Understanding Your Fertility Options
IN-VITRO FERTILIZATION (IVF)
In-vitro fertilization (IVF) is the process in which eggs are retrieved from ovaries and fertilized by sperm in a lab. Once fertilized, the embryo is implanted into the uterus with the goal of developing into a full-term pregnancy.
The History of IVF
IVF was developed in the 1970s as a method to treat infertility caused by blocked or damaged fallopian tubes. Lousie Brown was the first baby conceived with IVF in 1978. Since then, over 3 million babies have been born via IVF.
The Steps of In-Vitro Fertilization
Step 1: Ovarian Stimulation + Monitoring
First, we conduct an evaluation to assess fertility. Once we establish egg quantity and quality, we begin a personalized regimen of injectable fertility medications to stimulate ovaries to produce eggs. During stimulation, we monitor ovaries through bloodwork and ultrasounds to ensure medication is optimally dosed throughout the cycle.
Step 2: Retrieval of Eggs
When follicles reach the appropriate size, we provide an injection to trigger egg matriculation. Approximately 36 hours after the injection we retrieve eggs using a needle and ultrasound guidance. During the procedure, patients are sedated. The procedure typically takes less than 30 minutes and most patients are able to resume normal activities within 1-2 days.
Step 3: Culture + Fertilization
In the embryology laboratory, an embryologist fertilizes the mature eggs using intracytoplasmic sperm injection (ICSI), a process which involves the microinjection of sperm into the cytoplasm of a mature egg (ovum).
Step 4: Embryo Transfer
Fertilized embryos are identified and placed in the uterus using a catheter and ultrasound guidance. Using this step, the physician implants the embryo on the uterine wall. Most women recover in less than a day. A pregnancy test is taken 12 days after the embryo transfer to determine if the embryo has successfully implanted, and the patient is pregnant.
Who is the Ideal IVF Candidate?
Couples who have been unable to conceive
Women who have undergone unsuccessful fertility treatments including hormone medications or IUI (intrauterine insemination)
Individuals diagnosed with the following:
- Tubal Factor Infertility: Damage or blockage affecting the fallopian tubes
- Endometriosis: Endometrial tissue growing outside the uterus that may lead to scarring in a woman’s reproductive system
- PCOS: Polycystic Ovary Syndrome
- Low Sperm count or Poor Sperm Quality
- Unhealthy Eggs or Sperm
Individuals Interested in Genetic Testing
- PGT-A Preimplantation Genetic Testing for Aneuploidies: Genetic test of the embryo produced during IVF treatment to identify numerical chromosome aneuploidies (imbalances). This test identifies chromosomally normal embryos and their sex.
- PGT-M Preimplantation Genetic Testing for Monogenic disorders (formerly PGD): Genetic test that helps significantly decrease the chance of having a child with an inherited genetic disorder by analyzing embryos before transfer.
OVULATION INDUCTION (OI)
Ovulation induction is the process of stimulating an ovary through fertility medication to ovulate or release an egg. Ovulation induction can be done independently or as a step in the process of intrauterine insemination (IUI).
You may be a candidate for ovulation induction if you are experiencing the following:
- Absence of ovulation (anovulation)
- Infrequent or irregular ovulation (oligo ovulation)
- Absence of menstrual cycle (amenorrhea)
- Polycystic ovary syndrome (PCOS)
- History of obesity, thyroid disease, stress, endometriosis or an eating disorder
INTRAUTERINE INSEMINATION (IUI)
Intrauterine insemination is a method of artificial insemination in which sperm is collected, concentrated and placed inside a woman’s uterus using a catheter. The insemination occurs during a woman’s menstrual cycle when eggs are released. During the procedure, patients experience minimal to no discomfort.
Depending on the cause of infertility, IUI procedures may be synced with a woman’s natural menstruation cycle. In some situations, fertility medicine is used as part of the IUI process.
In what cases should IUI be considered?
- Same Sex Couples
- Polycystic Ovary Syndrome (PCOS)
- Low Sperm Count or Motility
- Ejaculation Issues
- The Presence of Cervical Scar Tissue
- Thick Cervical Mucus
MINIMAL STIMULATION (IVF)
Although less effective, IVF can be performed with minimal or without hormone injections. This process includes oral and potentially low dose injection fertility medications; however, some patients forego the injections in their entirety. Following the medication, minimal stimulation IVF follows the same protocols as full stimulation IVF.
What are the Benefits of Minimal Stimulation IVF?
Some advantages of minimal stimulation IVF may include a lower cost, fewer injections, fewer office visits, fewer monitoring days, and less exposure to hormone medications.
Note: The success rate of minimal stimulation IVF is lower than the success rate of full stimulation IVF.
Who Might Benefit from Minimal Stimulation IVF?
- Patients who do not create many ovarian follicles during a full stimulation IVF
- Patients with previously failed full stimulation IVF
- Patients with diminished ovarian reserve
- Patients with advanced maternal age
DONOR EGGS FOR IVF
Individuals and couples may use donor eggs as part of the IVF cycle. Donor eggs provide the ability to use eggs that may be stronger candidates for fertilization and could subsequently yield a higher pregnancy success rate.
Typical candidates for donor eggs:
- Women with a history of unsuccessful IVF attempts
- Older women
- Gay or single men (with the use of surrogate or gestational carrier)
- Women who have undergone cancer treatments and as a result have infertile eggs
- Women with a history of hereditary genetic issues
USING DONOR EMBRYOS OR EMBRYO ADOPTION
In-vitro fertilization (IVF) and other assisted reproduction technologies (ART) have helped millions realize their dreams of parenthood over the past 50 years. Because of this immense success, there is a growing surplus of frozen embryos. Currently, in the United States, there is an estimated surplus of 1,000,000 frozen embryos.
Most biological parents choose to keep and store their frozen embryos for future use. Of this population, an increasing number are electing to donate their fertilized embryos to infertile couples.
The Donor Embryo and Adoption Process
Candidates interested in adopting a donor embryo will complete an application, select a donor embryo and in some cases legally adopt the embryo. From here the donor embryo is placed in the recipient’s uterus for implantation, just like the traditional IVF process.
Finding a Donor Embryo to Adopt
We have close relationships with embryo donation centers and will help you find a great match for your donor embryo. We currently work with these highly qualified embryo donation centers:
A gestational carrier is a woman who carries and delivers a baby for another couple or individual. For couples or individuals who cannot carry a pregnancy to term, a gestational carrier presents a solution. The gestational carrier is involved with the prospective parents-to-be, also referred to as the “intended parents” from the start of the process. After the baby is born, the intended parents become the legal guardians of the baby.
How Does the Use of a Gestational Carrier Work?
First, a couple or individual decides if they want a fresh or frozen embryo transfer. If a fresh embryo transfer is selected, the gestational carrier must be selected and prepared prior to undergoing IVF treatment. Regardless of a fresh or frozen embryo, the gestational carrier will take estrogen to thicken her uterine lining. Once thickened, she takes progesterone hormones to prepare the uterus for embryo implantation and successful pregnancy development. After progesterone is started, the embryo transfer is scheduled. A pregnancy test is taken 12 days after the transfer to determine if the embryo successfully implanted and if the carrier is pregnant.
Candidates for Gestational Carrier
- Same sex couples
- Single men or women
- Women with uterine abnormalities or no uterus at all
- Women who are unable to safely carry a pregnancy to term
Finding the Right Gestational Carrier
We work with agencies that help couples and individuals identify and select gestational carriers. Here’s who we recommend:
Surrogate Vs. Gestational Carrier
There is an important difference between a surrogate and a gestational carrier. A surrogate uses her own egg as part of the fertilization process, meaning the child is biologically her own. A gestational carrier uses the egg and embryo from another woman, resulting in no genetic connection between carrier and baby.