In Vitro Fertilization

Advanced Treatment

Intracytoplasmic Sperm Injection (ICSI)
The ICSI technique is used to fertilize mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle. ICSI allows couples with very low sperm counts or poor quality sperm to achieve fertilization and pregnancy rates equal to traditional IVF. It is also recommended for couples who have not achieved fertilization in prior IVF attempts. Special types of urological procedures may be used when there is difficulty obtaining sperm or for men with no sperm in the ejaculate.

Assisted Hatching
Assisted Hatching (AH) is a procedure performed prior to transfer in selected cases. An embryo needs to escape or "hatch" from its protein shell, called the Zona Pellucida, before it can implant in the uterus. In AH, a chemical or a laser can be used to dissolve part of the zona, to facilitate the hatching process later. This technique is often used for patients with prior unsuccessful IVF cycles when the female age is over 38, and for eggs with abnormally thick zonae.

Percutaneous Epidydimal Sperm Aspiration and Testicular Sperm Extraction (PESA and TESE) and Microdissection
Some men have no sperm in the ejaculate but still produce them in the testes. This may occur due to a vasectomy, to a congenital obstruction of the sperm ducts leaving the testes, or to inadequate development of the sperm such that they cannot leave the testes. In these situations, one of our consulting urologists can remove sperm by placing a needle into the testis or the tubes that drain it. These procedures are done under anesthesia and can be very effective when combined with ICSI. Occasionally a testicle biopsy is used for sperm extraction with (microdissection technique) or without the use of microscopes as part of the retrieval process.

Cryopreservation
Embryos that are not transferred but continue to thrive in the laboratory can be cryopreserved (frozen). We recommend freezing for any high quality embryos that survive to the blastocyst stage. These embryos are stored in liquid nitrogen and can be thawed at a later date. While the pregnancy rates with frozen embryos are not as high, the procedures involved in preparing for a frozen embryo transfer are much simpler and less expensive. Freezing only embryos that survive to the blastocyst stage maximizes the chance for success in a thaw cycle.

Preimplantation Genetic Diagnosis
PGD testing is performed on a single blastomere from early dividing embryos in conjunction with an In Vitro Fertilization cycle. After the patient’s eggs are retrieved, they are fertilized with the partner’s sperm in the laboratory. Once fertilization occurs and embryos develop over the next 2-3 days to the 6-8-cell stage, the embryologists in the IVF Laboratory remove one or two cells from each embryo. The biopsied cells are immediately analyzed in our PGD Laboratory by sophisticated techniques such as fluorescence in situ hybridization (FISH). Using FISH we can determine the proper structure for any chromosome and appropriate number for chromosomes 13, 15, 16, 17, 18, 21, 22, X and Y. DNA analysis is used for a growing list of single gene defects, such as Cystic fibrosis or Muscular dystrophy. Results are usually available within hours, well before the embryo would need to be transferred back into the uterus.

As a result, for an increasing number of genetic disorders, PGD allows only those embryos identified as being free from the genetic disorder to be transferred for implantation and pregnancy. This provides great comfort for patients with genetic disorders who now may be able to transfer only normal embryos. It can also increase the likelihood of initiating a normal pregnancy in patients undergoing IVF.

Egg Donation
In many situations, especially when a female patient is in her late 30’s and early 40’s, infertility may result from a decrease in ovarian function and a consequent fall in egg quality. In the event of a severe compromise in ovarian function, successful pregnancy is very unlikely. A treatment that offers an excellent chance of success is to use eggs from a donor who is capable of producing good quality eggs. This is a complex treatment option from medical, psychological and ethical viewpoints, but one that provides a very good chance for pregnancy.

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