Treatments

Ovulation induction

Ovulation induction helps follicles to mature through the use of oral medications. Inducing ovulation is often the only treatment needed for women who do not ovulate or release an egg each month. This treatment involves taking 1-3 pills for 5 days, early in your menstrual cycle. We often use this medicine in combination with Intrauterine insemination (IUI). The idea is to help you release more than one egg at the time of insemination. This increases the chance of a pregnancy but also increases the risk of twins, or multiple gestation.

Hyperstimulation

Controlled ovarian hyperstimulation involves stimulating the ovaries to produce eggs using many of the same medications we use with IVF. Unlike the pills used in ovulation induction, these injections can be used to recruit multiple follicles (and eggs). Since this poses a greater risk for twins and high-order multiple gestations, this treatment is usually reserved for older patients with a lower chance of pregnancy or patients for whom oral medications are unable to help them ovulate.

IUI

Intrauterine insemination involves placing a concentrated sperm sample into the uterus. This helps in cases where there is a moderately low sperm count or for cases of “unexplained infertility.” With normal intercourse, most sperm will die in the vagina. IUI preserves most of the viable sperm and gives them a head start on their journey to find the egg. IUI is timed with ovulation. To determine the best time for an IUI, some patients use home ovulation predictor kits while others use ultrasound monitoring and we “trigger” ovulation with an injection.

When we feel confident that ovulation is occurring, we prepare a sperm sample and advance it through a thin catheter that is passed through the cervix into the uterus. The concentrated sperm sample is then inserted and given a gentle assist to reach the egg and achieve fertilization. This procedure is usually painless and you can resume your normal activities straightaway.

 

Different medications may be used with IUI, most commonly pills for ovulation induction. Some patients may benefit from injectable medications and progesterone supplements as well.

IVF and ICSI

Normally, one egg matures each month, but when we stimulate the ovaries for IVF or ICSI, we attempt to mature multiple eggs for fertilization. In vitro fertilization (IVF) involves removing eggs from the ovaries and fertilizing them outside of the body (“in vitro”). With conventional IVF, many sperm are placed in a dish with a healthy egg, whereas with Intracytoplasmic sperm injection (ICSI), a single sperm is carefully injected directly into each egg.

Ovarian stimulation usually requires 10-14 days of hormonal stimulation and monitoring before the eggs are retrieved. Once the eggs are in our care, we need to consider several key steps:

  • Fertilization: Conventional IVF or ICSI?
  • When to plan your transfer: How long should we care for your embryos before transferring or freezing them? 2-3 or 5-6 days?
  • Embryo Transfer: Fresh or frozen? If frozen, do we transfer them in the future using a controlled or natural cycle?
  • Genetic testing: Do we test your embryos before transferring them?

Based on your history, assessment, and goals, we’ll help you navigate several steps and decision points depending on your particular situation and requirements.

What else should you expect? Learn more about the IVF and ICSI Process.

Male infertility

Did you know that 30-40% of infertility cases are solely due to a form of male factor infertility?

For men, the evaluation is simple. We need to know if there are enough motile (swimming) sperm to reach and fertilize an egg (typically we like to see at least 20 million). The test for this is a semen analysis. Low or absent sperm counts can be due to problems in producing sperm or in a blockage preventing the sperm from being released. Note: appearing to ejaculate normally does not mean there are enough quality sperm being emitted.

While the evaluation for women can be invasive and require multiple visits, the basic male evaluation can be addressed by examining two key questions:

Do you produce a sufficient number of “swimming” sperm to total sperm? Fertile men typically produce tens of millions of sperm per ejaculate. It’s not enough to produce sperm; the job isn’t done until they reach the egg and fertilize it. Unfortunately, it’s a long journey, and therefore nature provides millions of sperm in the hope that one is able to make it to the egg, attach and fertilize.

We evaluate sperm count with a semen analysis, which tests the percent motility, or the number of sperm per ejaculation. We also examine direction and speed, shape, and other factors that can give your doctors insight into your ability to conceive without assistance.

Are the sperm able to leave your body? Just as women have tubes that can be blocked (the fallopian tubes), the same is also true with men. The vas deferens is the tube that carries sperm from the testes to the penis. Sometimes these tubes can be blocked or congenitally absent. With an obstructed vas deferens, a man’s semen may appear normal but lack sperm.

These procedures are included in our Same Day 360° Evaluation and Action Plan. Contact us to book your evaluation today.

Genetic testing

In order to optimize their chance of having a successful, healthy pregnancy, many patients elect to pursue genetic testing to ensure the most successful procedure and to increase their chances of having a healthy baby.

There are three types of genetic testing commonly obtained at Spring Fertility:

Preconception Genetic screening (before trying to conceive)

What it is: This is a blood test performed before undergoing treatment or trying to get pregnant. The goal is to see if you and your partner carry any recessive genetic traits that could cause severe illness in your child, if you both have the same one. There are diseases that cause death or severe disability in children with two copies of an abnormal gene, but cause no symptoms in an adult if they only have one. Many of us don’t know if we carry these traits. About 40% of our patients test positive for one and then we test their partner to see if they carry the same gene.

How it helps: Rarely, both partners carry the same recessive mutation (like cystic fibrosis). If you each carry a mutation for the same gene, we can use PGD (Pre-implantation genetic diagnosis) to ensure that you do not have a child that is born sick with the disease.

Preimplantation Genetic testing (before embryo transfer)

What it is: This is testing performed on the embryo before transferring it in order to make sure the embryo is healthy. There are two types of preimplantation genetic testing procedures, Preimplantation Genetic Screening (PGS) and Preimplantation Genetic Diagnosis (PGD). Both involve embryo sampling, where 1-5 cells of an embryo are delicately removed in order to test if the embryo is healthy. The sample is usually taken on Day 5 or day 6 of development when the embryo is called a blastocyst.

How it helps: Testing embryos can identify and prevent chromosomal abnormalities that lead to miscarriages or Downs Syndrome, or lethal mutations that cause severe illness or death in babies.

Preimplantation Genetic Screening (PGS)

What it is: This is the most common genetic testing procedure on embryos. This is for patients without any known genetic diseases. A few cells are sampled from each embryo and tested to determine if it has 46 chromosomes (the healthy and normal number). Because we test for all 23 pairs for chromosomes, PGS is also referred to as Comprehensive Chromosome Screening. Embryos with the correct chromosome number are called “euploid.”

How it helps: The goal of PGS is to increase the chance of pregnancy with each embryo transfer and reduce the risk of miscarriage. Since PGS screened embryos have such a great chance of success, we only put back one at a time, making it most likely that patients will have one baby at a time, (rather than twins or triplets). Once we have a euploid (chromosomally normal) embryo to transfer, age is virtually eliminated as a factor for success. Although older women have fewer and sometime no chromosomally normal embryos, those that do have the same or better success rates as a young woman doing IVF. Euploid embryos have over a 50% chance of having a live birth with only a single embryo transferred. Similarly, these pregnancies have very low miscarriage rates, despite the intended mother’s age.

Preimplantation Genetic Diagnosis (PGD)

What it is: PGD refers to testing embryo of parents with a known genetic disease. PGD is performed in cases where one or both parents are known to carry severe mutations that can result in disease or disability in their offspring. In these cases embryos are created and tested to see if they carry the disease.

How it helps: Two parents carrying the same mutation have a 25% chance of having a severely sick baby. Instead of waiting to find out if their pregnancy is affected by an invasive procedure 14 weeks into your pregnancy, PGD allows families to make sure that only healthy embryos are transferred back to the intended mother.

Hysteroscopic repair

Sometimes the uterus can develop abnormalities like polyps, fibroids, adhesions and blockages that can cause infertility. A hysteroscopy is a minimally-invasive outpatient procedure where our specialists use a thin, fiber-optic scope inserted through the cervix into the uterus (endometrial cavity). This procedure enables our team to diagnose and treat a variety of conditions that are preventing pregnancy or causing recurrent pregnancy loss. A hysteroscopy usually takes less than 30 minutes and no incisions are made. Patients usually recover within a day or two.

Donor Sperm

Donor sperm can help achieve pregnancy for people who either do not have sperm or are experiencing male infertility. Spring Fertility is committed to helping everyone bring healthy children into the world. We work with sperm banks and agencies to help our patients obtain donor sperm to achieve their parenting dreams. Donor sperm is carefully handled and secured before it is transported for fertilization here at our IVF lab. Whatever your needs, we are here.

Donor egg IVF

Although IVF and assisted reproductive technologies have made tremendous advancements, we still rely on having sufficient numbers of healthy eggs. Sometimes we find that despite the best protocols and efforts, there are not enough good quality eggs. In these cases donor eggs (usually from a healthy woman in her 20s) have been used to help thousands of families achieve their family-building goals. Success rates with donor eggs are around 60% per attempt.

How common is it to use donor eggs? For over 30 years, egg donation has made parenthood possible for people having difficulty conceiving. In the US alone, there are over 18,000 egg donation cycles every year, and nearly 1 in 10 babies born annually from IVF in the United States were conceived using donor eggs.

But donor eggs don’t have my DNA, is it really my baby? Yes. While it’s true that donor eggs will have different DNA than the intended mother, your connection is no less intimate or meaningful. Carrying a pregnancy from donor eggs gives mothers the opportunity to nurture the baby for nine months in utero and have tremendous influence on how the baby’s DNA is expressed. Recent studies have shown that the time in utero can vastly influence how DNA works for the rest of one’s life. These recurring observations have led to a whole new field of epigenetics, and a field of study regarding “The Fetal Origins of Adult Disease”.

Who donates their eggs and why do they do it? Egg donors are bright, motivated, and healthy women aged 21-30 who donate their eggs because they want to help other people have families. These women go through extensive medical, physical, and psychological screening in line with FDA guidelines. While many women apply to be egg donors each year, only 3% usually qualify.

Spring Fertility’s EggShare Program lets eligible women donate eggs while freezing some for their own future use.

How will I find the right donor? Choosing an egg donor is a personal decision, with many factors to consider. Your timeline and goals will influence whether you turn to an egg bank for frozen eggs or a donor agency with candidates who will provide fresh eggs. We can talk you through how to navigate this and connect you with the best donors and eggs. We’ll support you every step of the way.

Gestational carriers

A gestational carrier is a woman who agrees to carry a baby to term for intended parents who cannot safely carry a pregnancy. An embryo is created by the intended parents through IVF and transferred to the gestational carrier.

California is one of the most favorable environments for parents who need to use a gestational carrier. We work with top agencies to help our patients identify healthy women to achieve healthy, successful pregnancies. Northern California has great health care and no Zika virus, making it a great place for women seeking this option. Contact us for information. We can help.

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