Bay IVF - Advanced Reproductive Care Palo Alto 650-322-0500
Our Soft-IVF procedure represents a new approach to treating infertility by combining gentle ovarian stimulation with the latest advances in embryology laboratory techniques.
Soft-IVF uses oral medications and very few shallow, subcutaneous injections to stimulate the development of a moderate number of as high-quality eggs as possible (quality over quantity).
Since Clomid used for Soft-IVF ovarian stimulation can cause thinning of the uterine lining and reduce the probability of implantation, all Soft-IVF embryos are frozen and transferred inside the uterus as frozen-thawed embryos.
Soft-IVF treatment requires only 4 to 6 brief visits to the Clinic, and most patients will be able to continue their everyday lifestyles during the treatment. It is our goal to make your conception experience pleasant, relaxed, and as natural as possible.
The indications for Soft-IVF are similar to conventional In Vitro Fertilization:
History of tubal blockage and pelvic adhesions
Male Factor Infertility
Infertility associated with endometriosis
Infertility associated with mild to moderate polycystic ovary syndrome (PCOS)
Long-standing infertility (no contraception for more than a year and a half)
A need for intrauterine inseminations (IUI) and ovarian stimulation treatment (Soft-IVF is a much more successful treatment alternative).
Soft-IVF treatment is a two stage process. The first phase consists of the development and freezing (cryopreservation) of embryos.
Egg retrieval procedure
Fertilization of eggs
Culture of embryos
Cryopreservation (vitrification) of embryos
The second phase includes embryo thawing and a uterine transfer of the embryos.
Preparation of endometrial lining
Thawing and culture of cryopreserved embryos
Assisted embryo hatching
I. Stage One
Development and Storage of Embryos
This is an example of the first stage of Soft-IVF treatment. Your treatment is always individualized and can take less or more time to complete:
The Soft-IVF treatment begins with the onset of a menstrual period. Oral contraceptives are started within the first four days of the menstrual cycle. They prime the ovaries for optimal response.
Approximately seven days after your last contraceptive pill, your ovarian stimulation will start with a Lupron injection followed the next day with Clomid oral medication.
These hormones will stimulate the production of multiple eggs in the ovaries. During this time, your progress is monitored by ultrasound examinations.
As soon as the diameter of your largest follicles (grape-like structures containing eggs) reaches 14 mm, you will start taking microdose of Human Chorionic Gonadotropin (HCG) injections daily for a total of approximately three to six days. The volume of the injections is very small, and they are given just under the skin with tiny needles.
Once ovarian follicles are at the appropriate size, Clomid and the microdose HCG are stopped, and you will take a regular dose of HCG. This is also a subcutaneous injection. This injection will trigger the final stages of egg maturation. Thirty-six hours after the HCG injection, the eggs are aspirated from the ovaries.
The ultrasound image below shows a stimulated ovary. Each of the grape-like follicles (dark circles) contains a microscopic egg.
Egg Retrieval Procedure
The egg retrieval procedure is performed at our Center. The procedure only takes a few minutes, and we use very comfortable conscious sedation for analgesia.
Using ultrasound guidance, the tip of a thin needle is passed through the top of the vagina into the cul-de-sac (a space behind the uterus). The ovaries are located near the bottom of the cul-de-sac allowing the tip of the aspirating needle to enter the ovarian follicles and aspirate the follicular fluid from them. The fluid is examined under a microscope to identify the eggs.
Fertilization of Eggs
On average, two to eight eggs are aspirated during the Soft-IVF egg retrieval procedure. The eggs are identified under the microscope and placed in petri dishes filled with culture medium. The composition of the medium resembles the fluid secreted by the Fallopian tubes. This allows the eggs and embryos (fertilized eggs) to develop in our laboratory environment at the same rate as inside the Fallopian tubes.
The male partner collects a semen specimen by masturbation the day of the egg retrieval. The highest quality sperm are extracted from the semen and combined with the eggs six hours after the egg retrieval. This process of in vitro fertilization takes place over several hours during the following night.
If the male partner has never caused a pregnancy, or if his test results indicate a possibility of male infertility, Intracytoplasmic Sperm Injection (ICSI) is performed. In ICSI, a single sperm is inserted into an egg. This can significantly increase the probability of normal fertilization for selected patients.
Culture of Embryos
Evidence of fertilization can be seen the next day, 16 hours after insemination. The fertilized eggs are transferred into a growth medium and continue to be cultured in our laboratory.
A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm.
The following day, embryos reach 4 cells, the day after, 8 cells, and by the fifth to seventh day after the egg retrieval, the embryos should reach the blastocyst stage (80 or more cells).
This picture shows a morphologically exquisite, day three, 8-cell embryo. At this stage, human embryos are still microscopic and invisible to the naked eye.
This picture shows an advanced stage of blastocyst development. Notice the central fluid-filled cavity. The cells within the blastocyst have already differentiated into the inner cell mass (at seven o’clock) that will give rise to the fetus and the trophectoderm cells that will form the future placenta.
Cryopreservation of Embryos
Embryos that develop normally are cryopreserved (vitrified). Preparation for the freezing process involves removing water from within the embryos and replacing it with cryoprotective substance to prevent ice crystal formation during vitrification and subsequent thawing. The embryos are then flash cooled to −196 °C (−321 °F). Such rapid freezing (vitrification) prevents any damaging water crystal formation.
Following the vitrification process, the embryos are transferred to a liquid nitrogen storage chamber in our Laboratory. Theoretically, there is no limit on the length of storage, but conceiving past the age of 40 may result in a high-risk pregnancy.
II. Stage Two
Thawing and Uterine Transfer of Embryos
When you decide to conceive with your cryopreserved embryos, you will have one or more embryos thawed and transferred inside your uterus. This Frozen Embryo Transfer (FET) treatment can start as early as the first menstrual period after your egg retrieval (usually two weeks later).
A large majority of vitrified embryos will survive the vitrification and thawing process. The implantation rate of the thawed embryos is equal to the "fresh" embryo implantation rate.
This is an example of the second stage of Soft-IVF treatment. Your treatment is always individualized and can take less or more time to complete:
Preparation of Endometrial Lining
The treatment begins with taking oral contraceptives, which are started within the first four days of the beginning of a menstrual cycle. Oral contraceptives "put the ovaries to sleep" and temporarily stop their production of estrogen and progesterone. The estrogen and progesterone secretion by the ovaries would interfere with the development of the endometrial lining.
Approximately seven days after your last contraceptive pill, your endometrial stimulation will start. You will begin taking estrogen in the form of skin patches. The progress of the development of your uterine lining is monitored with ultrasound examination(s).
When the endometrial lining is sufficiently developed, progesterone is added to the estrogen. The addition of progesterone opens the "window of receptivity" of your uterus and synchronizes development of its lining with the developmental stage of your cryopreserved embryos. Progesterone is given as vaginal capsules.
Thawing and Culture of Cryopreserved Embryos
You will need to decide and communicate to us how many vitrified/thawed embryos you would like to transfer. Please let us know if you need help with this decision.
Most patients should select one or two embryos for the thaw and transfer to eliminate the risk of a high order multiple pregnancy (triplets or more). With this approach, most pregnancies from cryopreserved embryos are single baby pregnancies.
Assisted Hatching is a laboratory procedure used to create a "weak spot" in the egg shell of an embryo. Since embryo freezing commonly hardens the embryo egg shell, assisted embryo hatching is always a part of the Frozen Embryo Transfer treatment.
This picture shows an embryo after Assisted Hatching with an opening breaching the egg shell at 12 o´clock position.
Transfer of cryopreserved embryos into the uterus is identical to "fresh" embryo transfer: Just before the embryo transfer, the embryos are placed into the tip of a thin embryo transfer catheter. The catheter is then passed through the cervical canal to within 15 mm of the top of the uterine cavity, and the embryos are gently released.
Prior to your embryo transfer, the length of your uterus has been measured twice: once during your pre-treatment evaluation and the second measurement is done at the end of your egg retrieval.
Having done thousands of embryo transfer procedures, Dr. Polansky will precisely place your embryo(s) within the endometrial cavity. The embryo transfer usually takes only a few seconds to complete, and no resting is required afterward.
After the embryo transfer, the endometrial lining gently holds the embryos within the top of the uterus. There is no restriction on your physical activity.
This picture shows a healthy blastocyst in the process of "squeezing out" of its eggshell. Once fully hatched, it will stay in the uterus unattached for one to two days and then implant.
A blood pregnancy test is done two weeks after the embryo transfer. If the pregnancy test is positive, an ultrasound examination is scheduled two weeks later to visualize the implantation site and to look for a heartbeat within the embryo. Once a heartbeat is seen, there is a 95% probability that the pregnancy will continue to a baby.
This ultrasound picture shows a six-week pregnancy. The pregnancy sac is 25 mm in diameter. The baby inside the sac is only 13 mm long. It is already possible to distinguish the baby's head and body and to see the cardiac activity.
Supplementation of estrogen and progesterone must continue until the placenta produces enough of its own estrogen and progesterone to sustain the pregnancy. You will be closely monitored for 6 to 8 weeks as this transition takes place. Once all medications are discontinued, you will be referred to your OB doctor for the remainder of your obstetrical care.
Please use the following links for financial information about Soft-IVF and to request a consultation.