In Vitro Fertilization in Los Angeles, CA
What is In Vitro Fertilization?
In Vitro Fertilization (IVF) is an assisted reproductive technique that is used to treat infertility due to multiple etiologies including tubal disease, male factor, endometriosis, and unexplained causes. California Fertility Partners provides In Vitro Fertilization at its Los Angeles Fertility Clinic. IVF treatment involves stimulation of the ovaries to produce multiple eggs, removal of the eggs by an ultrasound directed needle aspiration, followed by insemination of the eggs in the laboratory. The fertilized eggs, or embryos, are grown in culture for 3-5 days before being transferred into the uterine cavity under ultrasound guidance.
A woman’s natural cycle
A woman’s natural cycle is self-regulated to produce one egg per month. The eggs develop within fluid-filled sacs inside the ovaries, called follicles. The hormone that is released by the pituitary to stimulate the follicles to grow each month is called follicle stimulating hormone, or FSH. By giving daily injections of medications containing FSH we can increase the blood level of this hormone, causing several eggs to develop to maturity.
Medication used to Prepare for IVF
There are several different types of medications used to prepare the ovaries for an IVF aspiration. Lupron and Ganirelix are used to prevent the surge of LH in mid-cycle and thereby prevent ovulation. Preparations containing FSH include: Gonal F, Follistim, Bravelle, and Menopur. These medications are used to stimulate multiple follicle growth.
Harvesting your Eggs
Careful monitoring of the ovaries during treatment is essential for the development of high quality eggs as well as patient safety. Serial ultrasounds and blood tests are used to evaluate the ovarian response and timing of egg recovery. The sizes of the follicles correlate with maturity of the eggs inside. When the eggs reach predicted maturity, an ultrasound guided aspiration procedure is scheduled to harvest the eggs.
Egg Retrieval Process
The egg retrieval is a simple outpatient surgical procedure that is performed under intravenous anesthesia. A vaginal ultrasound probe is used to guide a needle through the vaginal wall and into the ovary. Once the needle is inside the follicle, suction is used to aspirate the fluid and egg into a test tube. The embryologist then examines the fluid for the presence of an egg. The entire procedure takes approximately twenty minutes to perform.
Sperm Injection (ICSI)
Our embryologist then mixes the eggs with sperm or assists fertilization by sperm injection (ICSI). The embryos are then cultured in a tightly controlled laboratory environment for 3-5 days. Extra embryos may be frozen and stored until a later time. The number of embryos transferred into the uterus is determined based on the woman’s age. The number transferred will range from 1 to 6 embryos. A blood test twelve days following embryo transfer later will diagnose pregnancy.
Some women are fortunate enough to have sufficient eggs and embryos from one egg retrieval procedure to allow the extra embryos to be frozen and stored for future use. Any remaining good quality embryos that are not transferred in the fresh cycle may be frozen. The frozen embryos may be stored for an indefinite time period. When needed, the embryos are thawed and transferred into a hormonally prepared uterus.
A developing embryo must break free of its shell before it can attach to the uterine wall. As the embryo develops in culture, the cells of the embryo secrete enzymes that degrade the thickness of the cell’s protective coating, the zona pellucida. Some embryos in the laboratory are deficient in the enzymes needed to begin this zona-thinning process. In addition, some embryos grown in the laboratory may have a harder shell than normal.
Assisted hatching is a technique that is used to assist the natural hatching process. In this procedure, the embryologist directs a small amount of dilute acid to the embryo’s outer coating, to initiate the thinning process. This procedure is most beneficial for women over the age of 38, women with mild elevation of their FSH levels, women with multiple failed IVF cycles, in women with unusually thick zona pellucidae, and in frozen embryo cycles.