About FSMG

San Diego Center for Reproductive Surgery (SDCRS)

Our Facility

The San Diego Center for Reproductive Surgery (SDCRS) is a state-of-the-art facility which offers you the latest in diagnostic and surgical care. The IVF laboratory has the most advanced equipment available allowing us to provide the most up to date IVF and Andrology services. We fully encourage patients to use ancillary services such as support groups, yoga, and acupuncture and are happy to refer patients if desired.

FSMG/SDCRS is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). In addition, our Embryology, Andrology and Endocrinology laboratories meet the highest standards and are certified by the Clinical Laboratory Improvement Act (CLIA). We adhere to all Food and Drug Administration (FDA) guidelines.

SDCRS provides the following treatments:

  • Egg Retrievals
  • Embryo Transfers
  • Vitrification
  • Egg/Embryo
  • Hysteroscopy
  • Tubal Reversal
  • Sperm Retrievals (TESA/MESA)

Egg Retrievals

Center for Reproductive Surgery

All egg retrievals are performed in our facility at the San Diego Center for Reproductive Surgery (SDCRS). Egg retrieval is a minor surgical procedure that is performed under deep sedation, also known as IV sedation. On the day of your egg retrieval you will come to the SDCRS and the IVF Nurses will help prepare you for your egg retrieval. We ask that you arrive at least 45 minutes prior to your scheduled procedure time so that you may change into the proper attire, complete paperwork and meet with your anesthesia provider. You will then be brought into the procedure room where you will lie on an exam table and your IV sedation will be started by the anesthesiologist. A speculum is then placed into your vagina to be cleansed with sterile fluids. A vaginal U/S probe along with a thin aspiration needle is then placed into your vagina and under U/S guidance the needle is inserted through the back wall of your vagina into the ovary. The physician then punctures each follicle with the needle tip and aspirates the fluid from the follicles. The fluid is collected into sterile test tubes that are passed along to the ART laboratory where the contents are screened for an egg.

The egg retrieval lasts about 20-30 minutes. You will then go to our recovery room for about 30-45 minutes and when you're completely awake and alert, you will be allowed to go home.

The egg retrieval procedure is well tolerated by the majority of patients and you should be able to go back to your usual routine the day after the retrieval. On occasion the retrieval procedure can cause mild to moderate discomfort especially in your pelvic area. While the egg retrieval is a very safe procedure, as with all surgical procedures there are possible risks including:

  1. The attempt to recover eggs may not be successful.
  2. Other internal organs such as the bladder, bowel or blood vessels could be injured and require further surgery (this is extremely rare).
  3. Limited bleeding from the ovaries may occur and surgery may be required to stop the bleeding (again extremely rare).
  4. Infections following the egg retrieval are possible, but are rare and you will be placed on an antibiotic after the egg retrieval.

An IVF Nurse will contact you the day after your procedure to check on your recovery.

Embryo Transfers

The embryo transfers are all performed in a procedure room at the SDCRS. You are to arrive at the SDCRS reception area at least 15 minutes before your scheduled embryo transfer time. The IVF Nurse will come and get you from our waiting room, bring you into the embryo transfer room and instruct you on preparing for the transfer.

An embryo transfer is performed between 2 and 6 days following your egg retrieval. This is tailored to your clinical situation and the quality of your embryos. After discussion with Drs Morales or Lindheim, about both the quality and number of embryos, we will recommend the appropriate number to transfer to your uterus with your mutual consent. Our goal is to optimize your chances of conception, while at the same time minimizing your chances of having a multiple pregnancy, especially in high order multiple pregnancies.

These are taken from the embryo culture into an embryo transfer catheter by our embryologist and are gently introduced into your uterine cavity.

We perform your embryo transfer using ultrasound guidance to assure your embryos are in the correct place within your uterus. Depending on the preference of your provider, a transvaginal or transabdominal ultrasound will be done during your transfer. In order for the abdominal U/S method to work best your bladder should be full. When you arrive at SDCRS for your embryo transfer, drink a large glass or two of water.

Cryopreservation/Vitrification

For decades, science has allowed us to freeze sperm and for years we have been able to freeze embryos, but only just recently have we been able to freeze eggs. Numerous studies have been reported in search of developing an ideal oocyte (egg) cryopreservation method after the first report of a successful pregnancy using a frozen thawed oocyte in 1986. Since that time several centers around the world have reported similar success. Most of these pregnancies were achieved by a slow-freezing method. The survival of oocytes following thawing after this slow-freezing technique has been very low, as have pregnancy rates. Therefore there has been a pressing need to develop a more efficient way to cryopreserve oocytes. Such a protocol must reduce the damage to cells caused by ice crystal formation during the freezing process.

At the present time vitrification offers the best solution to the problem. FSMG currently offers vitrification of eggs & embryos. Vitrification is a very simple procedure and requires no programmable freezing equipment. In the process of vitrification, an oocyte is placed in a very small volume of fluid and is then cooled at an extremely rapid rate. The fast freezing eliminates the formation of ice crystals in the oocyte. Subsequent to the vitrification, the oocyte is stored in liquid nitrogen until such time as it is to be thawed and fertilized.

Center for Reproductive Surgery

Vitrification has been used successfully since 1999. Successful pregnancies following the use of this technology are being reported with greater frequency. To date, approximately 200 children have been conceived using this technology. Currently, the American Society for Reproductive Medicine(ASRM) considers egg freezing investigational unless used for women who are utilizing it's being done as a heroic measure for women who may risk loosing their reproductive function as a consequence of surgery or chemotherapy for cancer.

Sperm Retrievals (TESA/MESA)

Men who have azoospermia (no sperm in their ejaculate) due either to an obstruction or testicular dysfunction may have the option of undergoing a surgical sperm retrieval process. Patients must see a Urologist prior to proceeding through ART, to better understand the cause of the azoospermia and determine the best approach for retrieving sperm.

Recovering sperm can be done by aspirating fluid from the epididymis (Microsurgical Epididymal Sperm Aspiration or MESA) of the male reproductive tract, or by removing a small piece of tissue directly from the testis (Testicular Sperm Aspiration or TESA). These procedures can usually, but not always, be performed prior to the day of the egg retrieval. The sperm that is retrieved can be processed in the embryology laboratory, frozen and stored until needed. The main benefits of freezing include flexibility in the scheduling of the procedure and the fact that usually sufficient sperm are frozen from one SSR to allow several ART attempts.

Depending on the preference of your Urologist, SSR procedures may be performed at their office, our FSSD office, the SDCRS facility or another medical facility. Various methods of anesthesia may be utilized, depending on the procedure.

Hysteroscopy

Hysteroscopy is a surgical procedure that allows the physician to inspect the inside of the uterus by inserting a hysteroscope (a small telescope about the size of a pen) through the vagina and cervix and into the uterus. This procedure takes place in an operating room or in a doctor's office. Gas or liquid is placed into the uterus through the hysteroscope to separate the walls and allow inspection. Fibroids, polyps, scarring, abnormal contour and malignancies may be seen and corrected.

Tubal Reversal

Tubal reversal (reanastomosis) is a surgical procedure which can restore the function of fallopian tubes which have been blocked by a previous sterilization operation.

Tubal reversal operations are best performed using microsurgical techniques, in which microscopes are used to visualize and bring together the very narrow hollow center portion of the fallopian tubes. Microsurgery also uses very thin suture materials, the smallest possible incisions, specially designed instruments and non-traumatic tissue handling techniques. FSMG/SDCRS offers this procedure following a comprehensive assessment with one of our skilled physicians.

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

 

 

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