Male Fertility Specialists in San Diego

Many couples wonder what is in-vitro fertilization (IVF). This is a basic understanding of what happens. IVF is a process by which the fertility information-bearing cells (germ cells) are removed from the bodies of both male and female and then brought together through one method or another and then placed back in the female once fertilization has occurred.

In the female, all the eggs she will ever have are created inside her body while she is still in the womb of her mother. There are approximately half million or so eggs. The eggs develop almost to the point of being able to undergo fertilization, and then put into a state of suspended animation for many years until the female goes through puberty and with each month’s menstrual cycle some eggs start the process of developing the rest of the way under the control of a hormone named FSH (follicle-stimulating hormone). Approximately a dozen or so cells hear the message from FSH each month and start the process, but typically only one will fully respond to that message and the others involute or die off. The cell that does fully respond to FSH becomes ripe, is expelled from the ovary, and moves into the fallopian tube where it waits for sperm to come fertilize it.

In the process of IVF, it would be very inefficient to only have one egg available to attempt fertilization. Therefore, the female is given very high amounts of FSH to try to stimulate many eggs to become fully ripe. These eggs or follicles are followed and the egg ripening is closely controlled by the reproductive endocrinologist so that a target number of eggs are all fully ripe at the same point in time. Typically, the reproductive endocrinologist would shoot for 10 to 18 eggs as an optimal number. Too many eggs, and the female may hyperstimulate, which creates other problems and oftentimes leads to less healthy eggs. Too few, and the chances are lower that fertilization and pregnancy will occur. In any event, these eggs are all removed at once through the vagina using a very small needle and then they are brought together with sperm in the test tube (“in vitro”) as opposed to in the body or (“in vivo”).

The most powerful form of the in vitro process is intracytoplasmic sperm injection (ICSI). With ICSI instead of a large number of sperm to try to create fertilization, only one sperm per ripe egg is injected into the cytoplasm of the egg, thus the name intracytoplasmic sperm injection. To understand the anatomy of this, you could consider a chicken egg. If we break open a chicken egg, the yellow or yolk is the part that contains the DNA. All the clear fluid surrounding it is the cytoplasm. In the process of ICSI, the sperm is injected into the cytoplasm, and then the DNA within the sperm mingles with the DNA in the yolk of the female oocyte (egg) and approximately 70% of the time fertilization occurs.

Once fertilization occurs, these new cell masses are following in the IVF laboratory for approximately three to five days. By five days the cells have typically reached the blastocyst stage. Depending on what the couple had chosen, the cell masses are evaluated at the three to five-day stage and the decision is made as to how healthy they look and whether they will be able to survive the fresh embryo transfer (FET) and implant into the female’s womb and truly become a pregnancy. Anywhere from one to three embryos are typically transferred, and again this is a very personalized decision that varies for each and every couple and their particular situation. The more embryos that are transferred, the higher the likelihood that a pregnancy will occur. However, along with this there would be a higher likelihood that multiple gestations may occur with transferring higher numbers of embryos. The expected take-home baby rate with a single cycle of IVF varies largely from as low as 2 to 3% up to 70% in accordance with many factors, mostly female factors with age being the most important. Each program has different success rates with different concerns, but again across the board female age (egg age) is a critical factor.

Even though the best embryos are chosen for the initial fresh embryo transfer (FET), there may still be some left that have adequate quality for freezing. If this is the case, once these embryos are frozen they can last for a significant period of time, even years, much like frozen sperm. They can then be thawed out at a later date if, for instance, the couple did not get pregnant on their first cycle of IVF or even if they did get pregnant on their first cycle IVF but they wish to enlarge their family size. The female’s womb is prepared to accept the embryo for implantation, but many of the other hormonal manipulations are not necessary, thus making a frozen embryo transfer cycle less economically and emotionally taxing for the couple.

Some of the very strong points about IVF include the rapidity of which it may be successful. For instance, it typically takes anywhere from four to six weeks to prepare a female fully and get her ready for oocyte (egg) retrieval. For a person of advanced maternal age, this may be a very powerful factor in leading the couple on their decision-making path. For some couples, IVF offers them a chance to not only start a family together but to have a somewhat increased likelihood of having a multiple gestation birth to really get their family started together in a big way. Interestingly, some studies have shown that up to 75% of couples are quite pleased with twins when undergoing an IVF cycle. Though I found this information somewhat surprising at first, on further thought when a couple has to work so hard to bring another life into this world, it makes some sense that more babies may lead to the feeling of more love (not to mention efficiency). Though IVF is somewhat expensive and intense, it is increasingly popular with couples facing fertility changes and its increasing success rate make it a very viable option. Take a look at the fertility clinics Dr. Bastuba works with in the region.