In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is the process of fertilizing the female partner’s matured eggs by the male partner’s sperm in the IVF lab for transfer of embryo(s) into the uterus. The procedure is performed by one of our reproductive endocrinologists, Dr. Shahryar K. Kavoussi, Dr. Maya Barsky, and Dr. Dan I. Lebovic, at our state-of-the-art IVF Austin center. As the only fertility clinic in Austin with an in-house IVF lab, our mission is to ensure the best care and comfort for our patients.

Why Couples Seek IVF Austin

At our Austin IVF clinic, we’ll help you figure out what the reasons are that are preventing you from conceiving naturally. There could be many reasons for infertility both female and male causes which we’ll be able to help diagnosis at our Austin fertility clinic. With both in-house doctors specializing in female and male infertility, we can ensure full fertility care along with IVF treatments.

Is IVF Right for You?

One of our IVF Austin physicians can help determine if IVF treatments are viable options for you. Schedule an initial consultation with one of our IVF specialists to discuss your concerns, answer your questions and figure out if in vitro fertilization is right for you.

Our Austin IVF procedures

Ovarian Stimulation

This phase of the in vitro fertilization (IVF) process involves the use of injectable medication under the skin of the abdomen in order to stimulate the ovaries to grow multiple follicles which contain oocytes (eggs).  The injections involve small needles that are relatively user-friendly.  Stimulation medications include follicle-stimulation hormone (FSH) and lower doses of leutinizing hormone (LH) which grow eggs and help the eggs produce estradiol.  A medication is also used to prevent an LH surge, thereby preventing ovulation during the IVF process – either a type of medication known as a Gonadotropin-Releasing Hormone (GnRH) agonist or a type of medication known as a GnRH antagonist is used for this purpose.  Interestingly, the egg reserve blood test called Anti-Müllerian Hormone (AMH) has been found to be helpful in individualizing the IVF stimulation protocol, including medication dosages, for IVF patients.

Transvaginal ultrasound monitoring and hormone level checks

During the ovarian stimulation process, 4-5 transvaginal ultrasounds and estradiol lab tests are performed in order to monitor the growth of the follicles, which are fluid collections within the ovaries that contain the microscopic oocytes.  When the follicles have grown enough in size and number, human Chorionic Gonadotropin (hCG) injection is given in order to mature the oocytes for egg retrieval and subsequent fertilization in our IVF Austin laboratory.

Egg retrieval

The egg retrieval procedure is performed in the egg retrieval suite at Westlake IVF. This procedure is performed 35 hours after hCG injection and an intravenous sedation (“twilight anesthesia”) is given so that the patient is sleeping during the egg retrieval.  A needle is used to aspirate the follicles that have grown and the fluid from the follicles is then given to our embryologists in our adjacent Austin IVF laboratory so that they can isolate and count the number of eggs retrieved.  The procedure typically takes 10-20 minutes to perform and the patient typically has a one hour recovery time at Westlake IVF.

In Vitro Fertilization (IVF)

The fertilization of eggs by sperm in the IVF laboratory can be facilitated by our embryologists via “conventional IVF” or “intracytoplasmic sperm injection (ICSI)”.   In the case of conventional IVF, 50,000 or more sperm from the male are placed with each of the female’s eggs in vitro and normally-functioning sperm would attach to the outer cover of each egg, and ideally, one sperm enters the oocyte and fertilization occurs.  In the case of ICSI, a normal-appearing sperm is injected into the egg by the embryologist.  Normal fertilization, as evidenced by a one-cell embryo with two nuclei (one nucleus from oocyte, one nucleus from sperm) can be observed the next morning, also known as “Day 1”, approximately 18 hours after conventional IVF or ICSI.

Embryonic cell division

On Day 2, an embryo that has divided into a multicellular embryo (typically 2-5 cells) is at the “cleavage stage”.  Embryos at the cleavage stage are graded based on cell number and “fragmentation”, which refers to extra, non-uniform “pieces” of cytoplasm which are not cells.  On Day 3, an embryo with favorable morphology has 6-8 cells and a fragmentation grading of A or B, both of which indicate minimal fragmentation.

Embryo Transfer (ET)

The transfer of fresh embryo(s) into the uterus of the female occurs either on Day 3 or Day 5.  The ideal day for embryo transfer is dependent on various patient-related and embryo-related factors.  When the embryo transfer is performed, embryo(s) are carefully placed into the uterus with a thin-caliber catheter as the uterus and the catheter are visualized with abdominal ultrasound.  The embryo transfer truly is a special event for the couple.

Estrogen and progesterone supplementation

Since the woman who has just had an egg retrieval does not ovulate during the IVF cycle, the ovaries do not produce estrogen and progesterone as they normally would after ovulation.  Estrogen and progesterone medication is given to support the uterine lining after egg retrieval and through the time of embryo transfer until the pregnancy test.  With a positive pregnancy test, the patient continues estrogen and progesterone supplements until 10 weeks of gestation, at which time the medications are discontinued since placental estrogen and progesterone production is well underway at that point.

Cypropreservation of surplus embryos

After embryo transfer, if there are surplus embryos that are good quality blastocysts, they can be cryopreserved for the future.  The embryologists at Westlake IVF cryopreserve embryos by means of vitrification, which is a fast-freeze protocol.  The vitrification of good quality blastocysts results in a high freeze-thaw survival rate.

Some indications for IVF include tubal factor infertility, male factor infertility, severe endometriosis and unexplained infertility.  Each patient’s IVF protocol is individualized based on age, ovarian reserve testing, and previous responses to fertility medication.

Extensions of IVF

In certain cases some of these additional Assisted Reproductive Technologies (ART) procedures are performed as extensions of IVF.

ICSI for male factor subfertility or unexplained subfertility

In cases where semen analysis parameters (such as sperm concentration, motility, or morphology) are low or in cases of unexplained subfertility, there is concern about the ability of sperm to fertilize the egg.  In such circumstances, ICSI can be performed by our embryologists in order to optimize the opportunity for fertilization.  ICSI is the process by which the embryologist uses an instrument called a micropipette and injects a single viable, motile sperm with a normal appearance into a mature oocyte while looking with a microscope.  On average, ICSI is associated with fertilization rates of 50-70%; some couples may have even higher fertilization rates.  Since one sperm is needed per mature oocyte injected, ICSI is a highly effective method to achieve fertilization in the cases of very low semen parameters and may be considered for cases of unexplained subfertility.

Assisted Hatching

For an embryo to implant into the uterus, the embryo must first “hatch” from its covering which is known as the zona pellucida.  As the embryo grows, it expands and, as a result, the surrounding zona pellucida becomes thinner.  As the zona pellucida thins, it eventually has an opening from which the embryo hatches out of the covering and then can interact with the endometrial lining in order to have an opportunity at implantation.  Assisted hatching is the artificial thinning or opening of the zona pellucida with the goal of increasing the chances for implantation and successful pregnancy.  Existing research shows that assisted hatching may help with implantation and clinical pregnancy rates in women who are > 38 years of age, in those undergoing frozen embryo transfer cycles, and women who have not been pregnant after several IVF cycles.  Traditionally, assisted hatching has been performed by using mechanical or chemical means; more recently, laser-assisted hatching (LAH) has been used for this process.  Our IVF laboratory’s embryologists perform LAH equipped with state-of-the-art laser technology.

Preimplantation Genetic Screening/Diagnosis (PGS/PGD)

Embryos can be tested for abnormalities in chromosome number or for specific genetic diseases via PGS or PGD respectively.  In order for genetic analysis of an embryo to be performed, “embryo biopsy” is performed in order to obtain cell(s) from the embryo which can be genetically analyzed at a reference laboratory.  Embryo biopsy on day 3 embryos involves the removal of one cell from the embryo.  Embryo biopsy from a day 5 or day 6 embryo at the blastocyst stage is called “trophectoderm biopsy”, which can give more accurate results about chromosome number than day 3 embryo biopsy.

Couples who are seeking fertility with us can be both evaluated by Dr. Shahryar K. Kavoussi, Dr. Maya Barsky, or Dr. Dan I. Lebovic, one of our board certified reproductive endocrinologists (female fertility specialist) and Dr. Parviz K. Kavoussi, our fellowship trained reproductive urologist (male fertility specialist) to ensure comprehensive and personalized fertility treatment. Our doctors will personally review in detail your treatment options with you during consultation and perform all procedures themselves.

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Assisted Reproductive Technologies

ggh-2012Motherhood is an experience that no one has to miss out on, even if biological factors are interfering. At Austin Fertility & Reproductive Medicine, the physicians are able to offer services of a state-of-the-art in vitro fertilization (IVF) lab called “Westlake IVF”, used for assisted reproductive technologies (ART). Dr. Shahryar Kavoussi explains what those technologies are and what steps to take when considering treatment by a fertility specialist.

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