Exploring IVF: Do Not Let Infertility Hold You Back
Issues with fertility can be incredibly difficult as they prevent you from building or growing your family.
At the Center for Fertility and Gynecology, we offer advanced in vitro fertilization (IVF) services to help you overcome infertility.
Find out more about IVF at our fertility clinics serving Los Angeles, CA, Tarzana, and Bakersfield...
Learn more about IVF from our caring doctors...
Modern Advancements Have Made IVF Highly Successful
Why do we recommend IVF?
Other Concerns Addressed by IVF
Inheritable Genetic Diseases
You are certainly a potential candidate for IVF if you or your partner is at increased risk of passing on an inheritable genetic disease. Often, couples are aware of a potential genetic problem and seek help before attempting to conceive. The IVF process can include PGT-M (PGD) so abnormalities can be detected prior to placing an embryo in the uterus. For some patients, PGT-M (PGD) is vastly preferable to other prenatal screening tests that are performed farther along in pregnancy.
Some patients may choose to combine IVF and PGT-M (PGD) to screen their embryos before returning them to the mother’s womb. Using PGT-M (PGD), we are able to examine the genetic content of each embryo and determine if an embryo is genetically normal or not.
Some couples don’t have trouble conceiving, but struggle with multiple miscarriages. This condition can be especially frustrating and emotionally devastating; fortunately, depending on the cause, it can be treated with a variety of modalities including IVF. If you have experienced more than one pregnancy loss, an evaluation can help determine the cause. In some cases, genetic (DNA) abnormalities are the issue, and IVF combined with pre-implantation genetic diagnosis PGT-M (PGD) can help identify the best embryos for transfer into the womb.
So how do you know if you are a candidate for IVF?
If you decide to pursue IVF, your choice of doctor matters...
Why Choose Us?
The IVF program at the Center for Fertility and Gynecology (CFG) is second to none. We have five conveniently located offices serving Los Angeles, Tarzana, and Bakersfield. Our many years of experience along with talented staff members and a state-of-the-art laboratory have resulted in exceptional pregnancy success rates and consistently high patient satisfaction.
Dr. Michael Vermesh and Dr. Tannaz Toloubeydokhti perform all aspects of IVF, including intracytoplasmic sperm injection (ICSI), assisted hatching, pre-implantation genetic diagnosis PGT-M (PGD), oocyte (egg) freezing, oocyte (egg) donation, and gestational surrogacy. In addition to these more traditional methods, we also offer some unique treatment modalities, including ZIFT and GIFT.
"We are repeat customers"
Leaders in the Field: Our IVF Success Rates
In vitro fertilization (IVF) success rates at our infertility clinic are consistently among the best in the nation. In fact, we’re especially proud of our results because of our unique treatment philosophy. Simply stated, we don’t screen our patients. Many clinics are careful to weed out particularly difficult cases, refusing treatment to some patients and laying the groundwork for inflated success rate statistics. To us, this doesn’t seem right. We strive to help each of our patients achieve the dream of parenthood, so you won’t be turned away if your condition is considered “complex” in order to improve our numbers. Instead, we offer hope to prospective parents who have decreased ovarian reserves, or who have failed elsewhere and are considered to have low chances of having a baby. Our success rates are particularly impressive in light of our refusal to stack the deck in our favor.
You can learn more about achieving your goal of parenthood during a consultation at our practice. Reach out to us today to schedule an appointment at any of our five locations throughout Los Angeles, Tarzana, and Bakersfield.
The Measure of Success
There are no iron-clad guarantees of IVF or other infertility treatments’ success. However, ongoing advancements in the field have led to a dramatic increase in success rates since the technique was introduced in the late 1970s, and there is a good chance you can become pregnant with fertility assistance.
IVF, which involves laboratory cultivation and transplantation of embryos, is a delicate procedure that requires a high degree of skill and years of experience. Our physicians have been performing IVF and other infertility treatment procedures for more than 30 years. This vast experience and knowledge of this field contribute to an impressive record of results.
The History of IVF
In Vitro fertilization is a procedure in which the sperm and embryo are united in the lab. IVF is probably the most well known of the "Assisted Reproductive Technologies." It was developed as a way of bypassing the fallopian tubes in order for a fertilized oocyte (egg) to gain access to the uterus. The first in vitro fertilization or 'test tube" baby was born in 1978 and in 1981 the delivery of the first IVF pregnancy in the United States was announced by Howard and Georgianna Seegar-Jones.
Over the last two decades IVF success rates have dramatically risen. With lab improvement and culture media changes, the rates have increased to over 50% in women under 37.
The possibility of continuing pregnancy cannot be predicted for any one patient as it depends on many variables-age, reproductive health of both parents, etc. However, the possibility of continuing pregnancy being achieved by IVF has improved from practically zero to one in 4 to 6 at IVF centers worldwide.
In Vitro provides many people with the opportunity to attempt pregnancy in the face of one or more factors that may otherwise decrease their chances.
How IVF Benefits Hopeful Parents
The greatest benefit of IVF treatment is that it gives hopeful parents in Los Angeles, Tarzana, and Bakersfield a wealth of options in growing their families:
- The ability to overcome a variety of fertility issues: IVF treatment can help patients overcome a number of infertility problems, including male factor infertility, damage or blockages in the reproductive tract, ovulation disorders, and unexplained infertility.
- Opportunities for non-traditional families: IVF can use donated eggs and sperm, so families of all kinds are able to conceive with this treatment. At the Center for Fertility and Gynecology, we are happy to help hopeful parents in non-traditional families experience parenthood.
- Avoid passing on certain genetic conditions: We can employ a technique called preimplantation genetic diagnosis PGT-M (PGD) to screen embryos for genetic disorders and chromosomal abnormalities. This allows our laboratory technicians to select the healthiest embryos for implantation in the mother's uterus.
- Egg preservation: As a woman grows older, the viability of her eggs decreases. IVF gives women the option to freeze healthier eggs when they are younger. The eggs can then be used during an IVF cycle at some time in the future when they feel ready to have a child.
- Post-menopausal opportunities: By either using her own banked eggs or donor eggs, IVF treatment provides the opportunity for a post-menopausal woman to conceive and carry a child.
- Outstanding success rates: IVF consistently provides the highest success rates of all ART treatments. IVF success rates are higher in patients under the age of 35, but patients in their late 30s and 40s can also conceive with IVF.
What Happens during IVF?
The IVF process is composed of four steps:
- Step # 1: Over a 2 week period, fertility medication stimulates the ovaries to produce multiple eggs. During this time, serial ultrasounds and blood work are employed to monitor the growth of the eggs. This step is referred to as ovarian stimulation or "superovulation".
- Step # 2: When the eggs are appropriately mature based on ultrasounds and blood work, the final signal is given with an injection of Human Chorionic Gonadotropin ( HCG) known as the "trigger shot".
- Step # 3: 36 hours after the trigger shot, the eggs are retrieved by an ultrasound-guided-needle aspiration. This procedure is usually performed under anesthesia. At the same time, a sperm specimen from the partner/donor is obtained and prepared. Washed sperm is then injected into the eggs (ICSI), or placed in a dish with the eggs to allow fertilization. After 18 hours, the eggs are checked under a microscope for evidence of fertilization (the pronucleus of egg and sperm). The eggs are now embryos. The embryos are then incubated for further development into multi-cell embryos.
- Step # 4: One to five days later, the embryos are transferred into the fallopian tubes (in the case of a ZIFT) or the uterine cavity via a catheter inserted through the cervix. The number of embryos transferred varies based on patient age, quality of embryos and patient desire. If additional embryos remain, they can be frozen and stored for future use.
IVF Begins with Ovulation Induction
Superovulation, or ovulation induction, is the first stage of in vitro fertilization. It increases the likelihood of conception, and gives doctors the ability to select only the healthiest eggs for fertilization. At the Center for Fertility and Gynecology offices in Los Angeles, Tarzana, and Bakersfield, we accomplish ovulation induction through the use of different medications and hormones. Dr. Vermesh and Dr. Toloubeydokhti will perform a thorough evaluation and determine the appropriate dosage and treatment plan for you.
Medications Used to Achieve Ovulation Induction
No two patients' needs are the same, and IVF can be customized to meet different needs. Dr. Vermesh or Dr. Toloubeydokhti will determine which fertility medication is most appropriate for you. Common medications include:
- Clomiphene citrate - Clomiphene citrate is an oral medication that stimulates the ovaries by blocking estrogen receptors. Your body interprets this as having low estrogen levels and compensates by producing more follicle-stimulating hormone (FSH), which causes superovulation.
- Human menopausal gonadotropin - Human menopausal gonadotropin (hMG) is a fertility medication composed of FSH and luteinizing hormone (LH). These hormones naturally induce ovulation, and when taken in greater amounts, they can induce superovulation. The hMG hormone is injected, and the dosage will vary among patients.
- Follicle-stimulating hormone - FSH can be administered with or without LH to induce ovulation. Some patients only require FSH for ovarian stimulation. FSH is administered in injectable form.
- Human chorionic gonadotropin - Human chorionic gonadotropin (hCG) is a natural hormone that is administered 36 hours prior to egg retrieval. It is also known as the trigger shot because it causes the release of the eggs from the follicles. The hCG shot also encourages the body to release progesterone and prepare the lining of the uterus for implantation of a fertilized egg.
- Leuprolide and synthetic gonadotropin inhibitors - These medications work by inhibiting the release of FSH and LH, and eliminate the possibility of a premature surge of LH, which could cause the eggs to be released early.
During your treatment, your doctor will monitor the effect of the medication with blood tests and ultrasounds to determine the optimal time to deliver the trigger shot of hCG. Approximately 36 hours after the trigger shot, egg retrieval can begin.
In most cases, patients who take ovulation induction medications do not experience adverse side effects. However, these medications can cause ovarian hyperstimulation syndrome, a condition in which the ovaries become swollen and painful.
Egg Retrieval through Ultrasound-Guided Aspiration
When the eggs have matured, a "trigger shot" is administered to stimulate their release from the follicles. We perform technologically sophisticated, minimally invasive egg retrieval.
The Egg Retrieval Procedure
Our doctors employ a technique called ultrasound-guided needle aspiration to harvest the mature eggs at the appropriate time. This procedure is performed under anesthesia to ensure your comfort and safety. During your surgery, Dr. Vermesh or Dr. Toloubeydokhti will direct a needle, which is guided by ultrasound imaging, through the vagina and into the ovaries.
Once the ovaries have been accessed, the needle punctures the mature follicles and draws out the fluid and eggs. Our fertility specialists will then select the healthiest and most viable eggs to prepare for fertilization.
The entire procedure can typically be performed in under 30 minutes, and your doctor can retrieve multiple eggs during this stage of treatment. The retrieved eggs can be frozen and saved for future use, or prepared for fertilization in our laboratory. A few days after the egg retrieval procedure, patients will return to our office for the embryo transfer portion of the IVF process, or the embryos are frozen for future use.
After Your Egg Retrieval Surgery
Most patients do not have any significant pain following their procedure, and only experience minor discomfort that can be managed with over-the-counter pain relievers. Dr. Vermesh or Dr. Toloubeydokhti may prescribe additional pain medications to ensure your comfort. You will also be given a series of medications that will prevent infection and reduce inflammation to promote a faster recovery. Your doctor may also prescribe hormone supplements that will support the endometrial lining following the procedure. Patients generally do not require any significant downtime after the procedure, and can typically return to their normal routines later that day.
Advanced IVF Fertilization
When patients undergo IVF fertilization at our practice, skilled fertility technicians select the healthiest sperm and eggs to maximize the chances of conception.
After retrieving sperm from a partner or donor, the sample will be prepared. This involves the removal of chemicals that can interfere with implantation, and the separation of the sperm from the seminal fluid to improve the fertilization capabilities of the male sample. Once the sample has been prepared, the healthiest sperm will be selected and placed in a laboratory dish with an egg to facilitate fertilization.
Intracytoplasmic Sperm Injection (ICSI)
If the male partner has fertility issues such as poor sperm motility, we can perform a procedure called intracytoplasmic sperm injection (ICSI). ICSI is a relatively new technique where a specially designed glass needle (micropipette) is used to inject a single sperm into a single egg.
Intracytoplasmic sperm injection, known as ICSI, Originally, ICSI was used in cases of severe male factor infertility, where fertilization could not occur on its own. Over the past few years, however, its indication has expanded to include cases where there are a limited number of eggs, a history of failed fertilization and following sperm or oocyte cryopreservation. At CFG, our embryologists are experts in the micromanipulation required to successfully perform ICSI. This is evident in our outstanding fertilization rates. Below is a microphotographic (magnified 300X) depiction of the ICSI procedure.
ICSI is one of many tools your reproductive endocrinologist can utilize to help you become pregnant. Like any procedure
ICSI has helped many couples conceive, and Dr. Vermesh or Dr. Toloubeydokhti can determine if it is appropriate for your case. For more information, please contact us at any time.
Photographs of ICSI Explained
TOP: A human oocyte (egg), held in place by a
MIDDLE: The micropipette has entered the oocyte and is injecting the spermatozoon.
BOTTOM: The micropipette is removed with the spermatozoon left in place (arrow points to the spermatozoon). (300X magnification)
Assisted hatching involves creating a small "window" in the wall surrounding the embryo. This process allows the embryo to "hatch" or "exit" the Zona Pellucida and implant in the uterine lining. The gap in the wall can be made using either chemical (acid), mechanical or laser methods.
Pre-implantation Genetic Diagnosis
After fertilization has occurred, the embryos become eligible for pre-implantation genetic diagnosis PGT-M (PGD) testing. This technique allows us to screen for genetic conditions and chromosomal abnormalities. When the embryos are five days old, PGT-M (PGD) can be performed by removing several cells for analysis. We can then test for an abnormal number of chromosomes and conditions that are caused by single gene defects. PGT-M (PGD) can also be performed to determine the sex of embryos.
After the cells are removed, our technicians employ various techniques to analyze the genetic makeup of the embryo. Using all of the information gathered during testing, we are able to select the healthiest, most viable embryos for transfer into the uterus. Numerous studies have shown that PGT-M (PGD) is a safe and effective procedure, and can greatly benefit hopeful parents who are carriers of genetic conditions that they do not want to pass on to their children.
Embryo Transfer: The Final Step in IVF Treatment
The final step in an IVF cycle is transferring the healthiest and most viable embryos to the mother's uterus for implantation. Three to five days after fertilization has occurred, the embryos can be tested for genetic defects, chromosomal abnormalities, and gender using PGT-M (PGD). This is an optional technique that allows our fertility specialists to select the most suitable embryos for transfer.
The transfer procedure will typically take place two to four days after fertilization has occurred, when the embryos have between two and eight cells. Your doctor will determine how many embryos to transfer to increase the likelihood of successful implantation and pregnancy.
The embryo transfer procedure can be completed in less than 20 minutes. Using ultrasound imaging as a guide, the doctor will introduce the predetermined amount of embryos through the vagina and cervix and into the uterus with a small catheter. Anesthesia is generally not required, and there is little pain or discomfort during and after the procedure.
Once the embryo transfer is complete, patients are encouraged to rest for the remainder of the day. For the next few days, our physicians recommend that you take supplemental progesterone or other medications to increase the chances of successful implantation.
Elective Single-embryo Transfer
Some patients may be candidates for elective single-embryo transfer (eSET). The embryos are allowed extra time to develop in the laboratory. When more cells develop, the embryo becomes a blastocyst, which has higher implantation rates. This higher rate of implantation allows our doctors to only transfer one blastocyst rather than multiple embryos.
ZIFT and GIFT
For patients who suffer from cervical obstructions or stenosis, or have had multiple failed IVF attempts, we can perform a zygote intra-fallopian transfer (ZIFT) or gamete intra-fallopian transfer (GIFT). These techniques involve the fertilized egg being transferred to the fallopian tube rather than the uterus. In the GIFT technique, the sperm and egg are mixed, and immediately transferred to the fallopian tubes. In ZIFT, the fertilized eggs (or zygotes) are transferred within 24 hours. Our team will help you decide which technique will give you the best chances of becoming pregnant.
Frequently Asked Questions about What Happens after IVF
Do you have questions about Invitro Fertilization and the days and weeks after the actual procedure?
At the Center for Fertility and Gynecology in Los Angeles, Tarzana, and Bakersfield, we help couples become loving parents through several conception methods, including in-vitro fertilization (IVF). We will be with you every step of the way to help create a loving family. While each patient is different, and your doctor can give you a more specific answer, here is what you can expect to hear based on some of our most common post-procedure questions
After the invitro procedure, how long until we can again have intercourse ?
While there is no definitive answer, most medical professionals recommend abstaining from sexual intercourse for up to three weeks after IVF. Alternatively, intercourse up to the night before the procedure is acceptable, and even recommended by some doctors that believe it helps increase the chances of conception.
Are there potential complications after the procedure?
About twenty percent of all pregnancies are lost, regardless of how they are conceived, so that is always a possibility. Additionally, a very small percentage (less than 1%) of IVF pregnancies result in what's called an ectopic pregnancy. This is where the eggs implants outside of the uterus. As with most medical procedures, bleeding and infection is a mild concern, as well as possible allergic reaction to any medications used. Your doctor will be able to give you a more complete list of what to look out for following the procedure.
Why choose a fertility clinic for artificial insemination?
There are many advantages to choosing the medical assistance and supervision of a fertility clinic over home insemination. A mother's health and safety is the number one concern of any fertility center. They have the tools and knowledge to ensure that sperm is properly tested to remove the risk of transferring sexually transmitted diseases. Without medical supervision, like in the case of home insemination, there is a chance of injury, which can cause even more problems with conception.
How long until I can resume my normal activities?
Most doctors agree that a patient that receives IVF should be sedentary for at least 24 hours after embryo placement, until regular activities should resume. As for especially strenuous activities, like jogging, swimming, etc - these should be avoided until pregnancy is confirmed.
Do I need special testing done later?
Regular prenatal care is essential for good health in both the mother and baby, but no special testing is needed for pregnancies from invitro fertilization. The Center for Fertility and Gynecology will ensure that you receive the best care following your procedure.
Will I experience pain afterwards?
Most women experience little or no pain at all during the procedure itself, but there are cases where some feel soreness in the vagina or lower stomach. Vaginal spotting is also common one or two days following.
IVF Treatment Cost
At the Center for Fertility and Gynecology our aim is to provide innovative and progressive fertility treatments at reasonable prices. As part of this mission, we have implemented new pricing for in vitro fertilization, making the most advanced treatments more affordable than ever for families in Los Angeles, Tarzana, and Bakersfield.
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Some of the benefits of using Prosper Healthcare Lending for financing your fertility treatment include:
Financing ANY fertility or surrogacy treatment related expenses, including medication
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Understanding In Vitro Fertilization Risks
As with any other medical procedure, IVF has risks. These risks are uncommon but should be mentioned.
Ovarian Hyperstimulation Syndrome (OHSS)
This condition is a result of the stimulation of the ovaries with fertility drugs. Following retrieval of the eggs, the ovaries may become swollen and painful. Typical symptoms of mild to moderate OHSS include bloating and nausea which may last a week. Pregnancy may aggravate the symptoms and their duration. Severe OHSS may be associated with abdominal pain, vomiting, decreased urine output, shortness of breath and rapid weight gain due to water retention. The physicians at the Center for Fertility & Gynecology, Los Angeles have extensive experience in the prevention and management of this condition.
The risk of miscarriages after IVF appear to be similar to that of women who conceive naturally. In fact, the risks may be lowered by performing PGT-M (PGD)/PGT-A (PGS).
The risk of multiple births (twins, triplets, etc.) is directly related to the number of embryos transferred to your uterus. We recommend that only one or two embryos be transferred to avoid multiple births and the higher risk of early labor and low birth weight.
In a small percentage of IVF procedures (1-3%) the fertilized egg may implant outside of the uterus usually in the fallopian tube. In such
Retrieval of the eggs from the ovaries is performed with a needle under anesthesia. Complications are rare and include bleeding, infection
There is controversy whether IVF specifically increases the risk of having a baby with birth defects. In general, the age of the mother is the primary risk factor for birth defects. Performance of (PGT-M (PGD)/PGT-A (PGS) may help in reducing certain chromosomal/genetic abnormalities.
During your consultation at our Los Angeles, Tarzana, or Bakersfield offices, our doctors will fully inform you on the risks.
The Center for Fertility and Gynecology
The Center for Fertility and Gynecology has been providing comprehensive fertility services since 1987. We use innovative techniques to achieve some of the highest pregnancy rates nationwide. Dr. Michael Vermesh and Dr. Tannaz Toloubeydokhti are proud to be affiliated with a range of prestigious organizations, including:
- The American College of Obstetricians and Gynecologists
- American Society for Reproductive Medicine
- Society for Reproductive Endocrinology and Infertility
For more information about our services, contact us online or call (818) 881-9800 today.