Los Angeles Fertilization Services

A full range of fertility services can be found in the Los Angeles area. Some services include: In Vitro Fertilization- Embryo Transfer, Tubal Transfers, Preimplantation Genetic Diagnosis (PGD), Intracystoplasmic Sperm Injection (ICSI), Sex selection, Assisted Hatching, Egg Donation- Surrogacy, Intrauterine Insemination, Conception for Non-traditional Families, Tubal Reversals, and Ovulation Induction.

In Vitro Fertilization:

IVF-ET is probably the most well known of the "Assisted Reproductive Technologies". It is otherwise known as "test tube baby", and has helped infertile couples conceive and bear children for over two decades. These days, fertilization actually occurs in a dish, and not a test tube. It was originally developed to help couples overcome tubal factor infertility, but has become useful in treating other factors, such as immunological problems, unexplained infertility and male factor infertility.

IVF is basically a four step process.

First, you take medications to make multiple follicles begin to develop on your ovaries. This step is referred to as ovarian stimulation, or superovulation.

Step two involves monitoring follicular growth by ultrasound, to determine egg growth and uterine lining development. When it is determined that the follicles and the uterine lining are appropriately mature, a trigger shot of Human Chorionic Gonadotropin is then administered.

36 hours after the trigger shot, the third step begins with retrieval of the eggs by ultrasound-guided-needle aspiration, an in-office procedure. A sperm specimen is then washed and prepared for insemination. The washed sperm is then placed in a dish with the eggs, and they are placed in an incubator for 18 hours. After 18 hours, the embryos are observed for normal fertilization, under a microscope, where the pronucleus of egg and sperm can be seen. The embryos are then incubated for further development into multi-cell embryos.

The fourth and final step involves transferring the embryos into the uterine cavity via a catheter inserted through the cervix. The number returned varies with the desires of the patient, under the guidelines of age categories; under 35 years old, up to three embryos; 35-40 years and older, up to four embryos. Additional embryos may be frozen and stored for future use.

Preimplantation Genetic Diagnosis:

Some doctors use PGD to analyze an embryo’s DNA so parents can choose to have a male or female placed in the womb. Last year, a survey found that 1 of every 11 Pre-Implantation Genetic Diagnosis treatments was for sex-selection alone. The study by Johns Hopkins University also found that 42 percent of clinics offering PGD offer it for sex selection. PGD involves screening the embryos created during an IVF cycle BEFORE they are returned to the uterus. A single cell is removed from the embryo and the genetic material is examined to screen for abnormalities. Particularly useful for couples with a known history of genetic disease, this early screening of embryos allows only embryos without known genetic defects to be returned to the uterus. Some of the diseases which may be screened out with this procedure include Downs Syndrome (Trisomy 21), Cri du Chat (Trisomy 18), Tay Sachs disease, Huntington's disease and cystic fibrosis as well as many X-linked diseases. PGD may also be used to look for chromosomal aberrations as an explanation for repeated miscarriage and/or failed previous IVF cycles.

Tubal Reversals:

This is a procedure performed on women who have had their tubes "tied," and is their only cause for infertility. Tubal ligation reversal (reanastomosis) is a surgical procedure, which can restore the function of fallopian tubes after tubal ligation. Pregnancy rates in the range of 70% are achieved. The physicians participating in this website have been subspecialty trained, and are Board Certified, in Reproductive Endocrinology and Infertility.

Reversal operations are performed using microsurgical techniques, in which loupes (special magnifying eye glasses) are used to visualize and reconnect the tiny hollow center portion of the fallopian tubes. Microsurgery also uses suture finer than a hair, the smallest possible incisions (approximately 3 inches), micorsurgical instruments and non-traumatic tissue handling techniques. Patients go home the same day.

Cost is a major factor to be considered, because tubal reversals usually are not covered by insurance.

Ovulation Induction - Gonadotropins

Follistim, Gonal-F, Bravelle, Repronex, Menopur - These compounds are human hormones produced by the pituitary gland (LH and FSH) and are used to stimulate ovarian follicular development. They can be urinary, meaning they are extracted from the urine of postmenopausal women; or recombinant, meaning they are produced by bacteria that are genetically altered to produce LH and FSH specifically.

These drugs can't be ingested orally, and are therefore administered by injection. Hormone injections are administered subcutaneously in most cases. Occasionally, intramuscular administration is necessary.

Injections usually begin on day 3 of the menstrual cycle and continue for several days until the developing follicles are approximately 16-20 millimeters in diameter. Daily dosage, and the length of time needed for adequate stimulation, varies from patient to patient, and from cycle to cycle. Most patients will receive injections for 7-8 days.

During the stimulation with these gonadotropins patients are monitored closely with ultrasounds and estradiol levels.

These compounds are used in women who do not ovulate, or did not respond to clomiphene citrate (CC), or to produce multiple follicles for insemination or an ART procedure such as in vitro fertilization.

An injection of hCG is given to cause ovulation when ultrasound and estrogen measurements indicate appropriate follicular development. All of these compounds are excreted from the body and will leave no long lasting effects on the menstrual cycle. Remember these hormones are naturally produced by the pituitary gland, they are chemically the same, they are not synthetic (man-made) like CC. Dosages are adjusted based upon a myriad of factors, including but not limited to the patient's response to treatment, age, appearance of her ovaries, and her medical diagnosis.

Potential other side effects can include: ovarian cysts, nausea, vomiting, diarrhea, abdominal cramps, bloating, weight gain (usually mild), irritation at the injection site, and multiple births.

Multiple births occur about 20 to 25% of the time.

Failure to adequately monitor and adjust dosage can lead to a very serious condition, ovarian hyperstimulation syndrome (OHSS). This syndrome is characterized by ovarian enlargement, followed by abdominal pain, abdominal distention, weight gain, circulatory problems, sometimes requiring hospitalization. OHSS can be very serious. Therefore once a patient start on a regimen of gonadotropins it is very important that they follow the physician and nurse coordinator's instructions.

 

More info on:

• Choosing Your Baby's Sex
• In Vitro Fertilization Procedures
• Ovulation Induction