While in vitro fertilization (IVF) is often used with women facing fertility issues or decreased egg health due to age, it is a necessary process in order to mimic what would happen naturally for one woman carrying a pregnancy and the other donating an egg. Specifically, while the donating mother is put on medications to stimulate the eggs to mature, the carrying mother is put on medications to help prepare the uterus for an embryo to implant. And once fertilization has occurred, questions such as how many embryos to transfer should be considered.
Known worldwide for his expertise in complex reproductive matters, Dr. Kolb is one of the largest providers of egg donation and surrogacy in the United States. His practice is also known for helping to develop and implement cutting-edge technologies in the genetic screening of embryos, along with new laboratory technologies and highly efficient, patient-centric treatment. He has received the Los Angeles Magazine Super Doctors award since 2010 and the European Society of Human Reproductive and Embryology award for outstanding scientific research.
So IVF is used under a number of circumstances. Certainly, within a lesbian couple where one partner’s donating and the other carrying. IVF is a very necessary part of this. But there’s many other circumstances where a woman may need in vitro fertilization. Age is a big part of this unfortunately. So women in their late ‘30s and early ‘40’s, may decide to move directly to IVF over simplifier forms of conception just due to the efficiencies of IVF. Individuals that may have blocked fallopian tubes, or a variety of other medical conditions that really make the success with things such as artificial insemination very low.
In reciprocal IVF where one partner’s gonna carry the pregnancy and the other partner is gonna donate the eggs, it’s very important that we evaluate both partners individually. For the woman donating the eggs we want to make sure her egg quality has been appropriately assessed. Her general health is good. We want to do a genetic screen just to make sure that we can avoid passing any genetic diseases to the offspring. For the woman carrying the pregnancy it’s very important that her health be in good condition. Her health exams be updated. That we do a good uterine evaluation so that when we transfer an embryo to her she has the best chance of having a successful implantation and subsequent pregnancy.
So with IVF the individual donating the eggs she will start medications on her menstrual cycle. The medications are there to stimulate the eggs to mature. She’s on those for about ten days before the egg retrieval. Her partner will start taking medications to stimulate the uterus to be receptive to having the embryos implant. Really much of what we’re doing is to duplicate what happens in nature but in a very coordinated fashion.
The egg retrieval’s very straightforward, a safe process. It’s a little bit scary because it’s something that people are not familiar with. But it should not be feared. It’s done in a surgery center. The woman undergoing the egg retrieval she has IV anesthetic, so her health is protected. From there the eggs go into the IVF laboratory.
Fertilization occurs either by mixing the sperm and eggs together; often we’ll inject sperm directly into the egg to help ensure fertilization. The embryos are typically cultured anywhere from three to five days. And then the partner carrying the pregnancy will come in and have the embryo transfer. The embryo transfer itself is very simple and straightforward. The discomfort of it should not be anything more than just having a simple pap smear. We encourage both partners to be there during the transfer. We take a very small catheter and gently put a small number of embryos into the uterus.
One very big question is how many embryos do we transfer? And ideally if you’re working with a good laboratory, a good center, you’re gonna have high quality embryos. And we want to take a very responsible approach to an embryo transfer. My general recommendation is to transfer as many embryos as you’re willing to carry pregnancies or fetuses. If this is about having one child, transfer a single embryo. You can always take the excess embryos and freeze them. With the new freezing techniques, they do very well.
I’d say one of the most exciting advances in the IVF laboratory is our ability to genetically screen embryos. There’s preimplantation genetic screening which is looking at the number of chromosomes present in an individual embryo. We’ll take a single cell from each embryo. If I have a healthy embryo, it should not jeopardize that embryo. And we look at all the chromosomes inside. So we can pick up things like Down Syndrome. We can pick up the gender of the embryo. Preimplantation genetic diagnosis is a little bit different. The removal of the cell occurs the same way that we can look for individual diseases within that embryo. So a couple that might have cystic fibrosis, Huntington’s disease, there’s literally hundreds of diseases that we can test for within that embryo. And the idea is, is for us to be able to select the best, healthiest embryos for transfer.
So the embryo transfer to me is one of the most exciting days in this process. It’s a day where everybody comes together. We’ll review the embryos. How the embryos are growing. The couple will get a picture of the embryos. We’ll decide which embryos and a number of embryos to transfer on that day. The partner will be in the room with the embryo transfer. We use an ultrasound to guide the catheter with the embryo into the uterus. And it’s something that the partners will watch together. So it’s actually a very loving moment for everybody in that room. We’ll watch the release of the embryos. Overall, it’s kind of a magical day and a very special moment through this process. It takes it from a very clinical to a process that’s very special.