Bay IVF - Advanced Reproductive Care Palo Alto 650-322-0500
Embryo Banking: Postpone Having Children
Some couples may delay starting their family so much that by the time they decide to have children, it may be very difficult, if not impossible, to conceive. Embryo Banking can be used to postpone having children while pursuing your educational and professional goals.
Impact of Female Age Female fertility begins to decline many years prior to menopause despite continued regular ovulations. The likelihood of a successful pregnancy decreases by approximately 10% to 15% each year after the age of 32 and at an even faster rate after the age of 37. Most women 42 and older will require Donor Egg In Vitro Fertilization to have a child.
The successful outcome of the Embryo Banking treatment depends primarily on the patient’s age at the time of embryo cryopreservation. Unfortunately, the success rates of Embryo Banking appear to decline significantly for older women (40 years or older).
Embryo Banking consists of retrieving eggs from your ovaries, fertilizing them with your partner's semen, cryopreserving the resulting embryos, and storing them at our clinic for your future use.
Cryopreserved (vitrified) embryos are kept in liquid nitrogen which allows them to remain in a suspended state, "frozen in time." The uterus does not "grow old," so the probability of a successful outcome from cryopreserved embryos is independent of the patient’s age at the time the embryos are thawed and transferred into the uterus.
Probability of Success
The probability of conception from frozen-thawed embryos would be expected to be the same as with In Vitro Fertilization when "fresh" embryos are transferred. No increase in chromosomal abnormalities, birth defects, or developmental deficits has been noted in children born from cryopreserved embryos.
We use gentle, individualized ovarian stimulation protocols and strive for the highest egg quality. This approach decreases the likelihood of ovarian hyperstimulation without reducing the probability of a successful outcome.
Most patients will be able to continue their everyday lifestyles during their treatment. It is our goal to make your treatment experience pleasant, relaxed, and as natural as possible.
Embryo Banking Procedure
Embryo Banking treatment consists of:
Egg retrieval procedure
Fertilization of eggs
Culture of embryos
Cryopreservation (vitrification) of embryos
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 Embryo Banking is based on your reproductive history and your pre-treatment evaluation. Below is an example of a commonly used Embryo Banking treatment protocol. Your treatment is always individualized and may take less or more time to complete.
Embryo Banking 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.
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. The eggs are identified under the microscope and 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.
Cryopreservation of Embryos
Embryos that develop normally are cryopreserved (vitrified). Preparation for the freezing process involves removing water from within the embryos and replacing it with cryoprotective substance to prevent ice crystal formation during vitrification and subsequent thawing. The embryos are then flash cooled to −196 °C (−321 °F). Such rapid freezing (vitrification) prevents the damaging water crystal formation.
Following the vitrification process, the embryos are transferred to a liquid nitrogen storage chamber in our center. Theoretically, there is no limit on the length of storage, but conceiving past the age of 40 may result in a high-risk pregnancy.
When you decide to conceive with your cryopreserved embryos, you will have one or more embryos thawed and transferred into your uterus. A large majority of the embryos will survive the vitrification and thawing process. The implantation rate of the thawed embryos should be the same as the "fresh" embryo implantation rate, and, as mentioned previously, is primarily dependent on the patient’s age at the time of embryo freezing.
Please use the following links for financial information about Embryo Banking and to schedule a consultation.