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Assisted Reproductive Technology (ART) has become a dominant part of most programs designed for human reproduction. It involves widely known technologies, such as in-vitro fertilization (IVF) and lesser-known methodologies of treatment, such as gamete intrafallopian transfer (GIFT) or zygote intrafallopian transfer (ZIFT). All of these ART procedures are available at the Center for Human Reproduction (CHR). Though like most high quality ART centers, we perform GIFT and ZIFT only rarely, and a large preponderance of ART cycles are IVF cycles. In a good IVF program, there is only rarely an indication found for either GIFT or ZIFT. At CHR, we usually only perform these procedures if patients are insistent. This most often happens when religious considerations permit fertilization in the body, as with GIFT, but prohibit extracorporal (in-vitro) fertilization, as with IVF and ZIFT.
CHR's ART program is one of the largest in the country and is well respected for its quality of
services. The continuous research efforts we are involved in offer state-of-the-art care. This program serves as a training ground for colleagues from all over the world. Our outcome data is available for you to review in Pregnancy Rates. Should you have additional questions or wish
to make an appointment for services, please Contact Us.
Widely Known ART Technologies
In-vitro Fertilization (IVF)
In IVF, eggs are obtained from the female, after her ovaries have been
stimulated with infertility drugs through an egg retrieval. While the patient
is sedated for five to ten minutes, under
ultrasound control, a needle is inserted into the ovaries and eggs are aspirated.
These eggs are then fertilized in the laboratory (in-vitro) with the partner's
sperm and the ensuing embryos are watched
for three to six days while they start dividing. On the third day, when the better
embryos have reached eight-cell stage, most patients undergo an embryo transfer.
With a tiny catheter, usually
unperceivable to the patient, embryos are placed into the uterine cavity. A pregnancy
test (hCg) is administered approximately ten days later to determine if our patient
has become pregnant. Click here for a Pre-IVF Consultation.
State-of-the-"ART" Procedures
Preimplantation Genetic Diagnosis (PGD)
Approximately 85-90% of repeated pregnancy loss is due to genetic problems. This is a difficult and frustrating experience. However, there are solutions and treatment options that will help you, including CHRs Preimplantation Genetic Diagnosis (PGD) treatment program.
In June 2001, an official opinion of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Medicine stated that PGD was no longer considered experimental in nature.
PGD involves the genetic investigation of early stage embryos, which have been produced through in-vitro fertilization (IVF). PGD allows us to determine the sex of any given embryo (female or male) and the chromosomal make-up (whether the embryo is chromosomally normal, or, for example, has Downs syndrome). In more complicated testing procedures, it is possible to find out if embryos are affected by such diseases as Tay-Sachs disease, Cystic Fibrosis, Sickle Cell disease, Huntingtons Chorea disease, Cooleys Anemia, as well as many other genetically inherited diseases.
PGD is also used in non-medically related gender selection. In contrast to other available gender selection techniques, which are largely based on sperm sorting (X- vs. Y-carrying sperm), PGD is virtually always accurate.
We offer PGD at the Center for Human Reproduction and cooperate with many of the nations leading genetic laboratories. For further information on PGD, please download the PDF Version of the PGD Info Card.
[Download PDF Version of Info Card on PGD]
Gamete Intrafallopian Transfer (GIFT) and Zygote Intrafallopian Transfer (ZIFT)
In GIFT, eggs and semen are placed using a catheter into the fallopian tube where spontaneous
conception can occur. The hope is that fertilization will take place and the fertilized embryo(s)
find their way into the uterine cavity and implant, leading to pregnancy.
This procedure usually requires surgery in order to gain access to the fallopian tube.
Such access is generally obtained by performing a laparoscopy.
In ZIFT, the laparoscopy is performed to place fully formed embryos into the fallopian tube in the
hope that they will find their way into the uterine cavity and implant.
Other ART Procedures
Principal ART procedures are often accompanied by additional procedures. Many of these accessory
ART procedures commonly define the quality of an ART program. They include:
Intracytoplasmic Sperm Injection (ICSI)
This procedure has revolutionized the treatment of male infertility since it allows couples to
achieve fertilization, even when only a handful of sperm are available.
With ICSI, fertilization is achieved by the laboratory technician. During
routine IVF, by incubating eggs and sperm together, fertilization occurs on its own.
With ICSI, the embryologist surgically inserts one sperm into each egg. This is done by perforating
the membrane of the egg with a glass pipette, which contains the sperm. It requires highly
developed skills. Because only one sperm is needed per egg, even very small quantities of semen will
do.
This becomes especially important in males with azoospermia (the complete lack of semen on
ejaculation). In such cases, we can offer a procedure called testicular sperm extraction (TESE),
where our urologist extracts small amounts of semen directly from the
testes, which can be used for ICSI. In a very high percentage of
cases, azoospermic males can achieve fatherhood. Various testicular extraction procedures are also being performed.
The most frequently used go under the acronyms MESA, PESA and TESE.
Assisted Zona Hatching (AZH)
Another microsurgical procedure performed in the IVF laboratory is assisted zona hatching (AZH).
As embryos develop, they are encased by a membrane called the zona pellucida. Before an embryo can
implant, it needs to break this membrane and "hatch out." If the zona is too
thick, failure to hatch may prevent pregnancy from occurring. AZH is a procedure
in which, prior to embryo transfer, a small break in the zona pellucida is made to facilitate
hatching and embryo implantation.
Blastocyst Stage Transfers
In blastocyst stage transfer, developing embryos are allowed to grow undisturbed to blastocyst stage in the laboratory.
Every embryo usually hatches after it has reached the blastocyst stage.
Good quality embryos reach this point usually on day five after fertilization, though some may take
until day six. CHR routinely performs embryo transfers on the third day. In select cases, we
will culture embryos to blastocyst stage before transferring them into the uterus.
Blastocyst transfers can increase the chance of pregnancy per embryo, while decreasing the risk of
multiple pregnancies. CHR used to routinely culture almost all embryos to blastocyst stage
(i.e. transfer on the fifth day). However, we now have learned how to select the best embryos
by the third day and achieve pregnancy rates equal to those achieved with blastocyst transfers.
Cryopreservation and Frozen Embryo Transfers
ART also involves the cryopreservation of embryos, which is done routinely at CHR.
The availability of frozen embryos allows the performance of very economic IVF cycles since the
thawing of cryopreserved embryos and their use in a frozen/thawed embryo transfer (FET) is much
less involved and less costly than the generation of fresh embryos through a new IVF cycle.
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