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About Eden Centers For Advanced Fertility – An Intro

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  Eden Fertility is a Fertility Clinic in Orange County (Newport Beach and Fullerton). Eden is committed to providing  affordable fertility care to patients where ever they live. Many patients travel to California from other parts of the United States and overseas to achieve their dreams of building a family. Eden’s mission is to help patients in their journey by leveraging state-of-the-art technology to achieve the best possible fertility outcomes.

Board-Certified Reproductive Endocrinology & Infertility Doctors:

  Vitaly Kushnir MD completed medical school at Tel Aviv University in Israel followed by OBGYN residency at the Rutgers School of Medicine in New Jersey and REI fellowship at Emory University in Atlanta. Dr. Kushnir has practiced for many years in New York City where he served as the Director of Division of Reproductive Endocrinology and Infertility at Wyckoff Heights Medical Center and as an attending physician at Lenox Hill Hospital. Dr. Kushnir also serves as Assistant Professor of Obstetrics and Gynecology at Wake Forest University in Winston-Salem, NC. As a fertility specialist, Dr. Kushnir has published on numerous topics in the field and has been invited to give lectures at professional conferences in the North America, Europe, Asia and the Middle East. Dr. Kushnir speaks Russian. Dr. Kushnir’s areas of expertise are in treating women of advanced reproductive age, those with low ovarian reserve, and third-party reproduction.

  “Miracle” Embryology Lab Eden has one of the IVF laboratories in California, under the direction of Dr. Behr. Embryology lab director.

Areas of Expertise:

 

Comprehensive fertility evaluation

  This is the most important first step in evaluation of infertility, as well as, fertility potential in those individuals for whom it is of concern. At Eden, a comprehensive fertility evaluation includes a consultation with a board-certified fertility doctor who will gather the relevant medical history from both the female and male partners. Tests that may be ordered for the female include an ultrasound to visualize the uterus and ovaries, a hysterosalpingogram to check the fallopian tubes and endometrial cavity, and blood tests to check hormone levels and genetic test.  Tests for the male partner may include a comprehensive semen analysis, hormone levels and genetics. Combined these tests will help the doctor guide the individual or couple on their fertility journey.

Controlled ovarian hyperstimulation (COH) & Intrauterine insemination (IUI)

  COH & IUI treatments are used for women who either do not regularly ovulate on their own and those who ovulate but have not been able to conceive through intercourse. Medications that may be used for COH include clomiphene or letrozole tablets, as well as, injectable medications called gonadotropins. IUI can be performed using sperm from the partner or donor from a NY state licensed sperm bank. The chance of conception with IUI is best when the total motile number of sperm is in the millions. Pregnancy chances with COH/IUI in women below age 40 range from 5-20% per attempt depending on several factors. Whenever fertility-enhancing medications are used there is an increased probability of twin pregnancy.

Conventional Stimulation IVF and ICSI

  involve stimulating the ovaries with injectable drugs for one to two weeks followed by an egg retrieval procedure which is performed at our on-site surgical suite under anesthesia. A board-certified anesthesiologist will administer medications to make sure the patient is comfortable and safe during and after the egg retrieval. Eggs are then processed in our state-of-the-art embryology laboratory and are fertilized either by conventional insemination or intracytoplasmic sperm injection (ICSI) by a highly trained embryologist. Eggs that are found to be immature may undergo invitro maturation (IVM) – see below, prior to fertilization. ICSI is used in most IVF cycles in the United States, the main reasons for ICSI is to pick the most viable sperm cell to inject into each egg, which is very helpful in cases of male factor infertility. Additionally, because eggs are closely inspected prior to undergoing ICSI we learn about their quality. The day after fertilization, normally fertilized eggs called 2PN are selected for further culture. Embryo transfer typically happens either 3 days (cleavage stage) or 5-6 days (blastocyst stage) after fertilization. In most patients, a fresh transfer is recommended while those patients who produce a large number of eggs/embryos or are undergoing preimplantation genetic testing (PGT) the embryos may need to be frozen and transferred in a subsequent menstrual cycle. The stage and number of embryos recommended for transfer are individualized based on the patient’s history, age, number and quality of available embryos (see table). The goal is to maximize pregnancy chances while minimizing the risks of complications related to twin pregnancy. Following the transfer, it is important to take hormones and other medications that aid the implantation process and early pregnancy development. A pregnancy test is performed about 2 weeks after the embryo transfer and the first pregnancy ultrasound can be scheduled a week thereafter. Eden doctors manage early pregnancy until about 10 weeks at which point most medications can be stopped and care transitioned to the patient’s obstetrician. Live birth rates with IVF depend on the woman’s age and the underlying factors contributing to infertility in male and female. In young, good prognosis patients live birth rates tend to be higher than in older, poorer prognosis patients (see figure).

Minimal Stimulation and Natural Cycle IVF

  has gained popularity in recent years in many parts of the world, especially in Japan. These protocols involve less medications and a simpler process than conventional stimulation IVF.  These protocols also produce lower pregnancy chances per cycle than conventional stimulation IVF (see figure). However, especially in younger patients and those women with very low ovarian reserve who do not respond to fertility medications, they may offer a good option because these protocols are much simpler therefore less expensive. In these patients these protocols make sense because they make IVF more accessible financially allowing the patient to undergo several attempts at IVF for the same cost as a single conventional stimulation IVF. Most important is that live birth rates over several cycles will add up to match and, in some cases, even surpass those achieved in a single conventional stimulation IVF cycle.

In Vitro Maturation (IVM)

  This unique technology allows women to complete IVF with minimal to no stimulation drugs. Since we are able to collect immature eggs and develop them in the laboratory, our unique IVM technology can enable women to complete the IVF process with less medications, fewer side effects, fewer monitoring visits, and lower costs. Additionally, because of our expertise in IVM, whenever immature eggs are retrieved during conventional stimulation, minimal stimulation and natural cycle IVF, they too undergo IVM. If these eggs become mature in the laboratory they can be fertilized and produce additional embryos, increasing the overall pregnancy potential of the IVF cycle for the couple. This procedure is ideal for:
  • Women who want to take less medications during the IVF process
  • Women with Polycystic Ovarian Syndrome (PCOS)
  • Women with hormone-sensitive cancers, such as breast cancer
  • Women with high risk of Ovarian Hyperstimulation Syndrome (OHSS)
  • Women who have had severe side effects from hormonal medications
Primary live birth rate per oocyte retrieval cycle stratified by ovarian stimulation protocol. Based on combined final 2014 and preliminary 2015 US national data reported by the Society for Assisted Reproductive Technology. Conventional stimulation IVF served as the reference for all statistical comparisons. *P<0.05. Kushnir VA, et al. Observational retrospective study of US national utilization patterns and live birth rates for various ovarian stimulation protocols for in vitro fertilization. BMJ Open 2018; 8:e023124.

Low ovarian reserve

  in most patients, this condition is related to normal aging while in some it may be due to premature ovarian aging or underlying medical conditions which lead to premature depletion of eggs from the ovaries. In order to treat fertility issues in patients with low ovarian reserve, it is therefore very important to first correctly identify and address any underlying medical conditions which may include immune or genetic problems, as well as, endometriosis. Ovarian stimulation protocols are individualized for each patient to optimize outcomes. Many women who have low ovarian reserve can still produce multiple follicles and eggs with optimal stimulation, which greatly improves chances of achieving a pregnancy. Some women, however, produce very few follicles/eggs despite optimal stimulation with fertility medications. In these cases, approaches such as mild IVF and natural cycle IVF can offer a reasonable pregnancy chance.

Egg Freezing

  Egg Freezing is an increasingly popular procedure of fertility preservation which is done for both medical and elective reasons. Eden is committed to providing women an objective evidence-based approach to fertility preservation which includes an assessment of reproductive potential and an individual plan. It is important that women are counseled in detail about all of the alternatives to egg freezing, the expected pregnancy chances, and a number of cycles that may be required to bank enough eggs to ultimately achieve their desired family size. Eggs are frozen using the vitrification technique which has proven superior for this procedure with thaw survival rates in the 85-95% range. Who Should Consider To Freeze Their Eggs?
  • Women who want to preserve their eggs at their highest quality
  • Women who will be receiving radiation and/or chemotherapy for cancer treatment
  • Women who need to have their ovaries removed for any reason
  • Women with a family history of early menopause or premature ovarian failure
  • Women with endometriosis

Third-Party Reproduction

 

Egg Donation

  Your initial consultation with Eden will help decide if using donor eggs is the right option for your family. Eden will be your partner in this process, helping to guide you every step of the way! In general, you want your egg donor to be a healthy individual, and relatively young (age 21-32). Regardless of the donor you choose, whether it be a family friend, relative, or an anonymous source, the individual will be screened extensively per FDA and NY state department of health requirements. This screening includes infectious disease testing, evaluation of family genetic history, fertility and past gynecologic history, and a fertility workup to evaluate the potential for egg donation.

Egg Donor Options:

  • A family friend or relative
  • Anonymous fresh donor though Eden or an outside donor agency
  • Frozen Eggs selected from Eden’s Egg Bank
  • Frozen eggs selected from outside egg bank that are transferred to Eden

Sperm Donation

offers a great option for building a family to women who are single, in same-sex relationships, and to couples with severe male factor infertility.
  • Intrauterine insemination (IUI) – Donor sperm is inserted directly inside the uterus by the physician.
  • In Vitro Fertilization (IVF) – Your eggs are retrieved, fertilized by donor sperm, cultured and placed in your uterus to grow into a beautiful baby
Your initial consultation and fertility evaluation will help guide you as to the best treatment option for you. Once it is determined which route works best for you, you will select your sperm source. The sperm donor can be a family friend or an anonymous individual from a sperm bank. Eden works very closely with the best sperm banks all over the country and can help guide you in this selection process. Regardless of the sperm donor source, each sperm donor is screened extensively for infectious diseases according to FDA guidelines, as well as genetic screenings and a brief medical and family history is obtained. Sperm selected from a qualified sperm bank has already gone through the required quarantine and screening process.

Gestational Surrogacy

  Your choice of working with a gestational surrogate may be with the help a family friend, relative, or someone selected through an agency. Regardless of the reasons, as with our egg donors, extensive screening is required to minimize risks of complications along your fertility journey. Screening includes infectious disease testing according to FDA guidelines, a questionnaire on past gynecologic history, and a fertility workup to evaluate the potential for surrogacy.

Legal Protection for your Family

  Regardless of your choice of the egg donor and a gestational surrogate, Eden Fertility wants to make sure that we make this process as smooth as possible and as ideal to your wishes as we can! In order to make this possible, it is necessary to employ an attorney specialized in third party (egg donation/surrogacy) reproduction. You can select one on your own or Eden would be happy to recommend an attorney for you.

Psychological Preparation

  Lastly, we want to make sure that everyone participating in your fertility journey is thoroughly prepared for any and all outcomes. This includes counseling and emotional preparation for the egg donor, gestational surrogate, and for you, the intended parent! This counseling is helpful for anyone using an egg donor and/or a gestational surrogate. It can be an emotional process and Eden wants to make sure everyone is fully ready and excited to begin this journey with you!

Genetic Testing

  Has become increasingly important in reproductive medicine. Genetic testing can be performed on the patients, embryos before they are implanted, and the fetus during pregnancy. Currently, it is recommended that all couples be offered to screen for common inherited conditions prior to pregnancy if an increased risk is detected in the couple options of preimplantation genetic testing (PGT) or prenatal testing can then be pursed. Other reasons for PGT besides single-gene disorders may be to determine the sex of the embryo prior to implantation which can be done for medical or elective reasons. Many patients travel to the United States for elective sex selection for family balancing from abroad. Additionally, screening for embryonic aneuploidy (PGS) can be performed to identify embryos most likely to produce a viable pregnancy. PGS remains an area of controversy in the field of reproductive medicine since the technology is still rapidly evolving and there is no uniform agreement about which patients are most likely to benefit for PGS. Our current opinion is that PGS may be beneficial for women older than age 38 who are able to produce a large number of embryos during IVF, as well as, for some women who have had prior miscarriages due to embryonic aneuploidy. When considering genetic testing it is important that patients have access to counseling by a physician and a genetic counselor.
     

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