In-Vitro Fertilization (IVF) at WCFC in Orange County

In Vitro Fertilization has become a very important tool in the world of Assisted Reproductive Technologies (ART) allowing many couples to achieve their goals of having children.  Patients with severe endometriosis, blocked tubes, polycystic ovarian syndrome, male infertility, or unexplained infertility are excellent candidates for undergoing IVF.  Patients who are diagnosed with carrier state for a genetic disorder such as cystic fibrosis, sickle cell or Tay Sachs can benefit from IVF with PGD. In Vitro Fertilization involves combining the woman's oocytes (eggs) and the man's sperm using the method of ICSI in an embryology lab under the supervision of specialized scientists (embryologists).  Fertilization is defined as the union of a single sperm with a mature egg which is visually confirmed in our IVF lab. The fertilized eggs transform into embryos which are observed for 3 to 5 days followed by placement into the woman's uterus. Only a safe number of embryos are transferred to help avoid high order multiple births.

IVF usually consists of these five steps:

1. Ovarian Stimulation
   In a woman's normal menstrual cycle she will ovulate one egg every 28 days.  With the use of fertility medication, the amount of developing follicles can be increased depending on the medication and how herbody reacts. The treatment cycle typically begins in the first days of menstruation and the woman's ovarian response to the medication is followed closely. During the monitoring visits to our clinic, blood estrogen levels and ultrasound are used to check follicle growth. With daily growth, the egg develops inside the follicle for about 12days followed by the egg retrieval (aspiration). 

2. Egg Retrieval
   When the patient's follicles are determined to be mature, she is given human chorionicgonadotropin which prepares the mature eggs for retrieval. The eggs are then harvested byTransvaginal Aspiration (TVA) in our on-site certified Surgical Suite. The surgeon uses an ultrasound probe with a fine needle guided into each follicle under ultrasound control. As negative pressure is applied, the fluid and the egg are aspirated into a test tube which is immediately handed to the embryologist for identification and placement in an incubator. The TVA usually lasts about 30 minutes while the patient sleeps under the care of an anesthesiologist. Afterwards our patients are monitored for about 60 minutes by nurses specially trained in our on-site post anesthesia care unit (PACU).

3. Fertilization
   On the day of the egg harvest, the male produces a semen sample in our on-site Andrology Unit. The sample is processed under sterile conditions to remove the seminal fluid and dead sperms. Fertilization process involves placing about 40,000 viable sperms with each egg and left to incubate overnight. In other cases, a single sperm is injected into each egg (ICSI). Fertilization occurs 16 hours later and is defined as the appearance of the two nuclear bodies inside the now fertilized egg.

4. Embryo Culture and Selection
   After fertilization, each healthy egg transforms itself into an embryo as it is cultured in special incubators between 3 to 5 days. By day 3 of culture each embryo typically contains 6 to 8 cells. Our embryologists use a grading method to judge each embryo and decide which ones will be the best for an embryo transfer. Embryos are graded based on the number of cells, symmetry of growth and degree of fragmentation. 

5. Embryo Transfer
   On the day of embryo transfer Dr. Diaz meets with each patient to review the number and quality of embryos. Recommendation about the number to transfer involves multiple factors with the primary goal of achieving a singleton pregnancy that will proceed as safely as possible. It goes without saying that patient safety is our number one concern. During the transfer the embryos are placed in a thin, soft catheter and using vaginal ultrasound technique the embryos are carefully placed in the most favorable part of the uterus. The patient's family may view the transfer in a private observation room. After 30 minutes the patient leaves and rests quietly at home for three days. A blood pregnancy test is performed two weeks later. If healthy surplus embryos remain, they can be frozen in cryostorage for an indefinite time period.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

ICSI, which stands for intracytoplasmic sperm injection was developed in the mid-1980's and is a remarkable advance used in the treatment of severe male factor infertility. For our patients with very low sperm counts and low motility ICSI is recommended. Eggs are harvested in the usual manner however at the time of insemination, instead of adding thousands of sperm to each egg, our embryologist  selects a single high quality sperm to inject into each egg. We use a strict morphologic criteria as developed by Kruger.

The chosen sperm is drawn up into a microscopic glass needle. Under microscopic guidance, the egg is stabilized and the single sperm is injected using robotic manipulators. The sperm is placed into the fluid portion of the egg (cytoplasm) and the needle is withdrawn. Each egg is treated in a similar manner. After confirming fertilization the developing embryos are placed in special tri-gas incubators where they will be observed for 3 to 5 days. Our embryologists are highly skilled in the ICSI technique, achieving 95% fertilization rates.