At the Center for Advanced Reproductive Medicine and Fertility, we offer the following services for patients with infertility, recurrent miscarriage, and other reproductive disorders:

Diagnostic Services

Treatments Offered

On-site In Vitro fertilization (IVF) is rapidly becoming the most popular choice of treatment for couples with various types of infertility. It is generally accepted as the most successful and fastest method available to achieve pregnancy. While it was initially reserved for patients with blocked, damaged, or absent fallopian tubes (tubal factor infertility), IVF is now also used to overcome infertility caused by endometriosis, male factor issues, diminished egg quality, ovulatory problems, or other unexplained reasons.

IVF is an advanced method of assisted reproduction in which the man's sperm and the woman's eggs are combined in a laboratory where fertilization occurs, and the resultant embryos are then transferred to the woman's uterus (embryo transfer) in hopes of achieving a pregnancy. Initially, the patient undergoes ovulation enhancement (superovulation) with a combination of injectable fertility medications that results in the development of multiple eggs in both ovaries. When the eggs have sufficiently matured, the transvaginal ultrasound-guided egg retrieval procedure is then performed in the office, with an anesthesiologist present to provide complete pain relief. The patient is discharged home soon after the procedure.

On the day the eggs are harvested, the partner provides a semen specimen from which the sperm are isolated in the laboratory, and used to fertilize the eggs. If a significant male factor is present, such as low sperm concentrations, or a diminished percentage of normal appearing sperm (morphology) or normally motile sperm (motility), intracytoplasmic sperm injection (ICSI) is an extremely useful modality that is employed to maximize the chances for fertilization.

Intracytoplasmic Sperm Injection (ICSI) is a technique of gamete (sperm/egg) micro-manipulation, or assisted fertilization, in which individual sperm are captured in a microscopic glass pipette and meticulously injected directly into the individual eggs. The resultant fertilized eggs (early embryos) are then allowed to grow and mature in the sterile laboratory conditions in a manner similar to that of standard IVF. In cases where there is a complete absence of sperm in the ejaculate, such as in gentlemen who have previously undergone a vasectomy, microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) is performed by a specialized urologist here in our office for retrieval of the sperm, and ICSI is then carried out.

An appropriate number of fertilized eggs (embryos) are returned into the patient's uterus three days later following the egg retrieval via an embryo transfer, or in select cases, the embryos are cultured for an additional 2-3 days and a blastocyst transfer is performed. It is well recognized that the chances for pregnancy improve dramatically if more than one egg is fertilized and transferred to the uterus in a treatment cycle. At the same time, we are extremely careful to limit the number of embryos transferred so as to help avoid a high order multiple pregnancy from occurring.

Preimplantation Genetic Diagnosis (PGD) is a relatively new procedure, used in conjunction with in vitro fertilization, which helps increase the likelihood of genetically normal embryos to be selected for transfer to the uterus. PGD involves the microsurgical removal and biopsy of one blastomere (cell) from a six to eight cell embryo. The genetic diagnosis of the blastomere can be accomplished by using either PCR (polymerase chain reaction) or FISH (fluorescence in situ hybridization), depending on the indication for PGD. By prescreening a representative cell from each Day 3 embryo, the healthiest embryos with the greatest potential for implantation can be identified.

Preimplantation genetic diagnosis has been shown to be helpful for specific groups of patients. Women with recurrent miscarriage due to chromosome issues have been shown to have higher implantation rates and reduced spontaneous abortion rates when PGD is used in conjunction with IVF. In addition, carriers of single gene disorders (e.g. cystic fibrosis, thalassemia) benefit from prescreening of their embryos before they are transferred. PGD for gender selection in sex-linked disorders is also routinely utilized to improve chances for a successful outcome (i.e. having an unaffected pregnancy). By identifying the sex of the embryo, sex-linked disorders such as hemophilia can be avoided. The benefit of PGD is less clear in other groups of patients, including those with unexplained infertility, advanced maternal age, or repeat IVF failure.

The biopsy of the embryo and subsequent molecular analysis of the blastomere are both technically demanding and complex procedures that require highly trained laboratory personnel. Genetic results are usually reported within 24 hours of the biopsy, allowing for the subsequent transfer of unaffected embryos

.

Assisted Hatching is an advanced micro-manipulation technique that we commonly employ to help with embryo implantation for certain subgroups of patients in whom this may be less likely to naturally occur. If excess embryos are available, they may be cryopreserved (frozen) with the intent of thawing and transferring them at a later date. Less than two weeks following an embryo transfer, pregnancy testing is performed here in our office.

Egg donation is becoming an increasingly valuable therapy we have employed for patients with a poor prognosis for IVF success using their own oocytes (eggs). These include women with: premature menopause, advanced reproductive age (e.g. over 40 years old), elevated FSH levels (e.g. > 12 U/L), poor response to injectable fertility medications, multiple failed IVF cycles caused by poor egg or embryo quality, repetitive pregnancy loss, and other factors. Women may choose to have a known egg donor (e.g. a relative or friend), or an anonymous donor who we would help to match her with following an intense and comprehensive screening process. Egg donation is a very successful treatment option, and one that has allowed many couples who in the past had run out of hope to now experience the joys of childbearing. Click HERE to read more.

Intrauterine insemination (IUI) is a treatment that may be used when the female partner does not produce sufficient cervical mucus at the time of ovulation, or in some cases of unexplained infertility. This procedure is also commonly performed as part of a superovulation-IUI treatment cycle for infertile couples where adequate numbers of healthy sperm are present in the husband's ejaculate, and at least one fallopian tube is open. If the sperm parameters are significantly compromised, IUI is unlikely to improve the chance for pregnancy, and these couples are best treated by IVF with ICSI. However if this is not the case, IUI has been shown to increase the pregnancy rates even with mild ovulation induction protocols using (e.g.) clomiphene citrate (Clomid tablets).

In our office, we are equipped to perform all of the diagnostic test listed above, including flexible office hysteroscopy for evaluation of the uterine cavity prior to attempting conception. Minimally invasive diagnostic/operative laparoscopy and more advanced operative hysteroscopy procedures are performed at one of our local hospitals, and our patients almost universally go home that same day.