In Vitro Fertilization

IVF has literally made possible thousands of healthy births from couples previously considered infertile. Long-range studies indicate there is no increased risk for birth defects or other abnormalities in children born from the procedure. HRC Fertility’s IVF success rates exceed the national averages.

HRC Fertility offers IVF treatment services at our offices in Los Angeles, Orange County, San Diego and Rancho Cucamonga. Contact us today to discuss treatment options.

Assisted Hatching with IVF

At HRC Fertility, assisted hatching may be recommended for women who have failed IVF or for women over 35. During the initial stages of development, an embryo is contained in a layer of proteins known as the zona pellucida. To successfully implant into the uterine lining, the embryo must hatch out of the zona pellucida and attach to the walls of the uterus.

Assisted hatching is a lab technique that was developed when it was observed that embryos that had a thin zona pellucida had a higher rate of implantation during in vitro fertilization (IVF). Embryologists create a small hole in the outer lining using micromanipulation techniques under a microscope during the fourth day of embryo development.

Assisted hatching helps with IVF success in couples in which the women are over 35 or couples who have had multiple failed IVF cycles. It is thought that some women may fail multiple cycles of IVF because their eggs have a thicker shell, and assisted hatching can help with this problem.

HRC Fertility does not use assisted hatching with every patient. Assisted hatching may be indicated for patients with a poor prognosis, such as older patients or those with two or more failed IVF cycles and poor embryo quality. In those patients, there have been higher clinical pregnancy rates and implantation rates after assisted hatching. There is some risk of monozygotic (identical) twins and risk of damage to the embryo with this procedure.

Blastocyst Transfer with IVF

A blastocyst is an embryo on Days 5-7 of cell division in which two types of cells are present — a group that form the placenta and a group that form the fetus. With recent advances in assisted reproductive technology, IVF laboratory staff now have the means to grow embryos in the proper nutrients to this advanced stage of development before transferring them into a woman’s uterus.

The blastocyst transfer is an in vitro fertilization (IVF) technique that was developed to increase pregnancy rates and decrease the risk of multiple pregnancy. If the embryos are grown in the lab to the blastocyst stage, they are highly developed and ready to hatch out of the zona pellucida and attach to the uterine wall (implantation).

In conventional IVF, embryos are usually only grown in the IVF lab for two or three days before they are transferred into a woman’s uterus, where they must continue growing and developing for four or five more days before they become blastocysts and are ready to implant. At this early stage of development, it is more difficult for an embryologist to determine which embryos will have the greatest success at growing into blastocysts and implanting, which is why more embryos (two to three) are usually placed in the uterus, which increases the risk of multiples.

By keeping embryos in the IVF laboratory for a few more days, the embryologist can better determine which embryos have successfully developed into blastocysts and have a greater likelihood of implantation. Many abnormal embryos will stop growing during development before they reach the blastocyst stage, so by growing embryos to the blastocyst stage, that embryo has the higher potential of developing into a successful pregnancy and a healthy baby.

Embryo Cryopreservation

Cryopreservation is the freezing and thawing of embryos for use in future in vitro fertilization (IVF) cycles.

During an IVF cycle, the fertilized eggs are transferred to incubators where they develop until ready for transfer to the uterus, usually 3-5 days.

The number of mature embryos available for transfer varies by patient, as does the number placed back in the uterus. Since the maximum number of embryos that will be transferred to the uterus is limited, there are often excess embryos.

Embryologists have perfected techniques for transferring embryos to different solutions as they are frozen and thawed. Great care is taken not to rupture the membrane surrounding the embryo.

The major advantages to using frozen embryos in future IVF cycles is that the female does not have to undergo ovulation induction, which also dramatically reduces medication cost. Success rates are variable depending on patient characteristics, embryo quality and clinical history.

IVF with Donor Egg

IVF has made it possible for a woman with ovarian failure to carry and deliver a child using an egg donor. The egg donor undergoes ovulation induction with FSH and her eggs are retrieved when mature. At this point the eggs may be frozen for a future donor egg IVF cycle, or used in the current cycle. If they are used in the current cycle, they are fertilized and allowed to develop.

IVF using an egg donor requires that the recipient mother receive medications, such as progesterone, to prepare her endometrium to accept the developing embryos. Essentially, her cycle is synched with the egg donors. When the embryos mature and are ready for transfer, they will be placed into the recipient mother’s uterus.

Egg donor success rates are equal to the age group of the donor and are typically high.

IVF With ICSI

IVF with intracytoplasmic sperm injection (ICSI) is now the mainstay treatment for moderate to severe male infertility.

IVF with ICSI involves inserting a single sperm directly into the egg. The sperm is usually obtained from the ejaculate; however, it can also be obtained directly from the male reproductive tract including the testicles.

IVF with ICSI makes it possible for men with no sperm in their ejaculate and men with severe spinal cord disorders to father healthy genetically related children.

PGD with IVF

If you are undergoing fertility treatment within vitro fertilization (IVF), you can choose to have preimplantation genetic diagnosis (PGD). Your fertility doctor at HRC may recommend PGD, particularly if you are at risk of passing on a genetic disorder or if you have suffered from recurrent miscarriage.  This laboratory technique screens for single-gene defects that may cause genetic disorders when one or both genetic parents carry a gene mutation or a balanced chromosomal rearrangement. PGD is performed to determine whether that specific mutation or an unbalanced chromosome has been transmitted to the egg or embryo.

With PGD, the egg is fertilized in a laboratory via IVF using the egg and sperm from the couple or from an egg donor or sperm donor. Then a single cell is taken from a Day 3 embryo, or six to eight cells are taken from a Day 5 or 6 blastocyst. The cells are removed and the chromosomes examined for genetic abnormalities by geneticists and specialists using one of several techniques. At HRC Fertility, the PGD methods used to examine the chromosomes include fluorescent in situ hybridization (FISH) and/or the polymerase chain reaction (PCR). FISH involves labeling the chromosomes with a fluorescent tag allowing them to be examined by the embryologist, while PCR enables making multiple copies of the DNA segments.

The embryonic cells continue to divide without the removed cell or cells. Studies have shown that any risk of damage to the embryo is small, and there is no increased risk of birth defects.

If a problem is found with an embryo, the couple can decide to transfer only the “good” embryos. PGD can screen out more than 50 genetic diseases, such as cystic fibrosis, Down syndrome, Tay-Sachs disease, spinal muscular atrophy and hemophilia A and B.

PGD may also be used to help couples select the gender of their child whether it is for family balancing or to try to prevent the transmission of a sex-linked genetic disease (a disease carried on the sex chromosome).

HRC Fertility was one of the first clinics to perform PGD using a laser, and one of very few using a laser to date. The laser affords the embryos less exposure to handling and general outside conditions while undergoing PGD. In 1989, HRC Fertility performed one of the first preimplantation genetic diagnosis (PGD) cases in the United States for a sex linked genetic disorder.

Single Embryo Transfer with IVF

Single Embryo Transfer with IVF  Elective single embryo transfer (eSET) with in vitro fertilization (IVF) performed in a high quality laboratory has been found in several studies to be the best solution for patients with a good prognosis. eSET is particularly effective in patients who are under 35 or who conceived with their first IVF cycle, as well as those who are concerned about a multiple pregnancy or who are using donor eggs.

With eSET, one embryo is selected and placed in the fallopian tube or uterus. The embryo selected might be a fresh embryo or a frozen embryo from a prior IVF cycle. The embryo could also be from a donor.

Researchers have found that transferring single embryos over several IVF cycles using both fresh and frozen embryos is less expensive and more effective than transferring two or more embryos at a time. And eSET is much less likely to result in multiple births and the ensuing risk of complication

Risks Associated with Multiple Births

Infants born in multiple births are more often born early / preterm, are smaller (lower birth weight) and experience more adverse health outcomes than singleton infants. Complications linked with early delivery can include problems with baby’s lungs, brain, intestinal tract or nervous system.

Women who carry multiples may be more likely to miscarry, or need Caesarean sections which may require a longer period of recovery, and at times, increase the risk of hemorrhage during and after delivery.

Why Choose IVF

In many situations in which a couple is experiencing infertility, HRC fertility doctors can treat the problem with first-line fertility treatments such as ovulation induction or intrauterine insemination (IUI). In other cases, the condition causing infertility is treatable with surgery for the male or the female.

For women in whom first-line fertility treatments have been unsuccessful or who have other situations or conditions, the treatment of choice may be in vitro fertilization (IVF). IVF was originally developed for women with tubal factor infertility (non-functioning fallopian tubes); however, because of major advances in in vitro fertilization, IVF is not always the treatment of last resort. In fact, it is often the first-line treatment.

Some common female infertility indications that may lead women to chooseIVF treatment include:

• fallopian tube damage
• endometriosis
• unexplained infertility
• age-related infertility
• being at risk of genetic disease such as cystic fibrosis (IVF with pre-implantation genetic diagnosis — PGD may be indicated
• infertility or recurrent pregnancy loss related to chromosomal abnormalities — IVF with PGD or pre-implantation genetic screening may be indicated

IVF is often the treatment of choice for couples in who are experiencing male factor infertility, particularly with intracytoplasmic sperm injection (ICSI), a procedure in which one sperm is injected directly into the egg. If you would like to learn whether IVF may be the best choice for you, contact us today.

To schedule a consultation with one of our Reproductive Specialists, call us at 866-HRC-4IVF or click the button below: