Bay IVF - Advanced Reproductive Care Palo Alto 650-322-0500
In Vitro Fertilization
In Vitro Fertilization (IVF) is the most powerful treatment available to help infertile patients achieve pregnancy from their own eggs and sperm. IVF can also be an excellent test of egg and sperm quality.
Gentle Treatment at Bay IVF
We use gentle, individualized ovarian stimulation protocols and strive for the highest egg quality rather than quantity. This approach minimizes the number of clinic visits and decreases the likelihood of ovarian hyperstimulation without reducing the probability of a successful outcome.
Over the years, we have streamlined and simplified the process of In Vitro Fertilization to minimize interference with your lifestyle. A cycle of IVF treatment can take as little as six to eight weeks and only requires 4 to 6 brief visits to the clinic.
Most patients will be able to continue their everyday lifestyles during their treatment. It is our goal to make your conception experience pleasant, relaxed, and as natural as possible.
Indications for In Vitro Fertilization
You should consider IVF treatment if any of the following apply to you:
You did not become pregnant with intrauterine insemination (IUI) cycles.
You did not become pregnant with ovarian stimulation cycles with oral or injectable medications.
In Vitro Fertilization Procedure
In Vitro Fertilization treatment consists of:
Egg retrieval procedure
Fertilization of eggs
Culture of embryos
Assisted hatching of embryos (when indicated)
There are several different forms of ovarian stimulation protocols, each with many modifications. Your treatment is always individualized to maximize the probability of a successful outcome. The selection of an optimal protocol for your IVF treatment is based on your reproductive history and your pre-treatment evaluation. Below are two examples of IVF treatment protocols used at Bat IVF Center.
Pituitary Down-Regulation Protocol
This widely used ovarian stimulation protocol should result in the development of a synchronous cohort of ovarian follicles yielding a large number of high quality eggs.
This graph is an example of this protocol. Your treatment is always individualized and may take less or more time to complete.
The treatment begins with the onset of a menstrual period. Oral contraceptives are started within the first four days of the menstrual cycle. They prime the ovaries for optimal response.
Seven days before the estimated onset of the next menstrual period, Lupron injections begin. Lupron prevents premature release of the eggs from the ovaries prior to the egg retrieval procedure and decreases the level of male hormones (beneficial for egg quality). The Lupron injections are given subcutaneously (just under the skin).
After approximately seven days of taking Lupron, a menstrual period will start. By the time you start your period, your pituitary gland has been "down-regulated" creating a "clean slate" for your ovarian stimulation.
Shortly after the onset of the period, follicle stimulating hormone (FSH) or a combination of FSH/luteinizing hormone (LH) injections will begin. FSH and LH stimulate the production of multiple eggs in the ovaries. FSH and FSH/LH injections are given once a day subcutaneously with tiny needles for approximately ten days.
During this time, your progress is monitored by estradiol (estrogen, E2) and progesterone blood levels and ultrasound examinations. Once the ovarian follicles (grape-like structures within the ovaries containing eggs) are at the appropriate size, Lupron and FSH/LH are stopped, and you will take a single injection of Human Chorionic Gonadotropin (HCG). This is also a subcutaneous injection. This medication triggers the final stages of egg maturation. Thirty-six hours after the HCG injection, the eggs are aspirated from the ovaries.
The flare-up protocol represents a different method of ovarian stimulation. It may result in the development of higher quality eggs for some patients.
This graph is an example of the flare-up protocol. Your treatment is always individualized and may take less or more time to complete.
The flare-up type of ovarian stimulation begins with the onset of a menstrual period. Oral contraceptives are started within the first four days of the menstrual cycle. They prime the ovaries for optimal response. Your menstrual period will start approximately three days after your last oral contraceptive pill.
Approximately seven days after your last contraceptive pill, your ovarian stimulation will start with either a Lupron injection followed the next day with an FSH (FSH/LH) injection, or your stimulation may start with FSH (FSH/LH) without taking the Lupron injection first.
These hormones will stimulate the production of multiple eggs in the ovaries. The volume of the injections is very small, and they are given subcutaneously (just under the skin) with tiny needles. The injections are administered every other day, typically for a total of four to six doses.
Once the diameter of your largest follicles reaches 14 mm, you will start taking Clomid tablets daily for a total of approximately three to six days. Clomid contributes to ovarian stimulation and reduces the likelihood of premature ovulation.
During this time, your progress is monitored by estradiol (estrogen, E2) and progesterone blood levels and ultrasound examinations. Once ovarian follicles are at the appropriate size, FSH/LH and Clomid are stopped, and you will take a single injection of Human Chorionic Gonadotropin (HCG). This is also a subcutaneous injection. This medication triggers the final stages of egg maturation. Thirty-six hours after the HCG injection, the eggs are aspirated from the ovaries.
Ovarian stimulation should result in the development of several eggs in each ovary. The ultrasound image below shows a stimulated ovary. Each of the several follicles (dark circles) contains a microscopic egg.
Egg Retrieval Procedure
The egg retrieval procedure is performed at our center. The procedure only takes a few minutes, and we use very comfortable conscious sedation for analgesia.
Under ultrasound guidance, the tip of a thin needle is passed through the top of the vagina into the cul-de-sac (a space behind the uterus). The ovaries are located near the bottom of the cul-de-sac allowing the tip of the aspirating needle to enter the ovarian follicles and aspirate the follicular fluid from them. The fluid is examined under a microscope to identify the eggs.
Fertilization of Eggs
On average, eight to fourteen eggs are aspirated during the egg retrieval procedure. After their identification, the eggs are placed in petri dishes filled with culture medium. The composition of the culture medium resembles the fluid secreted by the Fallopian tubes. This allows the eggs and embryos (fertilized eggs) to develop in our laboratory environment at the same rate as inside the Fallopian tubes.
The male partner collects a semen specimen by masturbation the day of the egg retrieval. The highest quality sperm are extracted from the semen and combined with the eggs six hours after the egg retrieval. This process of in vitro fertilization takes place over several hours during the evening after the egg retrieval.
If the male partner has never caused pregnancy, or if his test results indicate a possibility of significant male infertility, Intracytoplasmic Sperm Injection (ICSI) is performed. In ICSI, a single sperm is inserted into an egg. This can significantly increase the probability of normal fertilization for selected patients.
Culture of Embryos
Evidence of fertilization can be seen the next day, 16 hours after insemination. The fertilized eggs are transferred into a growth medium and continue to be cultured in our laboratory.
A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm.
The following day, embryos should divide into 4 cells, the day after into 8 cells.
This picture shows a morphologically exquisite, day three, 8-cell embryo. At this stage, human embryos are still microscopic and invisible to the naked eye.
By the fifth to seventh day after the insemination, embryos should reach the blastocyst stage (80 or more cells).
This picture shows an advanced stage of blastocyst development. Notice the central fluid-filled cavity. The cells within the blastocyst have already differentiated into the inner cell mass (at seven o’clock) that will give rise to the fetus and the trophectoderm cells that will form the future placenta.
Assisted Hatching is a laboratory procedure used to create a "weak spot" in the egg shell of an embryo. For selected embryos, this increases the likelihood of the embryo being able to hatch out of its egg shell, implant, and result in a baby.
This picture shows an embryo after assisted embryo hatching with an opening breaching the egg shell at the 12 o’clock position.
The embryo transfer is performed two, three, or five days after the egg retrieval depending on the number and development of your embryos. The gamete embryologists assess the embryos prior to the embryo transfer to determine their likelihood of implantation.
This probability of success is one of the factors determining the number of embryos to transfer. Dr. Polansky will help you with your decision, but you will have the "last say." Most partners select one or two embryos for the transfer.
By the time of your embryo transfer, the length of your uterus has been measured twice: once during your pre-treatment evaluation and the second measurement is done at the end of your egg retrieval.
Just prior to the embryo transfer, the embryos are placed into the tip of a thin embryo transfer catheter. The catheter is then passed through the cervical canal to within 15 mm of the top of the uterine cavity, and the embryos are gently released.
Having done thousands of embryo transfer procedures, Dr. Polansky will precisely place your embryo(s) within the endometrial cavity. The embryo transfer usually takes only a few seconds to complete, and no resting is required afterward.
There may be more embryos than the future parents wish to have transferred. It is possible to vitrify (freeze) these embryos and store them in liquid nitrogen. A large majority of the embryos will survive the vitrification and thawing process. The implantation rate of the thawed embryos is equal to the "fresh" embryo implantation rate.
After the embryo transfer, the endometrial lining gently holds the embryos within the top of the uterus. There is no restriction on your physical activity.
This picture shows a healthy blastocyst in the process of "squeezing out" of its eggshell. Once fully hatched, it will stay in the uterus unattached for one to two days and then implant.
The lining of the uterus is made receptive for the embryos through the action of the hormones estrogen and progesterone produced by the ovaries. Ovarian progesterone production is supplemented with vaginal progesterone capsules.
A blood pregnancy test is done two weeks after the embryo transfer. If the pregnancy test is positive, an ultrasound examination is scheduled two weeks later to visualize the implantation site and to look for a heartbeat within the embryo. Once a heartbeat is seen, there is a 95% probability that the pregnancy will continue to a baby.
This ultrasound picture shows a six week pregnancy. The pregnancy sac is 25 mm in diameter. The baby inside the sac is only 13 mm long. It is already possible to distinguish the baby’s head and body and to see the cardiac activity.
At this point, your pregnancy becomes indistinguishable from a conception through intercourse, and your obstetrical care should be no different than if you conceived without any treatment.
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