To understand the pros and cons of IVF, it is important to understand the procedure. This method of achieving fertilization of eggs is used for non-male factor patients. A known concentration of washed motile sperm is added into culture dishes containing eggs. Eggs may be exposed to sperm for a few hours (the "Short exposure") or overnight (16-18 hours), during which time the sperm bind to the outer shell of the egg and penetrate through the shell to reach the egg membrane. Normally, a single sperm head fuses with the egg membrane and the sperm is gradually engulfed into the egg (this mimics the natural fertilization process). Average fertilization rates of 75% are achieved in our fertility center. If the prepared sperm or semen analysis shows suboptimal parameters, particularly when using cryopreserved sperm, but ICSI is not indicated, the sperm concentration used for insemination may be increased to enhance the fertilization rate.
IVF is simply the uniting of egg and sperm in vitro (in the lab). The embryos are then transferred into the uterus through the cervix and pregnancy is allowed to begin. The process is done inconjunction with ovulation induction through drugs, monitoring of hormone levels and follicle scans with ultrasound.
In most instances, all of the eggs (oocytes) will be inseminated 4-6 hours after egg retrieval. It is recommended that all healthy eggs be inseminated in order to maximize the chance of pregnancy. Since more embryos may develop than are used for the embryo transfer procedure, it is our policy to freeze (cryopreserve) any excess good quality embryos for a future attempt. If the couple does not wish cryopreservation (freezing) of embryos, then there is the option of limiting the number of eggs to be inseminated or freezing some of the eggs. (Note that at this time egg freezing is still considered experimental.) There are two methods of insemination: Conventional IVF or Intracytoplasmic Sperm Injection (ICSI).
Insemination For couples with a normal semen analysis and no history of low fertilization, antisperm antibodies or poor sperm survival, the laboratory will perform conventional IVF. This technique involves the addition of processed sperm to the eggs in a culture dish, allowing the natural process of sperm selection to take place. For patients with a borderline semen analysis, the laboratory will generally perform conventional IVF on at least some of the eggs.
Occasionally, fertilization with conventional IVF is unsuccessful and no eggs fertilize normally. There may be complete fertilization failure or abnormal fertilization (i.e. polyspermic fertilization where more than one sperm fertilizes an egg). Egg and/or sperm defects can cause fertilization failure. If a significant percentage of eggs fail to fertilize (i.e. there are too few fertilized eggs for a reasonable chance of pregnancy), ICSI may be performed on the unfertilized eggs the day after egg retrieval. There are only a few reports of pregnancies from eggs fertilized by ICSI on the day after retrieval. Immature eggs cannot be fertilized unless they complete the maturation process in culture. Some immature eggs require up to 24-36 hours in culture to mature. It is not unusual to observe “late” fertilization of such eggs up to 24 hours after insemination. However, the chance of a successful pregnancy from these late fertilized eggs is slim.
Intrauterine embryo transfers are routinely performed on day 2 or day 3 after oocytes retrieval (-48 or 72 h post insemination), although embryos may be transferred into the uterus at any stage between the zygote (day 1) and expanded or hatching blastocyst (day 5-6). Prolonging the culture period allows for selection of the better quality embryos, however, even if laboratory culture conditions are optimized there is the possibility of jeopardizing embryo viability by extending culture (particularly when there are only a few poor quality embryos). Thus, the day of transfer should be determined on a case-by-case basis taking into consideration number of embryos, embryo quality, patient age and patient history. Blastocyst transfers are generally limited to young women (<35 years old) or donor oocyte cycles with at least 10 oocytes and at least 3 good quality day 3 embryos.
Intracytoplasmic sperm injection (ICSI) is a laboratory procedure developed to help couples undergoing IVF due to male factor infertility. It has been performed routinely by many IVF programs throughout the world since 1993. ICSI is used to achieve fertilization of eggs when routine insemination of eggs with sperm is not possible or unlikely to result in a satisfactory fertilization rate. It is no longer considered an experimental procedure and appears to be a safe and effective therapy for the treatment of male factor infertility.
ICSI is a technique in which a single sperm is injected directly into a mature egg using a glass needle (pipette). The technique requires laboratory staff to be able to retrieve live sperm after semen processing. This technique can be adapted successfully for men with extremely low sperm counts (less than 0.5 million per ml). It is preferable, however, for the sperm used for ICSI to exhibit at least some motility. In cases where no motile sperm are observed on the semen analysis, a surgical sperm extraction procedure (testicular or epididymal) may be recommended.
People seeking San Diego IVF services will find that at Reproductive Sciences Center, ICSI is performed only when there is a medical indication for doing so, such as an abnormal semen analysis, previous poor fertilization with conventional IVF, unexplained infertility, and in conjunction with testicular and epididymal sperm extraction. ICSI fertilization rates generally range from 50% to 80% of injected eggs depending on both egg and sperm quality. Certain couples achieve consistently low ICSI fertilization rates (less than 30%) and they may be candidates for assisted oocyte activation with ICSI (an experimental technique that may enhance fertilization rates).
Inseminated eggs are assessed for fertilization on the morning following egg retrieval (day1). Normal fertilization is confirmed by the presence of two pronuclei (2PN) in the center of the egg. One pronucleus arises from the egg, and one from the sperm that penetrated the egg. The 2PN fertilization rate with conventional IVF and ICSI is approximately 70%. These figures are averages, and vary considerably from couple to couple. Although ICSI can overcome extremely severe sperm abnormalities, egg quality is an important factor in the success of ICSI fertilization. Problems with either egg or sperm quality may lead to a decreased number of eggs being fertilized. In rare instances, there may be a complete failure of fertilization of eggs.
Once normal fertilization is noted, the embryo is then maintained in culture in the incubator until embryo transfer or cryopreservation.
Some eggs may fertilize abnormally, with the most common abnormality being fertilization with more than one sperm. Such polyspermic (3PN) fertilization cannot lead to normal embryos, and therefore these embryos are discarded.
Another variant of fertilization commonly observed is the appearance of a single pronucleus (1PN). If eggs have been inseminated by ICSI, these eggs are considered abnormal, and cannot be used. If eggs were inseminated by conventional IVF, these eggs may be genetically normal, and can be maintained in culture separate from normally fertilized eggs. If the fertilization rate after insemination is low, the laboratory may attempt to perform “rescue fertilization” with ICSI. Pronuclear stage embryos (zygotes) are scored based on the appearance of the pronuclei. This information is used along with cleavage-stage morphology to select out suitable embryos for transfer and freezing.
Our fertility specialists at The Reproductive Sciences Center, or RSC, are conveniently located in La Jolla California in San Diego County. We have worked hard to create and maintain our reputation as the first-rate San Diego fertility clinic and sciences center. RSC has become synonymous with comprehensive and successful female and male infertility treatment, egg donor programs and surrogacy options, in vitro fertilization, ICSI and more.
While we have provided services to hundreds of patients throughout the Temecula, Murrieta, La Jolla, Riverside,San Bernardino and Encinitas areas, we also help many people from across the United States, Europe, Australia , Asia, Africa and the Americas who make us their final destination for treatment with infertility in San Diego. We lead the area as one of the leading fertility centers in the world.
Our fertility center has long been established as having one of the highest fertility success rates in the world, and with more than 75 years of combined medical training, experience and ongoing continuing education, our fertility specialists set the bar for the industry. Our medical director and leading fertility doctor is one of the most well-respected experts in the world.
Successful fertility treatment in San Diego is only possible with the best fertility specialists and staff in OrangeCounty. We have been providing unsurpassed treatment for infertility in San Diego, including IVF (In Vitro Fertilization) and other San Diego fertility services in La Jolla for more than a decade.
Some of our successful options for fertility treatment in San Diego include natural fertility treatment, advanced fertility treatment, IUI (Intrauterine Insemination), San Diego In Vitro Fertilization (IVF), ICSI for severe male infertility, genetic testing, embryo donation, blastocyst transfers, assisted hatching, and more. We are the top professionals of fertility options for women with cancer and fertility options for men with cancer in San Diego as well.
You can find patient testimonials, interviews, news features and personal stories about our San Diego infertility treatment programs on the Internet by searching for: Dr. Wood, Dr. Sam Wood, Dr. Adams, La Jolla fertility clinic, San Diego egg donors, fertility San Diego, fertility specialists, IVF clinic, ICSI, male fertility clinic and fertility clinic.
Everybody makes a typo here and there, right? Searching the internet is no different. As a result, sometimes our patients find us by typing: ferility, inferility, fertility centre, fertilty, infertilty, micscarriage, miscarraige, fertiliy, infertiliy, fertilitydoctors, clinicfertility, ferlity, and inferlity. Doctor Wood sometimes has his name spelled as Dr. Woods.