In Vitro Fertilization (IVF)
NOVA IVF has provided In vitro Fertilization treatments since its establishment in 1987, and has maintained a consistent success rate well above average in California, as well as nationwide.
In vitro fertilization is one of the most effective treatments available to achieve a pregnancy. The majority of couples at NOVA will have a 25 to 65% probability of a live birth, per IVF procedure/cycle at NOVA.
Indications for IVF:
- Tubal blockage/disease and pelvic adhesions.
- Male factor (low sperm motility, count or morphology)
- Azospermia (absence of sperm) – sperm aspirations are done at NOVA
- Endometriosis and idiopathic (unexplained) infertility
- Longstanding infertility (2 years or longer)
- Decreasing egg quality due to advanced maternal age (women over the age 39)
Process of In Vitro Fertilization
Below is an example of an IVF treatment sequence. Actual treatment is individualized.
All medications are given as pills, vaginal capsules or small subcutaneous injections just under the skin. All stages of this treatment take place in our clinic.
1. Ovarian Stimulation
To maximize the probability of a live birth, we use FSH (follicle stimulating hormone) and LH (luteinizing hormone) to stimulate production of multiple eggs (usually 6-14 eggs). These hormones are administered as subcutaneous injections.
During the 8 to 12 day ovarian stimulation, several ultrasound examinations and blood estrogen determinations are used to follow the development of the follicles. When the follicles have developed to the appropriate size, they are prepared for retrieval and a trigger medication is used to allow for the final maturation of the egg inside the follicle. In this final maturation step the egg gently lifts off the side of the follicle wall and floats in the middle of the follicular fluid on a small tether of cells.
The ultrasound image on the left shows fully stimulated ovaries. Each of the grape-like follicles (15 to 25 millimeters) contains a practically microscopic egg.
2. Egg Retrieval
Thirty-five to thirty-seven hours after the hCG injection, a non-surgical oocyte retrieval is performed at NOVA. This is typically a 3 to 7 minute procedure.
Using ultrasound guidance, a thin aspirating needle is passed through the top of the vagina into the follicles. Only the tip of the aspirating needle enters the pelvic area. Since the ovaries are located just above the top of the vagina, the tip of the needle is passed into the follicles without penetrating the uterus, cervix or the fallopian tubes.
If your infertility history suggests the possibility of a male factor significant enough to keep the eggs from being fertilized using regular laboratory methods, the ICSI procedure will be done on the eggs. ICSI or Intracytoplasmic Sperm Injection, is a micromanipulation technique in which a single sperm is inserted directly into an egg.
The next day, NOVA’s embryologist will examine the eggs for signs of fertilization. A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm (first image below).
The following day, embryos reach 4 cells, the day after, 8 cells and by day 5 after egg retrieval, they should reach the blastocyst stage.
4. Embryo Transfer
Two to five days after the egg retrieval, the resulting embryo(s) are transferred into the uterus by passing a thin embryo transfer catheter through the cervix to the top of the uterus. This procedure is always done under ultrasound guidance. This dramatically increases the chance of the embryo(s) implanting and causing a pregnancy. Sometimes the ultrasound will be transabdominal and other times it is better to be transvaginal, regardless of the method, embryos are never “blindly” placed into the uterus.
Extra embryos that are not transferred at this time can be cryopreserved and stored in liquid nitrogen.
5. Establishment of Pregnancy
Progesterone vaginal capsules are given for luteal phase support. A blood pregnancy test is scheduled approximately two weeks after the embryo transfer. A fetal heartbeat ultrasound is done two weeks after a positive pregnancy test.
This ultrasound picture shows an eight week pregnancy. The baby inside the sac is about an inch long, yet it is possible to already distinguish the head and the bottom portion of the baby’s body.