Advanced reproductive treatments are classified under the term Assisted Reproductive Technology, or ART. These treatments include In-Vitro Fertilization (IVF) and related therapies.
In-Vitro Fertilization- IVF
For those who have failed injectable medication with IUI, or for those individuals or couple whose needs warrant this level of care, IVF is extremely successful and represents the highest level of success, for all indications, in reproductive medicine. In IVF cycles, the woman receives injectable hormonal stimulation for usually 10-12 days, with ultrasound and blood monitoring to assess the safety and effectiveness of this regimen. Unlike IUI, however, in IVF cycles the main intervention after the HCG injection is an ultrasound-guide transvaginal collection (retrieval) of multiple oocytes (eggs) from the This procedure is done under conscious sedation anesthesia under the care of a Board- Certified anesthesiologist. The actual egg collection procedure is performed by the Reproductive Endocrinologist and takes 15-30 minutes on average.
Once the eggs are obtained, a lab specialist called an Embryologist will find and identify the microscopic eggs and fertilize the eggs in the lab using the husbands, partner or donor sperm. Advanced fertilization techniques, such as direct placement of individual sperm within the egg (Intracytoplasmic Sperm Injection – ICSI), is often used to enhance the success of the fertilization process.
Once fertilized, the fertilized eggs, now called embryos, will be grown in the laboratory for several days prior to replacement of a mutually agreed-upon number of embryos inside the uterus of the woman (embryo transfer) in order to facilitate success full pregnancy. The embryo is also often processed with gentle disruption of a portion of the human egg shell (Assisted Hatching- AH) prior to the Embryo Transfer, in order to achieve maximal chance of implantation success. Pregnancy rates with IVF can range from 40-60%, especially in women under the age of 40, though variability in individual response and success rates can occur.
Similar to IUI, a reduction in multiple birth rates and overstimulation can be facilitated by appropriate ultrasound and blood monitoring to maximize success and minimize complication. Additional embryos after the embryo transfer can also be frozen (cryopreserved) for another baby in the future or another attempt if the initial cycle is unsuccessful.
Pre-implantation Genetic Diagnosis- PGD
An additional procedure that can be performed in conjunction with an IVF cycle is Pre-implantation Genetic Diagnosis or PGD. This procedure can help screen for genetic abnormalities such as Trisomy 21, or Down Syndrome, in which there is an extra 21st chromosome. Indications for this genetic testing could include age-related risks of genetic issues, prior treatment failures and recurrent pregnancy loss. Genetic abnormalities such as a translocation, a type of disordered genetic information in the man or woman, can also be an indication for this testing. Gender identification, either for medical indications or for elective gender selection, can also be effectively accomplished by this technology.
This process involves the biopsy and genetic testing, utilizing a variety of advanced genetic evaluation techniques, of each of the embryos that are developing in the laboratory. The embryos are generally biopsied on the third day of growth, and genetically normal embryos are then transferred back to the uterine cavity for the Embryo Transfer by 5, once the results of the genetic testing are available. New approaches using day 5 biopsies utilizing laser and a multi-cell biopsy approach are increasing the effectiveness and accuracy of this technique. In experienced hands the risk of embryo damage with PGD is minimal.
Through wider use of this new genetic technology, it is anticipated that IVF success rates will be improved and miscarriage rates will be reduced. In addition, given that fact that the embryos will be genetically normal, the technology will help to limit the need to transfer extra embryos and decrease the subsequent risk of multiple gestation.