Tree of Life Center has been providing in-vitro fertilization to Los Angeles and beyond since 2004. We enabled thousand of parents access to Assisted Reproductive Technology including IVF and ICSI. We strive to make the the procedure simple and affordable. We work with eggs and sperm every day and will help you understand and master your fertility challenge.
The term in-vitro originates from Latin "in the glass". It is generally used to describe a process performed in an artificial environment. Thus, in-vitro fertilization means to fertilize the egg with sperm in a glass dish. Nowadays, the glass has been mainly replaced with special single use plastic dishes, but the principle remains the same.
The in-vitro fertilization (IVF) treatment is a very powerful fertility treatment that overcomes some of the hardest fertility problems. That said, not everyone needs this treatment and we are very selective who we recommend this procedure. We always try to find alternatives to IVF if possible. However, some couples do not have any other choice.
The IVF cycle can be broken down the following phases:
The most common misconception is that ovarian stimulation is necessary for egg retrieval. The sole purpose of administering injectable fertility medication is to increase the number of maturing eggs and prevent premature ovulation. However, every woman with regular menstrual cycles will spontaneously mature one egg each month. Our experience enables us to extract that egg in over 90% of the cases! However, in order to get 10 eggs, we would need to perform 10 natural cycles in a row. Now you understand why we stimulate the ovary and mature multiple eggs per IVF cycle. In some cases 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. The ovarian stimulation is a whole science and world in itself and there are many stimulation protocols.
This surgical procedure is normally performed while the woman is asleep, but can also be done while awake. Most of our patients undergoing natural cycles and mini-IVF do not need anesthesia. The egg retrieval is also known as oocyte aspiration, ovum pickup or simply "retrieval". A long needle is introduced through the vagina into the ovary with ultrasound guidance. 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 during the creation of a human embryo is the penetration of sperm into the egg. Only highly competent sperm are able to accomplish this task. Once sperm makes it inside, the male chromosomes will be delivered into the egg. This way the genetic material from the biologic father and biologic mother can fuse together. Some sperm an incapable of performing this task and need to be literally forced into the egg. This microinjection of sperm into the egg is called intracytoplasmic sperm injection (ICSI) treatment. It is used to treat severe male factor infertility to help individuals with very poor sperm count. This way, even a sperm showing very low motility can be used to fertilize the egg. Ther are over 5 million children born with ICSI procedure.
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 fertility clinics most sacred place since everything evolves about embryo well being. Skilled embryologists care about your embryo day after day. They observe and grade the embryo development from cleavage stage embryo to a fully expanded blastocyst. We will typically wait for 5-7 days until the embryo is ready for transfer. In addition to the optical assessment of the embryo, 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 placing your embryo back 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 an experienced fertility specialist will boost your 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.