In Vitro Fertilization (IVF)

About IVF

In Vitro Fertilization, is one of the most common and effective treatments for many people with reproductive complications. Several factors may necessitate proceeding to IVF, such as genetic diseases, medical history, issues with sperm or egg quality or quantity, recurrent miscarriage, and various other possibilities. The team at RMASoCal will closely monitor your IVF cycle to increase the chance of success.

An IVF cycle includes several important steps.

IVF Stages at a Glance

  • Ovarian Stimulation During the first eight to twelve days in the IVF process, patients will administer daily injections of several medications that stimulate your ovaries. The goal is to get the ovaries to produce multiple eggs without releasing them, during this stage, our medical team will monitor you very closely by means of repeated laboratory and ultrasound testing to ensure that the patient’s ovaries are responding to the medications. Once the eggs reach the proper size, a final injection of hCG (human chorionic gonadotropin) spurs the eggs to the final maturation stage. Doctor will retrieve the eggs 36 hours after the final injection.
  • Egg Retrieval Prior to the extraction of your eggs (known as the egg retrieval) you will be discuss whether or not you would want anesthesia sedation during the procedure. The egg retrieval process is quick and essentially painless and some patients prefer acupuncture instead of anesthesia.  The doctor will use ultrasound to guide the retrieval process. Once your eggs are extracted, they are sent to the IVF lab for the fertilization process. The retrieval process is minimally invasive and only takes about 15 minutes to complete, after the egg retrieval, you will rest in the recovery area, where a nurse will monitor you until you are discharged. Patients can go home the same day after recovery.
  • Extended Embryo Culture During the retrieval process it is the Embryologist who is responsible for not only your eggs but then creating your embryos.  The embryologist will most likely do the injection of the sperm into the eggs by means of ICSI (intracytoplasmic sperm injection).  The embryos will hopefully continue to grow in the IVF laboratory for five to six days until reaching the blastocyst state of embryonic development.  The blastocyst is the hollow mass of cells, that are comprised of 200 or more cells. At RMASoCal, we use an exclusive blastocyst stage culture IVF laboratory, and various scientific studies report that implantation rates are higher when implanting extended embryo cultures.
  • Embryo Transfer (ET)/ Frozen Embryo Transfer (FET) After another five or six days after reaching the blastocyst stage, the embryo is transferred back into the patient’s uterus. The procedure should be done with great care and usually takes between 10 to 20 minutes. Doctors perform the transfer under ultrasound guidance, to ensure proper placement of the embryos in the uterine cavity. If all goes well, the embryo will implant on the uterine wall and a healthy pregnancy will result. However, RMASoCal’s standard of care for all IVF patients involve FET. This process preserves the embryo for about 30 days until the patient’s hormone levels return to normal levels and the body is most ready to receive the embryo. FETs are scientifically proven to have higher implantation rates than typical ET procedures and lead to higher birth weights and lower risk of premature birth, which overall increases chances of a successful pregnancy.
  • Select CCS/ Comprehensive Chromosome Screening (CCS) as known as Preimplantation Genetic Screening (PGS) This is a more robust approach to embryo selection for IVF patients. Once your embryo cultures are made, RMASoCal staff will analyze them to determine which have the best chromosomal balance. Imbalanced embryos often lead to miscarriages or failed IVF cycles, and RMASoCal only uses The Foundation for Embryonic Competence, a non-profit reference lab, for embryonic screening.
  • Embryonic Biopsy Patients can opt-in for genetic screening. A small sample of genetic material is biopsied for analysis. Published scientific data reports that blastocyst stage biopsy at the trophectoderm layer of the embryo is safer than cleavage stage embryonic biopsy, and since 2012, RMA has only performed blastocyst stage embryo biopsies.

IVF Process Overview

Consultation and Workup

At RMASoCal we customize our treatment plans for each patient based on the factors of the patient’s infertility issues. After your initial testing and examinations which includes laboratory testing, ultrasounds, and uterine evaluation you will discuss with your doctor and start your IVF cycle.

Stimulation

The goal of the second stage of the IVF treatment is to harvest as many mature eggs as possible from the ovaries. During the last seven to ten days, patients will receive daily subcutaneous gonadotropin injections that stimulate the production of multiple eggs instead of a single egg normally produced each month. Our experts and nursing team will closely monitor the treatment progress using blood work and ultrasound. Once the eggs reach the appropriate size, a final injection of hCG (human chorionic gonadotropin) spurs the eggs to the final maturation stage and starts ovulation.

Egg Retrieval

An egg retrieval procedure will be scheduled 36 hours following the final injection. This is a 30 minute in-office procedure. You will discuss with your physician whether or not you would like anesthesia or even possibly acupuncture during the surgery.  Doctors will use an ultrasound probe to guide the needle into the follicles of the ovary to collect the eggs. Your physician will do their best to retrieve all ovarian follicles and the fluid is sent to the lab to count the number of eggs retrieved. Most women can return home after an hour or two following the procedure. Following retrieval, the patient starts injections or vaginal delivery of progesterone to prepare for the implantation of the embryo five or six days later.

Development

During this stage, eggs are mixed with sperm from the male partner or donor to start fertilization. After approximately 16-20 hours, the embryologist will check to see if fertilization has occurred. If male infertility is the issue, single sperm may be injected into each egg using Intra-Cytoplasmic Sperm Injection (ICSI). Your RMASoCal team will keep you updated as the embryos develop. After the embryos continue to rapidly divide and expand into the blastocyst stage, genetic testing can help determine the most viable embryos using the Select CCS platform. It is safe to biopsy the embryo to collect the genetic material required for testing. RMASoCal only uses blastocyst biopsy for the best possible results. After the development process is complete, patients return for the embryo transfer five to six days after the retrieval procedure.

Learn More About Select CCS.

Transfer

After the embryo development has been completed your physician will review the embryology data with you at the time of transfer.  Your physician and the embryologist will make their recommendations along as to which embryo to transfer. Using a catheter inserted through the cervix, your RMASoCal team will transfer no more than two of your embryos to the uterus using ultrasound for guidance. Thanks to effective embryo screening technologies, RMASoCal performs an increasing number of Single Embryo Transfer (SET) procedures today. Progesterone therapy continues for another 14 days following egg retrieval. We’ll confirm the pregnancy with a test, and if confirmed, you will continue progesterone treatment for another three to four weeks until your placenta produces enough progesterone on its own to sustain the pregnancy.

Learn More About Single Embryo Transfer (SET).

If you have any more questions about the IVF process, contact us today.