In Vitro Fertilization

In vitro fertilization (IVF) involves fertilization outside the body in an artificial environment. This procedure was first successfully used for infertility in humans in 1977 at Bourne Hall in Cambridge, England. To date, tens of thousands of babies have been delivered worldwide as a result of IVF treatment. Over the years, the procedures to achieve IVF pregnancy have become increasingly simpler, safer and more successful. 
There are several steps involved in the IVF process: 

  • Stimulation of the ovary to produce several fertilizable oocytes (eggs) 
  • Retrieval of the oocytes from the ovary 
  • Fertilization of the oocytes and culture of the embryos in the IVF Laboratory. 
  • Placement of the embryos into the uterus for implantation (embryo transfer or ET)

When IVF Might Be an Option 

Some of the types of fertility that might be helped with IVF include: 

  • Absent fallopian tubes or tubal disease that cannot be treated successfully by surgery 
  • Endometriosis that has not responded to surgical or medical treatment 
  • A male factor contributing to infertility, in which sperm counts or motility are low but there are enough active sperm to allow fertilization in the laboratory 
  • Severe male factor in which sperm must be obtained surgically 
  • Unexplained infertility that has not responded to other treatments 
  • Genetic diseases that result in miscarriage or abnormal births 

In addition to standard IVF procedures (including ICSI-Sperm injection, AH-thinning of the outer shell and blastocyst culture growing the embryo to day 5 to improve selection) we offer a more unique technique of embryo co-culture.
In this case, embryos are grown in “feeder layers” of cells from the patient that enhance that development. This technique appears to improve the embryo growth for patients with poor embryo development and in repetitive failure. 

Assisted Hatching

Assisted hatching involves the use of laser to thin the zone pellucida (outer shell) of the fertilized egg, prior to transfer into the uterus. It is believed that this outer shell becomes thicker and hardened with aging of the oocyte. Women of advanced age, or with an elevated follicle stimulating hormone (FSH) level on day 3, may have decreased chance for embryo implantation. The embryos of women with endometriosis and poor quality embryos may also have this problem. The technique of assisted hatching was introduced to enhance the embryos ability to hatch, and thus implant, after transfer. 
You may be a candidate for assisted hatching if you are 38 years of age or older, have an elevated basal FSH level, or if you have previously had one or more IVF cycles with failure of your embryos to implant despite otherwise good results. 

Blastocyst Culturing

Blastocyst culturing is a technique to grow embryos beyond the third day of culture. Typically we transfer embryos into the uterus ~3 days after the egg retrieval. On the third day, embryos generally are between 6-8 cells. Over the years improved culture environments have allowed  the ability to culture the embryos 2 additional days. During this additional culture period, the embryos continue to grow to become "blastocysts." 

The natural process of embryo development begins with the fertilization of the egg in the outer aspect of the fallopian tube. As the newly-formed embryo develops, it moves slowly toward the uterine cavity where it will ultimately implant. This process takes approximately 6-7 days. When the embryo reaches the "blastocyst" stage, it is ready to implant. 

In certain patients, the advantage of blastocyst culturing is to allow optimal selection of embryos for transfer resulting in an increased implantation rate per embryo transferred. However, it is important to understand that this technology may not necessarily increase your chance for pregnancy. The main advantage is that fewer embryos may be transferred to eliminate the possibility of multiple pregnancies, while maintaining a high pregnancy rate. 

Generally speaking, this procedure should be limited to patients with excessive numbers of embryos (greater than 5) in which case further selection of embryos beyond the day 3 stage would be advantageous. As a general rule, patients under the age of 37 are candidates for this culturing technique. 

For younger patients, up to 50% of all embryos will continue to grow to the blastocyst stage. However, 10% of patients will not have an opportunity for embryo transfer due to the absence of blastocyst development. As patients get older, fewer and fewer numbers of embryos are capable of developing in culture to the blastocyst stage.

Embryo Co-Culturing with Endometrial or Granulose Cells

Embryo co-culturing is a technique initiated in the UCSF IVF laboratory to improve the overall quality of embryos prior to your transfer. Several other IVF programs in the world have used this technique since 1996. It involves the use of human granulosa or endometrial cells that may secrete nutritional products to assist the growing embryos in order to improve their chance for survival.

We only recommend this technique to patients who have had failed IVF cycle(s) with poor embryo quality either here at UCSF or at another program. We do not recommend that patients select this option if they have never been through IVF before or if they have had treatment cycles with excellent embryo quality in the past. Using the co-culture system, we have seen an improvement in embryo quality and relative growth of the embryos 72 hours after egg retrieval (Remember that eggs fertilize within 18-24 hours after egg retrieval). 

An important concept to understand is that your likelihood of achieving pregnancy regardless of your age depends on the overall quality of your embryos. If you have generally good embryo quality, then you have a higher chance of conceiving from your IVF treatment cycle. Conversely, if you have generally poor embryo quality, then your chance for success diminishes. 

The risks associated with co-culture are unknown at this time. Because it has never been tested extensively, there is no information regarding children born of co-culture using these specific cells. It is because of this fact that we remain cautious about using this approach on patients who clearly may not benefit from this technique. It is important to understand that some patients may not have improvement in their embryo quality despite the use of co-culturing. 

If you and your physician agree to use co-culture for your IVF treatment cycle, then we will incubate all of your embryos in the co-culture environment as soon as fertilization has been confirmed by our embryologists. We will continue co-culture until the day of your embryo transfer. 

It is possible to freeze co-culture embryos. Co-culture will not affect the ability of your embryos to freeze well. We use the same standards for freezing co-cultured embryos as we do for standard cultured embryos. If your embryo quality is improved with co-culture, there is a greater likelihood that we will be able to freeze more embryos for you.