Advanced Fertility Treatment Options - Assisted Reproductive Technology (ART)

In-vitro Fertilization (IVF)

Overview
After completing the thorough evaluation and testing, those who choose to proceed with IVF will then be placed on a stimulation protocol tailored to their individual diagnosis and situation. The IVF procedure will only be available to eligible women who can complete the IVF treatment cycle(s) prior to their 44th birthday. The process can be divided into several phases or steps:

• Suppression: This phase usually occurs for the month prior to your scheduled retrieval. Oral contraceptive pills and/or Lupron shots are used to allow the physician to suppress your natural hormonal surges and “take control” of your stimulation with gonadotropins (injectable fertility medication).
  
  
• Stimulation: Daily gonadotropin injections (typically 8-11 days) stimulate the ovary to make numerous follicles which contain the eggs. Careful monitoring with ultrasounds and blood tests allow your physician to make necessary adjustments to your treatment regimen and minimize any complications from the powerful fertility drugs. Once the follicles have reached their ideal size, a subcutaneous injection of HCG mimics your own body’s hormonal LH surge which causes final maturation of the eggs prior to harvesting (retrieval).
  
  
• Egg Retrieval: Occurring 35-36 hours after receiving the HCG shot, the oocyte retrieval is performed in our dedicated procedure room within our Center. A board certified anesthesiologist will provide intravenous sedation to prevent any pain or discomfort during the procedure. Under ultrasound guidance, a very thin needle is passed through the upper portion of the vagina into the ovarian follicles and the fluid containing the egg is aspirated and subsequently identified by our embryologist in the adjoining laboratory.
  
  
• Fertilization: After retrieval, the sperm preparation obtained from the male partner or sperm bank is placed into a specialized culture solution with the egg. If intracytoplasmic sperm injection (ICSI) is to be performed, this is when it will occur. The egg and sperm are then placed in a specially regulated incubator and observed over the next 18-20 hours to determine if successful fertilization has occurred. Once a sperm fertilizes an egg, it is considered a zygote which then develops into an embryo. The embryos are then transferred to a different culture media and grown over the next 2-6 days. Any additional procedures (i.e. assisted hatching or PGD) prior to transfer of the embryo(s) into the uterus will be determined on an individual basis. Some embryos may also be cryopreserved (frozen) at the end of the culture period.
  
  
• Embryo Transfer: This brief, painless procedure involves the use of ultrasound guidance while the embryo(s) are placed into the endometrial cavity of the uterus either 3 or 5 days (blastocyst transfer) after fertilization, using a small highly specialized plastic catheter. No sedation is necessary for this procedure. After transfer, progesterone supplementation via injection and/or vaginal suppository will be taken for the next 10-12 days and a blood pregnancy test will be performed approximately 2 weeks from the retrieval date. Blood hCG levels will then be checked every 2 days for those who do have an initial positive pregnancy test. An ultrasound will be performed at approximately 5-6 weeks of pregnancy and repeated several times throughout the first trimester after which time, you will be referred back to your Ob/Gyn for appropriate obstetrical care.

ICSI (intracytoplasmic sperm injection)

• In the case of male factor infertility, ICSI provides an alternative for men with severe sperm dysfunction. In this procedure, a single sperm is microscopically injected directly into a mature egg. This procedure allows for the selection of a single sperm based on established criteria for normalcy, and injection of that sperm into the cytoplasm of a mature egg. The use of this specialized insemination technique represents a major advance in reproductive medicine and benefits couples in whom the male has lower than normal sperm numbers or abnormal sperm shape. It may also benefit those couples where the female has abnormal egg morphology and previous IVF history of poor fertilization.

(TESA/TESE) Testicular/Epididymal Sperm Aspiration/Extraction

• These procedures are for some men who have had previous vasectomy, experience blockage or other conditions that prevent the passage of sperm through the normal ejaculatory process. A minor surgical procedure can be performed by a urologist in which a small amount of tissue from the testicle is removed (TESE) or sperm is directly aspirated using a needle (TESA) under local anesthesia so the embryologist can find sperm to use for fertilization of the egg with ICSI.

Blastocyst Culture and Transfer

• Blastocyst culture is a relatively new technique in IVF in which embryos are grown in laboratory culture for 5 days prior to being transferred. In traditional IVF, 3-4 embryos are transferred on day 3 (at the 6-10 cell stage), whereas 2 blastocysts (50-100 cell stage) are usually transferred on day 5. As a result, this permits us to decrease the likelihood of higher order multiple pregnancies (twins, triplets) while maintaining an equally high pregnancy rate. An additional advantage to blastocyst transfer is our ability to perform PGD on the embryos of those selected patients who need it prior to transfer.

Assisted Hatching

• This laboratory technique is used to improve the probability of an embryo implanting into the uterine wall after transfer into the uterine cavity. The embryologist creates a small hole in the outer membrane or shell of the embryo (called the zona pellucida). By creating this thinning of the wall, the embryo is better able to exit its protective “shell” and implant into the uterine lining. Numerous studies have shown that AH improves pregnancy rates and implantation rates. Patients with previous IVF failure, poor embryo growth or quality, moderate to excessive fragmentation, or advanced maternal age may benefit from this additional procedure prior to embryo transfer.

Preimplantation Genetic Diagnosis (PGD)

• Overview (including process, advantages/disadvantages, costs, implantation rates): PGD is a highly specialized and delicate procedure which involves removing a single cell from a 3 day old embryo and testing it for abnormalities. These abnormalities can be one of two types. Single Gene Disorders are those of known chromosomal origin or Aneuploidy where extra or missing chromosomes lead to significant abnormalities. PGD permits the selection and subsequent transfer of embryos which are less likely to have chromosomal abnormalities or free of a known single gene disorder, hence increasing the chances for a successful pregnancy and healthy baby.
  
  
• If PGD is part of your treatment, our embryologist will perform the embryo biopsy and fixation and the cells will then be sent to one of two reference labs for the chromosomal analysis. The embryo-specific results will then be communicated back to our embryologist prior to embryo transfer on Day 5.

Embryo/Gamete Cryopreservation

• Cryopreservation (freezing) of embryos is utilized when the number of embryos produced during an IVF cycle exceeds the number of embryos that are transferred into the uterus. Embryos can be subsequently thawed and placed into the uterine cavity after many years of being frozen. By doing so, one can avoid repeating the entire stimulation and egg retrieval process for future attempts.
  
  
• Similar to embryos, sperm can also be frozen for potential future use.
  
  
• Current research is exploring the possibility of cryopreservation of the egg or ovarian tissue, however, techniques yielding consistently satisfactory success rates have yet to be demonstrated. At Advanced Fertility Care, we are committed to staying abreast and implementing any advances in reproductive technology once we have determined it to be safe and of benefit to our patients.

Donor Egg

• Overview: For many of our infertile couples, egg donation is one of the only ways they will be able to experience the joys of parenthood. Egg donation offers women who are unable to produce their own healthy eggs, a chance for conception. Some conditions that can be successfully treated using egg donation are: loss of ovaries, premature ovarian failure, previous ovarian surgery, previous radiation or chemotherapy, chromosomal or genetic disorders, advanced maternal age, and history of poor or inadequate response to previous fertility treatments.
  
  
• Our donors undergo a rigorous prescreening process for genetic, psychological and physical health abnormalities, sexually transmitted diseases, smoking, alcohol and drug use. Only those donors who have passed the complete screening process including preliminary ultrasound and hormonal fertility screening will be made available to our potential recipient couples.
  
  
• See Donor Program for details on our Donor process and benefits as well as details on our 100% Money Back Guarantee plan for those patients who qualify.

Gestational Carrier

• Women who have the ability to produce eggs from their ovaries, but are unable to use their uterus or do not have a uterus, may consider using a gestational carrier. A gestational carrier is a woman who has an embryo transferred into her uterus, becomes pregnant, carries a fetus throughout a pregnancy and delivers the child for another couple. A donated egg may also be used with a gestational carrier in the event a woman cannot produce her own eggs. In either scenario, the gestational carrier has no genetic link to the fetus she is carrying as the embryo is derived from the couple or in some cases a separate donor egg and/or sperm are warranted.
  
  
• Sometimes terminology can be confusing. Some people tend to confuse the terms “gestational carrier” and “surrogate”. True surrogacy is not legally permitted in the State of Arizona. A true surrogate is a woman who not only carries a pregnancy for a couple, but uses her own egg as the genetic material. In these cases, the fetus is genetically linked to the surrogate.