diagnosed with cancer and treatment (cancer treatment with chemotherapy or radiation) that might affect future fertility. Other candidates for egg freezing are women who desire future fertility but do not have a partner or sperm donor. They wish to stop their biological clock from ticking and not be forced into a relationship or marriage as a means of being able to have a child. Others who are single and intend to be single parents but have not found the appropriate sperm donor and are concerned about their egg quality as they are getting older will try to freeze their eggs. Egg freezing is not a procedure without technical difficulties. Anyone who desires egg freezing should sit down with one of our board certified fertility specialists and review the available treatment options and their advantages and disadvantages.

Not all embryos or eggs are eligible for cryopreservation. Embryos that are not candidates for cryopreservation include those that divide slowly or are irregular in any other way. Egg freezing may not be possible if the quality of the eggs give us indications that they may not survive the freeze/ thaw and the subsequent fertilization process.

If you want to learn more about your cryopreservation options, contact us in Valencia, Beverly Hills, or Burbank today.

IVF Micromanipulation Procedures
ICSI, PGD, and Assisted Hatching
Valencia and Beverly Hills

Micromanipulation involves the use of small, precise, robot-arms connected to a microscope and operated by remote control. The sperm, eggs, and embryos are magnified 1,000 times and viewed on a monitor. The micromanipulation procedures we perform at our Beverly Hills practice includes intracytoplasmic sperm injection ( ICSI), preimplantation genetic diagnosis (PGD), and assisted hatching (AH).

Intracytoplasmic Sperm Injection ( ICSI)

Intracytoplasmic sperm injection ( ICSI) 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). Additional conditions that may require ICSI include problems with sperm binding to and penetrating the egg, prior or repeated failure with conventional IVF methods, and obstruction of the reproductive tract.

Before the ICSI procedure begins, your partner will take fertility drugs to stimulate the development of several mature eggs. Once the eggs are mature, they will be removed and you will provide a sperm sample. Next, a single sperm is injected directly into the egg (oocyte) with a tiny glass needle (pipette). Two to five days following the ICSI procedure, each of the fertilized eggs will be an embryo. A Few of the embryos (after discussion with your doctor) are then inserted into your partner’s uterus (extra embryos may be frozen at this time in case this ICSI procedure does not succeed). If ICSI succeeds, the embryo will implant into the uterus and continue to grow into a baby.

ICSI can help couples with severe male-factor fertility achieve their dream of a family. That means that about 35 to 40 percent of couples having trouble conceiving can become pregnant with the use of ICSI. If you are struggling to conceive as the result of male infertility, we can help. Contact us in Beverly Hills, Valencia, or Burbank to schedule a consultation with one of our board certified infertility specialists.

Preimplantation Genetic Diagnosis (PGD)

In some cases, couples that are carriers of genetic disorders are reluctant to become pregnant because they are at risk of passing the disorder to their children. 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. Once the embryo is divided, preimplantation genetic diagnosis is performed at the Beverly Hills office.

Preimplantation genetic diagnosis involves the following steps:

• A single cell is removed from the embryo
• The cell is treated with probes for genetic abnormalities
• The DNA is evaluated to determine if the inheritance of the gene is present

Once the preimplantation genetic diagnosis procedure is complete and embryos without the genetic problems being tested have been identified, “normal” embryos are transferred into the uterus.

Who is a Candidate for Preimplantation Genetic Diagnosis

If you answer yes to any of the following questions, you may be a good candidate for preimplantation genetic diagnosis.

• Are you a woman age 35 or over?
• Are you a carrier of a sex-linked genetic disorder?
• Are you a carrier of single gene defects?
• Are you a carrier of chromosomal disorders?
• Have you had recurring pregnancy loss that is associated with chromosomal concerns?
• Have you had multiple IVF failures?
• Do you want to have the opportunity to have the embryos tested in advance for your peace of mind?
• Do you want to determine the sex of your baby in advance for family planning reasons or for medical reasons?

If these conditions apply to you and you are considering starting a family, contact us in Valencia, Beverly Hills, or Burbank to discuss preimplantation genetic diagnosis with one of our board certified fertility specialists.

What Are the Benefits of Preimplantation Genetic Diagnosis?

There are several benefits of preimplantation genetic diagnosis. It reduces the need for amniocentesis later in pregnancy and helps reduce expenses that are usually associated with certain birth defects. Preimplantation genetic diagnosis is performed before embryo implantation, so if a defect is identified, the couple can decide whether or not they want to continue with the pregnancy. But perhaps best of all, preimplantation genetic diagnosis enables couples that carry genetic disorders to try for a biological child of their own.

Preimplantation genetic diagnosis minimizes the risk of passing genetic defects on to future generations. If you or your partner has a genetic condition that you are afraid of transmitting to your child, preimplantation genetic diagnosis may be a good option for you. Contact our Valencia, Beverly Hills, or Burbank office to schedule a consultation.

Assisted Hatching

It has been speculated that fertility medications and the egg’s normal aging process can cause changes in the zona pellucida (the protective outer membrane that surrounds the embryo), which may interfere with the normal hatching process. 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 at our Valencia or Beverly Hills office, 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. Normally the embryo must “hatch” through the zona pellucida in order to attach to the lining of the uterus. Assisted hatching helps the embryo with thicker outer shell than normal to return to a normal state where they can now hatch, improving the chances of implantation and conception.

Assisted hatching can significantly improve the chances of conception for women who have had repeated failure of embryo implantation with IVF. Assisted hatching is indicated in the following conditions:

Your embryos show evidence of having a thick or hardened zona pellucida

• You are over the age 35 and using your own eggs
• You who have elevated FSH levels
• You are using frozen embryos (since the zona may be hardened as a result of cryopreservation)

Assisted hatching has helped many women achieve pregnancy through IVF after earlier failures. If you want to learn more about assisted hatching, contact our Valencia, Beverly Hills, or Burbank office today.

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.

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