Award-winning Dr. Koopersmith, and Dr. Landay and their team will provide you with the best quality IVF treatment available. Unlike any other IVF program, we listen to your concerns, take all the time it takes to answer all your questions and create an individualized IVF treatment plan for you. We will make sure you receive the highest quality care to maximize the best possible outcome of your IVF treatment.
In vitro fertilization, or IVF, is an assisted reproduction technique in which embryos are made in a lab (in vitro) instead of inside the body (in vivo). It is one of the most advanced and most successful fertility therapies available, and pregnancy rates from IVF are higher than with any other treatment.
IVF was initially designed to treat patients with blocked fallopian tubes but over the last quarter century it has expanded to treat all types of infertility, including male factor, ovulation disorders, age-related and unexplained. Pregnancy rates have risen dramatically in recent years— to over 60% in egg donation cycles. As success rates have increased, however, so have multiple pregnancy rates. Current practice endorsed by guidelines put forth by the American Society of Reproductive Medicine (ASRM) is to limit the number of embryos transferred and freeze extra embryos in order to maximize pregnancy rates per cycle and aim for singleton pregnancies, thereby decreasing multiple births and the complications associated with them.
Read also about our Mini Stim IVF program.
IVF STEP BY STEP
After the initial Infertility consultation, diagnostic tests are ordered to determine the underlying cause(s) of your infertility. A basic infertility evaluation should take no longer than 1-2 months unless there are extenuating circumstances. A follow up consult should be done to plan a treatment strategy.
If IVF is decided upon as the treatment plan, the following steps are recommended:
1. Initial IVF Consultation with Dr. Koopersmith or Dr. Landay
a) We will review planned procedures, review of consents, STD tests as required by law
b) ensure that the uterus has been recently evaluated and the cavity is normal
c) mock embryo transfer
2. Meet with financial director
Decision upon payment plans: cash, insurance, or financing, ensure the proper pharmacy is used and all requirements by your insurance company are met to ensure coverage (if you have coverage).
3. Pretreatment start
Stimulation decided upon: Down reg, flare, antagonist or ministim. Possible pretreatment preparations may include oral contraceptives, pretreatment lupron, pretreatment DHEA, or a start planned to coincide with your menses.
4. IVF Coordinator consultation
You will receive injection training, a thorough review your medications and learn injection techniques.
5. Initial ultrasound, blood test, start of Ovarian Stimulation
This will ensure you are ready to start fertility medications and ovarian stimulation. We will review the calendar of medication dosage with you and have you come back for follow up visits for scans and blood tests.
About Ovarian Stimulation
During IVF, the ovaries are stimulated to make multiple follicles containing eggs, a process called controlled ovarian hyperstimulation. There are several different medication protocols available, and all rely on self-administered injectable gonadotropins (Gonal F, Follistim, Menopur, Bravelle, Repronex, Luveris). The gonadatopins stimulate the ovaries to produce many eggs while another medication (Lupron, Ganirelix, Cetrotide) prevents premature ovulation. This process generally lasts between nine and 14 days, during which time we use vaginal ultrasound to monitor the eggs’ development and use bloodwork to determine key hormone levels (estradiol). When the eggs are likely to be mature and ready, the patient administers another injection to trigger final maturation and prepare the eggs for retrieval. Usually hCG is used as the trigger, but Lupron can also be used if it hasn’t been used yet in the stimulation.
6. Egg Retrieval
Approximately 35 to 36 hours after the trigger shot has been given, we perform an egg retrieval procedure. We perform retrievals at ART Reproductive Center in Beverly Hills or Reproductive Surgical Associates in Encino. The procedure takes about 10 to 30 minutes and is performed in an outpatient operating room with light anesthesia. A thin needle attached to a vaginal ultrasound probe pierces through the vaginal wall directly into the ovary to aspirate the follicles and remove the eggs. The follicular fluid is then immediately handed to the embryologist, who isolates the eggs and begins the fertilization process.
7. Sperm collection on the same day of egg retrieval
8. Fertilization/Embryo Culture
On the same day as the egg retrieval, the eggs and sperm are combined in order to allow for fertilization—either by standard insemination, where the eggs and sperm are mixed together in a dish, or by ICSI (Intracytoplasmic Sperm Injection), in which a single sperm is injected into each egg. The eggs are then transferred to an incubator, where the temperature and other environmental conditions can be highly controlled. The following day, the embryologist examines the eggs for signs of successful fertilization, and they closely follow embryonic development for an additional 2-5 days.
9. Culturing of the embryos
On day 1 we identify fertilized embryos. On day 3 we will check on cell division, growth and development of the embryos. On day 5 we will perform another check on the embryos and prepare the embryos for possible transfer or biopsy.
10. Embryo Transfer
We usually transfer embryos back into the uterus through the cervix three to five days after the egg retrieval. This is a simple procedure, performed without sedation or anesthesia other than valium, which both helps relax the uterus and calms the patient. You and your doctor will discuss and agree upon the number of embryos to be transferred, usually ranging between one and five. The embryos are placed into the uterus with a soft plastic catheter, using ultrasound guidance. The patient then rests for 15-20 minutes. Because of the Valium, it is important to arrange a ride home following the transfer.
Starting before the embryo transfer, patients take daily progesterone vaginal suppositories and, frequently, oral estrogen. Approximately nine to eleven days later we do two blood tests in our office to assess the level of the pregnancy hormone, beta hCG, 48 hours apart. It is at this point that we will know the initial results of the IVF cycle.
11. 10 Day Wait
Supplementation with estradiol and progesterone is recommended in most cases.
12. Pregnancy Test
You will come in for a pregnancy blood test. Congratulations!
An embryo must hatch—break free of the “shell,” or zona pellucida, that surrounds it—in order to successfully implant in the uterine wall. Hatching happens spontaneously in the normal course of embryo development and implantation, but assistance is recommended when:
- the patient is 38 years or older
- embryo quality is poor and/or
- there is a history of two or more failed IVF cycles
In addition, assisted hatching is always used when transferring previously frozen embryos or embryos made from frozen eggs, since freezing hardens the zona pellucida, making spontaneous hatching more difficult. The assisted hatching procedure is performed in the lab on the day of the embryo transfer, using a laser, acid solution or a microscopic needle to pierce the zona.
RISKS AND COMPLICATIONS
In vitro fertilization is used with great success around the world, and its safety has been evaluated and proven. However, all procedures are associated with some risks, and additional risks may become evident based on your particular medical and/or treatment history. We will discuss all of the risks related to the procedure with you prior to your cycle, and we encourage you to ask any questions you may have.
IVF is not always successful, and disappointments can occur at several points in the process including:
- Poor response to the medications with only a small number of follicles made
- Failure to recover eggs at the time of aspiration
- Few eggs or few mature eggs retrieved
- Failed fertilization of the eggs resulting in no embryos to transfer
- Degeneration of embryos or failure of embryos to grow resulting in no embryos for transfer
- Failed implantation (embryos transferred, but no pregnancy occurs)
- Biochemical pregnancy (pregnancy that stops growing before it is able to be seen on ultrasound)
- Miscarriage (pregnancy that stops growing after it is able to be seen on ultrasound)
Each of these situations can be emotionally difficult and the cause may or may not be able to be determined.
Reactions to Fertility Medications
The injectable hormones used in IVF can cause side effects in some patients. The most common side effects are local reactions, tenderness or bruising at the injection sites, moodiness and bloating. Hot flashes may also occur depending on the medications you are prescribed.
Ovarian Hyperstimulation Syndrome
Occasionally, Ovarian Hyperstimulation Syndrome (OHSS) can occur, though the symptoms are severe in less than 1% of patients. In OHSS, the blood vessels become leaky and water moves from inside the vessels into the abdomen and pelvis and can even collect around the lungs and the heart. Increased blood counts, clotting problems, electrolyte abnormalities, elevated liver chemistries and abnormal kidney function can result. In the most severe cases, hospitalization may be necessary and may last for many weeks, especially if pregnancy results.
The process of collecting the eggs is generally a brief, outpatient procedure. However, with any surgical procedure there are risks. Most commonly these include mild discomfort and bleeding. Other rare complications include infection and damage to other internal organs.
In IVF, more than one embryo is often transferred into a patient’s uterus in order to increase the chance that pregnancy will occur. However, this also increases the chances of having a multiple pregnancy with twins or much less likely triplets. Multiple pregnancies are higher risk than singleton pregnancies for both the mom and can result in complications like miscarriage, pre-term delivery, gestational diabetes, high blood pressure, birth defects, and pre-eclampsia.
An ectopic pregnancy is a pregnancy that implants and grows outside of the normal location in the uterus, most commonly in a fallopian tube. An ectopic pregnancy can be very dangerous and if this happens, the developing embryo must be removed in order to prevent serious medical complications.
Read also about our Mini Stim IVF program.
Schedule a Consultation
Take the first step toward parenthood and schedule a consultation with one of our highly trained fertility specialists. Drs. Koopersmith and Landay are available to answer any question you may have and help you achieve your dream of having a healthy baby. Follow this link to fill out a short contact form and we will be in touch with you shortly to schedule a consultation. We look forward seeing you soon.