Fertility Services

High Tech Treatment Options

Treatment Options

Though the causes of infertility are numerous and complex, both male and female factors can be successfully addressed with many of today's technologies. Our desire is to help you conceive as naturally as possible. Therefore, considering your diagnosis, we carefully move into the next steps. Treatment options may include minimally invasive surgery such as laparoscopy or hysteroscopy to correct or improve anatomical abnormalities. Ovulations induction therapy can be undertaken to increase the production of eggs with intrauterine insemination (IUI) precisely timed for when fertilization could occur. More advanced care with In Vitro Fertilization might be necessary.

Assisted Reproductive Technologies (ART)

At FSMG/SDCRS, we have the distinction of being staffed by Board Certified Reproductive Endocrinologists, Embryologists and Andrologists. Our lab director is board-certified as a High-Complexity Clinical Laboratory Director by the American Board of Bioanalysis. These unique qualifications have enabled FSMG/SDCRS to successfully integrate the clinical and laboratory aspects of ART to achieve excellent results for our patients. We strive for the highest pregnancy rates possible while maintaining a low rate of multiple pregnancies.

In Vitro Fertilization

The most common and well-known ART procedure is in vitro fertilization, or IVF. An IVF cycle consists of four basic steps: 1) ovulation induction; 2) egg retrieval; 3) fertilization and embryo development; and 4) embryo transfer. During the ovulation induction phases, medications are administered to stimulate the ovaries to produce multiple eggs. The eggs are then retrieved and united with the sperm to be fertilized in the laboratory. Some of the resulting healthy embryos are transferred back into the uterus.

in vitro fertilization

When semen has moderate or severe defects, we recommend treatment with a process of micromanipulation called intracytoplasmic sperm injection (ICSI). The embryologist (egg and sperm specialist) specially prepares the sperm and a single sperm is injected into each egg. This technique greatly increases the chances that fertilization will occur.

New developments in reproductive medicine have been made that may greatly improve your chances of success. These include the following advanced laboratory technologies:

Blastocyst Transfer

This new technique allows embryos to grow in the laboratory up to day 5 or day 6. An embryo at this stage is known as a blastocyst. Prior to this advance, embryos had to be transferred on day 3. Day 0 is defined as the day the eggs are retrieved. By allowing the additional growth, we can determine with greater certainty which embryos are the healthiest and have the greatest chance of implantation. As a result, fewer embryos need to be transferred, decreasing the chance of multiple gestations without compromising your chance of success.

An embryo transfer typically occurs three days following the retrieval and may occur five to six days following the retrieval which is referred to as blastocyst culture. With improved laboratory conditions, blastocyst culture involves placing embryos into culture for additional days to observe their continued development prior to freezing or transfer. The literature indicates that this technique may be useful in selecting the most viable embryos, resulting in the transfer of fewer embryos with a corresponding reduction in the risk of multiple pregnancies. We will discuss with the intended parents and you if you are a candidate for this process.

Intracytoplasmic Sperm Injection (ICSI)

The ICSI procedure has dramatically changed the prognosis for patients with moderate to severe male-factor infertility. In IVF, the egg and sperm are placed in a dish and fertilization takes place there. With ICSI, the embryologist takes a single sperm and places it directly into the egg using a micro-needle. The procedure produces better fertilization rates for these patients than IVF.

Assisted Hatching

Shortly before the embryo is transferred to the uterus, a small opening is made in the outer layer surrounding the embryo. This helps the embryo break out of the outer layer of cells (zona pelucida) and increases the likelihood that implantation might occur.

Cryopreservation

As a result of in-vitro fertilization, there are often excess embryos. Cyropreservation/Vitrification, or freezing of embryos, allows the intended parent(s) to store excess embryos for later use. Our embryologist grows embryos to the blastocyst stage, freezing those of the highest quality.

Pre-implantation Genetic Screening & Diagnosis (PGS/PGD)

PGD is a technique that utilizes both micromanipulation and DNA technology procedures to evaluate embryos for certain genetic abnormalities prior to embryo transfer. The procedure is usually reserved for those patients at increased risk for passing along specific inherited diseases due to a specific gene, but is increasingly being used to screen all embryos for chromosomal defect(s), referred to as Pre-implantation Genetic Screening (PGS). Not all diseases can be detected by PGD, but examples of diseases that can be detected include cystic fibrosis (CF), certain thalasemias, Tay-Sachs disease and Down's syndrome.

PGD is performed on the third day after the egg retrieval when the embryos are at the 6-10 cell stage of development. The procedure includes:

  • An opening is made on the outer covering of the embryo (zona pellucida) and then one or two cells of the embryo are removed using micromanipulation pipettes and gentle aspiration.
  • The cells are then sent to an outside laboratory that performs the analysis on the DNA (genetic material) of the cell, which usually takes one day.
  • The results are reviewed and then a transfer of non-affected embryos is performed on day 5 or 6.

The main advantage of PGD/PGS is that affected embryos are identified and only non-affected embryos are placed back in the uterus. PGD/PGS does not detect all genetic abnormalities and there are still genetic risks that may occur spontaneously (without known cause) during the course of your pregnancy, therefore PGD/PGS does not guarantee that your embryos are genetically normal. Prior to undergoing PGD/PGS detailed counseling and informed consents are required for couples using this form of technology.

Last updated: July 22, 2008
Author: Dr. Arlene J. Morales

 

 

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