The term in-vitro originates from Latin "in the glass". It describes a process performed in a test-tube. Thus, in-vitro fertilization (IVF) means to fertilize the egg with sperm in a glass dish. The process would naturally take place in the fallopian tube. Nowadays, the glass has been mainly replaced with single use plastic dishes, but the principle remains the same!
IVF treatment is a very powerful fertility treatment option that can overcomes severe infertility. That said, not everybody needs it and we are selective who to recommend this treatment option. We always try to find alternatives to IVF, like intrauterine insemination. Utilizing state-of-the-art high-end reproductive technology results in IVF costs being significantly higher compared to simpler treatments. However, for some couples participating in an IVF program remains the only family-building option.
Let's explain the IVF cycle step-by-step:
One common misconception is that ovarian stimulation is a mandatory step of IVF. The sole purpose of administering injectable fertility medication is to increase the number of maturing eggs and prevent premature ovulation. Every woman with regular menstrual cycles will spontaneously mature one egg each month - without medication! Our reproductive endocrinologists are able to extract an egg during a natural cycle in over 90% of the cases! This high success rate is the result of a meticulous egg retrieval technique. that benefits fertility patients who do not have many eggs during natural cycle and minimal stimulation IVF.
From the efficiency perspective, we would need to perform 10 natural cycles to get 10 eggs. Now you understand why using follicle stimulating hormone to mature multiple eggs per IVF cycle increases efficiency. In some patients we are able to retrieve over 30 eggs per cycle. The increased number of eggs improves chances of success and reduces the need to perform additional IVF cycles. New drug combinations almost completely eliminate the ovarian hyperstimulation syndrome (OHSS). This increases patient safety and avoids treatment complications from ovarian hyperstimulation. The ovarian stimulation is a science and world in itself and there are many stimulation protocols and blood tests. Our well respected Los Angeles doctors will provide you with the best IVF protocol suited to your fertility problem.
This surgical procedure is normally performed while the woman is asleep, but can be done under local anesthesia. Most of our patients undergoing natural cycles and mini-IVF do not require anesthesia. The egg retrieval is also known as oocyte aspiration, ovum pickup or simply "retrieval". A long ultrasound-guided needle is introduced through the vagina into into the follicle. Rarely, the egg retrieval is done through the abdomen or during a laparoscopy. The surgical risk is minimal and modern ultrasound equipment can visualize the pelvic anatomy including major blood vessels. Dr. Jovanovic has performed over ten thousand egg retrieval procedures to date
The first step is the penetration of sperm into the egg, also known as fertilisation. Only highly competent sperm are able to accomplish this task naturally. Once sperm makes it inside, the male chromosomes are delivered into the egg. This way the genetic material from the biologic father and biologic mother can fuse together. Some sperm incapable of naturally fertilizing the egg need to be forced inside. This microinjection of sperm into the oocyte is called intracytoplasmic sperm injection (ICSI) treatment. Intracytoplasmic sperm injection is used to treat severe male factor infertility and help individuals with very poor sperm count. Prior to the introduction of sperm injection technique,clinics would offer donated sperm to treat severe sperm.
Once the embryo is formed, we can culture it up to 7 days in the laboratory and observe its development. The IVF laboratory is the heart of the fertility clinic. Skilled embryologists perform and monitor every step of the IVF process. They observe and grade the embryo development from cleavage stage to a fully expanded blastocyst. We will typically wait for 5-7 days until the transfer. In addition to the optical scoring, we also utilize embryo biopsy and send the material for genetic testing. This is an optional procedure called preimplantation genetic testing (PGT) or preimplantation gentic screening (PGS). It can be employed to identify chromosomally or genetically abnormal embryos.
The embryo transfer process consists of replacing it into the uterus using a transfer catheter. This way we guide it into the optimal spot in the uterus where it can implant and develop into a pregnancy. This is a highly manual procedure and using a top fertility specialist will increase success rates for embryo implantation. You do not need to undergo anesthesia and you should ideally NOT feel your transfer. The less traumatic the insertion, the higher the success rates for a positive pregnancy test. The embryo transfer can either be performed in the same IVF cycle as the egg retrieval and is called fresh embryo transfer. If the embryos have been previously frozen, it is called frozen embryo transfer. The most important decision is the number of embryos to transfer and this will be a major discussion topic with your reproductive specialist.
Maintaining a receptive endometrium and the adequate hormonal environment ensures that your embryo can attach and develop into a viable pregnancy. We can perform the pregnancy test and detect the pregnancy hormone (beta-hcg or bhcg) already 7 days after embryo transfer. We will continue the hormonal support until we are sure that your body is producing enough hormone on its own and this will complete your IVF cycle. Any patient experiencing implantation problems will have a special workup so we can determine the reason for implantation failure.