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CHOOSE
THE GENDER OF YOUR NEXT BABY:
Using a process known as PGD
and combining this with in vitro fertilization, we are
able to determine with 100% accuracy the sex of the
embryo. Only an embryos of the desired sex, either male
or female, is replaced back into the womb.
An additional benefit of this technique is that embryos
can be checked for common genetic diseases such as Down’s
syndrome before they are replaced, helping to reducing
the tragic outcome of a child with a major birth defect.Please
call or come in for a free consultation regarding this
exciting technology.
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ASSISTED
REPRODUCTIVE TECHNIQUES:
Modern technology has made pregnancies possible that would
never have happened a few decades ago. The following is
an overview of most of the available treatments at Innovative
Fertility: |
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| a)
ARTIFICIAL INSEMINATION (AI): |
This treatment
can be performed with the patient's partner's sperm (Husband
Insemination) or an unknown donor's sperm (Donor Insemination).
(Here at Innovative Fertility Center, we have noticed
a marked reduction in Donor Insemination since the advent
of IntraCytoplasmic Sperm Injection [ICSI] treatment for
male infertility).
In AI, the physician inserts a syringe containing a prepared
sperm sample into the vagina and releases the solution
into the cervical opening. This technique is used mostly
for sperm problems but is also helpful when intercourse
can't take place often enough to conceive. |
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| b) INTRAUTERINE
INSEMINATION: |
| If the cause
of infertility is suspected to be the quality of the cervical
mucus or an inability of the sperm to move toward the
egg fast enough, intrauterine insemination can be tried.
Bypassing the cervix, sperm are deposited directly into
the uterus, from where they swim into the fallopian tubes.
Conception rates for this treatment range from 30-40%
when cervical mucus is the problem and 14-40% when inadequate
sperm are responsible. |
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| c) INTRAUTERINE
INSEMINATION WITH GENDER SELECTION: |
Over the past
few years, Innovative Fertility Center has noticed an
increase in interest from the public regarding sex selection
procedures. Innovative Fertility Center has provided this
service since 1989 and according to our records of these
procedures, we have found that the success rate for obtaining
the desired sex with the method used at our Center is
approximately 75-80%.
The subject is controversial and some countries still
consider it illegal. Those against sex selection are concerned
that more couples will opt for a boy, especially if they
are planning to have only one child. In one study of US
couples who would use gender selection, 81% of women and
94% of men reported a preference for first born sons.
In Innovative Fertility Center's experience however, the
average couple who requests information and who actually
use this procedure at our Clinic are those who already
have one, two or three children of a certain sex and who
simply want to balance their family. For example, Dr.
& Mrs. B had two boys aged four and six and they desired
to complete their family with a little girl. This couple
decided to use sex selection as a method to increase their
chances of having a little girl. Like most of Innovative
Fertility Center's patients who do use this procedure,
Dr. & Mrs. B wanted another child anyway and they
merely looked upon the procedure as a means of increasing
their odds of having a daughter. Dr. & Mrs. B achieved
a pregnancy on their third sex selection insemination
attempt. Their family is now complete and their two sons
have a sister.
Sex selection has been involved in about 3,500 births
in the past 22 years worldwide.
On July 25, 1978, the world's first in vitro fertilization
(IVF) baby was born. When Louise Brown's mother gave birth
to her daughter at Oldham Hospital near Manchester, England,
the world reacted as if she was a creation of science
fiction.
At that time, she was a miracle. Drs. Robert Edwards and
Patrick Steproe had master minded a revolutionary procedure
whereby uniting sperm and egg in a
glass dish had produced a beautiful baby girl who became
instantly known as the "test tube baby". Twenty
years after Brown's birth the in vitro fertilization procedure
is responsible for the birth of more than 500,000 healthy
children around the world. |
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| In Vitro
Fertilization (IVF) requires a team of experts, takes
several weeks and consists of five basic steps: |
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a)
Ovarian Follicle Development:
Women usually grow a single egg in a month. In order to
increase the chances of pregnancy occurring, the patient
takes medication that can be utilized alone or in combination
to induce several follicles to develop. (A follicle is
a bag of water that houses the egg and is usually visualized
on the video screen of an ultrasound machine). The monitoring
of the egg development is accomplished in three ways:
1) Ultrasound monitoring
of follicle growth
2) Monitoring of blood or urinary estrogen (E2), progesterone
(P4),
and luteinizing hormone (LH)
3) Physician's interpretation of the cycle data
The IVF team (physicians, nurses, and embryologists) evaluate
these data on an ongoing basis for the appropriate timing
of the administration of the human chorionic gonadotropin
(hCG) injection to trigger final stages of ovulation.
The hCG injection is usually given about 35 hours before
egg retrieval is scheduled. |
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b)
Egg Harvesting - Oocyte Retrieval:
In the early days of IVF, the eggs were retrieved by laparoscopy.
Today, they are collected by transvaginal ultrasound-guided
oocyte aspiration. This is a simple technique which involves
the introduction of a fairly small needle through the
vaginal wall guided by the ultrasonic probe. This technique
is easy to perform and has been utilized by our group
since its introduction in the US in 1985. The vast majority
of Innovative Fertility Center's patients undergo the
egg harvesting procedure in our office under local anesthesia
and IV sedation. In this way, there is no hospital fee
and Innovative Fertility Center does not charge a facility
fee for the aspiration. |
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c)
In Vitro Fertilization Laboratory:
After the oocyte collection procedure, a "baby incubator"
which houses a powerful dissecting microscope receives
the follicular fluid containing the eggs. This fluid is
placed in a special culture medium which consists of several
essential chemicals. The eggs remain in the carefully-controlled
extracorporeal system for 4-6 hours before the embryologist
adds the specially-processed sperm to allow the fertilization
process to occur. (If there is male factor infertility,
we would probably perform ICSI to assure fertilization).
After a period of 16-20 hours, the eggs are examined and
checked for the first signs of fertilization. At this
time, the embryologist can observe under the microscope
"two pronuclei". The egg essentially looks like
a "round ball with two eyes" and they represent
the genetic material from the husband and wife. After
two to three days, if the embryos are growing normally,
they are ready for the embryo transfer. |
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d)
Uterine Embryo Transfer:
The embryo transfer is not a complicated procedure and
is performed in our office without anesthesia. The embryos
are placed in a catheter (a tubular instrument) and then
the tiny plastic tube is introduced into the uterus through
the cervix and the embryo(s) are transferred into the
endometrial cavity. The woman is required to stay in a
gynecological position for a few minutes, then her legs
are repositioned to be more comfortable. We require the
patient to remain lying down for about an hour after the
embryos have been replaced into the uterus.
After the embryo transfer, we request patients to absolutely
restrict their physical activities for the first 24-72
hours and until a pregnancy test is performed approximately
9-12 days post transfer to moderately restrict their activities.
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e)
Luteal Phase Monitoring & Support:
This phase consists of monitoring of blood levels of progesterone,
estradiol, and BhCG (pregnancy tests). If there is a positive
pregnancy test, close monitoring of the early pregnancy
is highly advisable. At Innovative Fertility Center, we
continue to perform the blood tests plus the first pregnancy
ultrasound for detection of the baby's heartbeat and evaluation
of the number of embryos implanted is usually done between
the 4th and 6th week post transfer.
In the event of an unsuccessful cycle, Innovative Fertility
Center's patients are encouraged to talk to their physician
for understanding of the cycle and to actively participate
in planning for future treatments. During a treatment
cycle, we gather an enormous amount of information and
this is frequently beneficial to tailor a patient's future
treatments. |
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Gamete
Intrafallopian Transfer (GIFT)
GIFT is a fairly commonly used assisted reproductive technology
technique which was developed in 1984 as a variation of
the IVF procedure. GIFT is a successful alternative for
couples with unexplained infertility provided that the
woman has at least one open fallopian tube. The procedure
is also used in patients in who the infertility is caused
by cervical or immunological factors, mild endometriosis,
older women and in some cases of moderate male infertility.
GIFT also represents an alternative for patients whose
religious beliefs prohibit conception outside of the body.
In the GIFT procedure, fertilization takes place within
the fallopian tube and this is also where a limitation
of the procedure is evident. Unfortunately, GIFT does
not allow for confirmation of fertilization because it
occurs inside the body. The stages involved in the GIFT
procedure are very similar to IVF. |
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a) Ovarian stimulation
and monitoring: The initial steps of the ART procedures
are the same. The patient takes hormonal medications to
stimulate the ovaries to encourage the development of
multiple oocytes. The patient is followed during this
phase of treatment with ultrasounds and hormonal level
blood tests.
b) Egg retrieval: With GIFT, our doctors still retrieve
the eggs through transvaginal ultrasound aspiration. The
sperm is prepared in advance and the eggs are examined
microscopically and then combined with the sperm in a
special catheter.
c) Gamete transfer: The gametes (sperm and eggs) are transferred
laparoscopically. The catheter is inserted into the fallopian
tube(s) and the sperm and egg are placed directly into
the tube. Hopefully, the transferred gametes will fertilize
and the developing embryos will then move to and implant
in the uterus. |
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Zygote
Intrafallopian Transfer (ZIFT)/Tubal Embryo Transfer (TET)
ZIFT/TET is a further variant of the IVF procedure and
was developed in about 1986 . As with IVF and GIFT, ZIFT
involves ovarian stimulation monitoring and egg retrieval.
The major difference between ZIFT and GIFT is that once
the eggs are retrieved, they are fertilized in the in
vitro laboratory just as they are in the IVF procedure.
The difference between IVF and ZIFT is that the zygotes
or embryos are then transferred laparoscopically to the
fallopian tubes in a manner similar to a GIFT transfer.
The obvious advantage of ZIFT over GIFT is that as in
IVF, it is possible to document fertilization. On the
other hand, the procedure requires the woman to have at
least one functioning fallopian tube which is a disadvantage
when comparing ZIFT to IVF.
The use of ZIFT is not that widespread. However, at Innovative
Fertility Center we have leaned towards performing ZIFT
on a select group of patients because early on we noticed
an increase in pregnancy rates especially amongst older
patients and those with unexplained infertility. Innovative
Fertility Center's overall take home baby rate for 500
egg retrievals performed for ZIFT is 48%. This delivered
rate includes 81 egg retrievals performed on patients
over 40 years of age. The above data suggests that at
our center patients who have had multiple failed IVF cycles
or who have patent tubes but are older should consider
ZIFT/TET as a treatment option. It is possible that the
fallopian tube may have the capacity to rescue "marginal
embryos" as well as allowing the developing embryos
to remain in the tube and then as in a natural pregnancy
move into the uterus at the appropriate physiological
time for implantation. |
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Frozen
Embryo Transfer Program
A successful embryo cryopreservation program such as the
one at Innovative Fertility Center, where the pregnancy
rate for frozen embryo transfers approaches that of fresh
transfers, offers several important clinical applications:
1) It allows for the freezing and storage
of supernumery (extra) embryos from ART cycles. This enables
us to replace fewer fresh embryos thus decreasing the
multiple birth rate while at the same time allowing for
the preservation of any "extra" embryos which
can be frozen and stored to be replaced at a later date.
This increases the success rate per stimulated cycle and
also enables the patient to undergo one or more frozen-thaw
cycles before needing to face the added expense of a stimulated
cycle again.
2) At Innovative Fertility,
when a patient's endometrial lining is substandard, we
feel comfortable because of the high success rate achieved
in our frozen-thaw cycles, to recommend embryo freezing
with transfer in a subsequent cycle when an optimal endometrial
pattern is achieved.
3) The success of
our embryo cryopreservation program has allowed us to
continue our work with embryo accumulation cycles. As
we have previously reported, this treatment is offered
to couples who do not grow many eggs in a given stimulation
cycle such as some patients in their late 30's or early
40's. This also enables us to treat couples who cannot
undergo stimulated cycles such as certain cancer patients.
The patient's egg is harvested after undergoing a natural
cycle and the resulting embryo is frozen. After several
such natural cycles enough frozen embryos will have been
accumulated to undertake a frozen-thaw cycle. We continue
to be encouraged with the results of this treatment approach
and it has allowed us to offer realistic pregnancy potential
for patients with resistant ovaries and for those who
cannot take fertility medications.
4)
Innovative Fertilities successful frozen embryo program
is of paramount importance to ensuring the continued success
and improvement of our Third Party Reproductive Program.
Egg and embryo donation is highly dependent on the ability
to preserve the "extra" embryos obtained from
these cycles and at a later date to successfully thaw
and transfer them. The convenience factor plus the cost
savings afforded by Innovative Fertilities quality cryopreservation
program in addition to the augmented success rates of
the original egg donation cycles enables us to maintain
our Third Party Reproductive Program in the forefront
of this technology.
Some programs have reported that frozen embryos that were
obtained from a prior successful ART cycle are more likely
to result in a pregnancy in a thaw cycle. However, it
is interesting to note that at Innovative Fertility Center
in approximately half of the pregnancies established by
frozen embryo transfer procedures, the mother did not
establish a pregnancy at the time of the transfer of the
fresh embryos. Furthermore, a fairly high number of women
who had stored only a single frozen embryo, subsequently
produced a healthy child after a frozen embryo transfer
cycle.
Many patients may not be aware of the cost benefits associated
with frozen embryo transfer cycles. Innovative Fertility
would like to advise couples who still have embryos in
cryostorage that a frozen embryo transfer cycle is a relatively
inexpensive treatment being about half to a third of the
cost of a regular IVF cycle.
The preparation for such a cycle is essentially non-invasive.
The female may use either a spontaneous natural cycle
(without medications) or be prescribed some estrogen and
then progesterone in preparation for the embryo transfer.
Invariably, the transfer of these thawed embryos is done
without anesthesia on an outpatient basis, in the office
by the transcervical approach. |
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Embryo
Assisted Hatching
Patients who may benefit from Assisted Hatching (AHA)
are those whose embryos have thicker zonas, patients whose
Day three FSH level is elevated and those who have failed
IVF two or more times. Microembryonic hatching is a technique
whereby microscopic holes are created in the embryonic
shell to facilitate easier release of the embryo into
the endometrial cavity thereby improving the chances of
implantation. |
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Intracytoplasmic
Sperm Injection (ICSI) - UPDATE
Without fertilization of the egg by the sperm, the single
resulting cell (weighing about one twenty millionth of
an ounce) which would ultimately grow into a human being
could not exist. For many infertile couples, the inability
to achieve fertilization is the principal problem.
In 1992, a new technique known as ICSI was introduced
by a Belgian group which has revolutionized the treatment
of male infertility. The ICSI procedure is a remarkable
breakthrough because it requires only a single sperm for
fertilization to occur. Fertilization is accomplished
by the direct insertion of a single sperm into the cytoplasm
of the egg.
The success of ICSI is very dependent
on the skill of the embryologist and the number of procedures
performed. There is a large learning curve involved with
mastering this technique. |
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| Call Today to make an appointment! Innovative Fertility
Center |
| 1200 E. Rosecrans Avenue, Suite 202, Manhattan Beach,
CA. 90266 |
| (t) 310.648.BABY (f) 310.333.0666 (e) info@innovativefertility.com |
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