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Assisted Hatching
Assisted Hatching is a microscopic procedure in which an opening is made in the outer shell of the embryo, the zona pellucida, in order to promote the embryo’s ability to attach itself to the uterus. This micromanipulation procedure is especially helpful for couples for whom there have been multiple failed IVF treatments, or for whom the wife is over 39 years old, or has diminished ovarian reserve.

Blastocyst
Blastocyst is the last stage of development an embryo must reach before it implants itself into the uterine wall. Only about 40% of human embryos will be capable of reaching this stage of development in the IVF laboratory after 5 to 6 days of incubation. Transferring blastocyst stage embryos can produce the same pregnancy rates with the transfer of fewer embryos, and therefore lower the multiple pregnancy rate.

   

 

Egg Donor
An egg donor gives her egg(s) to a woman or couple who is unable to achieve pregnancy using her own eggs. An egg donor undergoes a medical process called egg retrieval in order to donate these eggs.

Egg Retrieval or Aspiration
The egg retrieval procedure is also referred to as egg aspiration. The eggs develop in fluid filled structures in the ovaries called follicles. Each follicle can be seen and measured by ultrasound and contains one microscopic egg. The egg is loosely attached to the follicle wall.

When the woman's follicles are mature (determined by ultrasound and hormone measurements), the egg aspiration procedure is performed to remove the eggs from the ovaries. Anesthesia medications are given during the egg retrieval procedure so that she will not feel the procedure. A needle is passed through the top of the vagina under ultrasound guidance to reach the ovary and follicles. The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary. The actual IVF egg aspiration procedure usually takes 5-10 minutes at an IVF clinic.

The fluid with the eggs is passed to the IVF lab where the eggs are identified, rinsed in culture media, and placed in small culture drops in plastic dishes. The dishes with the eggs are then kept in specialized IVF incubators under carefully controlled environmental conditions.

The oocyte-cumulus complex is removed from the follicle when the fluid is aspirated through the needle. When all of the follicles have been aspirated, the woman is monitored closely for about 1 hour - after which she is discharged home.

Embryo Cryopreservation
Embryo Cryopreservation or embryo freezing offers a second chance to conceive from the one IVF treatment cycle. Not all couples going through IVF will have extra embryos that are suitable for freezing. Pregnancy rates from previously cryopreserved embryos are usually only half of what the pregnancy rate was at the time that the original cycle took place.

Endometrial Biopsy
Endometrial biopsy is a procedure in which a tissue sample is taken from the lining of the uterus (endometrium), and is checked under a microscope for any abnormal cells or signs of cancer.

Gestational Surrogacy
In a gestational surrogacy, the surrogate mother is carrying a baby that is genetically unrelated to her. She becomes pregnant through in-vitro fertilzation.

Gestational Surrogate / Gestational Carrier
A gestational surrogate mother carries a baby that is genetically unrelated to her for another couple or person. The surrogate mother undergoes in-vitro fertilization to achieve pregnancy. In some states, the court recognizes gestational surrogacy and has clearly stated laws to define a gestational surrogate mother.

GIFT or ZIFT
Gamete Intrafallopian Transfer, or GIFT, is a treatment for unexplained infertility that is identical to IVF up to the stage of egg retrieval. Instead of incubation of eggs and sperm (gametes) in the laboratory, the gametes are laparoscopically injected into the fallopian tube(s) on that same day. Zygote Intrafallopian Transfer (ZIFT) is the transfer of one or more one-cell embryos or “zygotes” to the fallopian tube. ZIFT requires waiting one additional day for the eggs to fertilize in the IVF laboratory before performing the laparoscopic tubal transfer procedure. These procedures require at least one of the fallopian tubes to be completely normal and accessible laparoscopically. Of the 85,826 assisted reproductive technology treatment cycles performed in 2002 only 0.2% were GIFT and 0.5% were ZIFT treatments. Disadvantages to GIFT and ZIFT are the increased surgical risks and costs of laparoscopy. The possible advantage is allowing embryo development to occur in the natural environment of the fallopian tube.

hCG (human chorionic gonadotropin)
The hormone human chorionic gonadotropin (better known as hCG) is produced during pregnancy. It is made by cells that form the placenta, which nourishes the egg after it has been fertilized and becomes attached to the uterine wall. Levels can first be detected by a blood test about 11 days after conception and about 12 - 14 days after conception by a urine test. In general the hCG levels will double every 72 hours. The level will reach its peak in the first 8 - 11 weeks of pregnancy and then will decline and level off for the remainder of the pregnancy.

ICSI - Intracytoplasmic Sperm Injection
Intracytoplasmic Sperm Injection (ICSI) is a microscopic procedure to assist the sperm in fertilizing the egg by directly injecting the sperm into the cytoplasm of the egg. This assisted fertilization is especially helpful in otherwise untreatable cases of severely low sperm counts, and produces the same pregnancy rates as conventional IVF (incubation of eggs and sperm) in the majority of cases.


In-Vitro Fertilization
In Vitro Fertilization (IVF) is the process by which eggs (oocytes) are retrieved from the ovary, fertilized by the sperm in the laboratory, and cultured into early embryos. The embryos are then transferred into the uterus. Since multiple oocytes are desired in order to enhance the likelihood of pregnancy, stimulation with injectable gonadotropins are usually required. Frequent monitoring is necessary with sonograms and blood tests. When these diagnostic methods indicated that the time is appropriate, an hCG injection is taken to mature the eggs. The eggs are retrieved from the ovary just before they are ready to be ovulated. This is usually about 36 hours after the hCG injection.

For IVF, the eggs are usually retrieved by ultrasound guided needle aspiration through the vagina. Transvaginal oocyte aspiration is done using intravenous anesthesia, which is administered by an anesthesiologist. This is usually an outpatient procedure done in the clinic's surgery center.

After aspiration, the embryologist will determine the number of eggs obtained and classify them as mature, immature, post mature or degenerative. Immediately following the egg aspiration, your spouse will meet with the IVF Andrologist to provide a semen specimen. The sperm is then processed in the IVF laboratory. The sperm and eggs are placed in a dish and fertilization takes place (in vitro) outside the patient’s body in the laboratory. The fertilization process takes approximately 10-20 hours. Embryos are then cultured for 3-5 days before being replaced back in the uterus by a simple technique much like intrauterine insemination.

Embryo transfer occurs on day 3 or 5. Embryos are carefully placed into a special catheter and inserted into the uterine cavity. Generally, 2-3 embryos are transferred back into the uterus depending on the patient’s age, embryo quality and physician recommendation.

A serum progesterone level is checked several days after a completed IVF cycle, and the first pregnancy test is approximately 14 days following the IVF procedure.

Intended Father
The intended father is the man who will be known to the baby as his/her Father. He will have legal parental rights to the baby after he/she is born. He will be responsible for the baby immediately after birth.

Intended Mother
The intended mother is the woman who will be known to the baby as his/her Mother. She will have legal parental rights to the baby after he/she is born. She will be responsible for the baby immediately after birth.


Intrauterine Insemination
Intrauterine insemination (IUI) is a common treatment for infertility. This is used for traditional surrogacy arrangements where the surrogate mother is also the egg donor.

In this technique, semen is collected into a sterile cup by masturbation or into a special condom sheath used during intercourse and then brought to the office laboratory. It is prepared in special media, similar to that used for IVF. The objective of IUI is to insert a concentrated quantity of sperm directly into the uterus bypassing the cervix. Since IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract, the sperm function of the male must be reasonable and the fallopian tube(s) must be healthy and functional. Sperm function includes sperm number, shape and movement. The sperm wash takes about 45 minutes to 2 hours depending on the technique utilized. An IUI takes approximately 10-15 minutes to complete.

Timing of the insemination to coincide with ovulation is critical. In order to ensure this occurs, timing of ovulation is monitored by urinary hormone tracking methods or sonogram. Urinary LH ovulation predictor kits indicate that ovulation will occur within a 24 to 48 hour window. The urinary tracking method is performed at home, generally in the late afternoon or early evening. When the test is “positive”, insemination is performed 24 to 36 hours later. Another method used to time ovulation is sonography. The development of the follicle and impending release of the egg can be timed by serial ultrasounds performed in the office. Sonograms to time IUI’s are usually used when the patients are taking oral or injectable fertility medications. Patients generally use an hCG injection to further ensure release of the egg.

PAP Smear
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix.


PGD Testing
Preimplantation Genetic Diagnosis (PGD) offers the opportunity to test a single cell from an eight cell embryo for certain diseases caused by a mutation in a single gene (such as Cystic Fibrosis, Sickle Cell Anemia, and Huntington’s Chorea, to name a few ) prior to the embryo transfer procedure. This technology is beneficial when an inheritable disease is known to occur in one’s family or when DNA screening tests on the couple going through IVF are positive. It is also beneficial when recurrent miscarriages are known to be due to a Robertsonian translocation.

Saline Infusion Sonogram
A saline infusion sonogram (saline sonography) is routinely performed to make sure that the endometrial cavity (inside of the uterus) appears normal.

Sperm (Semen) Analysis
A semen analysis measures the amount of semen a man produces and determines the number and quality of sperm in the semen sample.

TESE/MESA
Even in men with no sperm seen at the time of semen analysis, there may be sperm within the testes. This sperm can be removed by aspiration from the epididymis or testes in procedures called TESE (testicular sperm extraction) or MESA (microscopic epididymal sperm aspiration). TESE and MESA procedures combined with ICSI allow many men, previously considered sterile, to produce children.

Traditional Surrogacy
In a traditional surrogacy, the surrogate mother's own eggs are fertilizated with the intended father's sperm. The surrogate mother will become pregnant through artificial insemination. In most states, the court recognizes this type of surrogacy as an adoption.

Traditional Surrogate
A traditional surrogate mother is both a surrogate mother and an egg donor. She is artifially inseminated with the intended father's sperm and uses her own eggs to achieve pregnancy. In most states, the court recognizes this type of surrogate mother as a birth mother in an adoption.

Ultrasound
Ultrasound involves the use of high-frequency sound waves to create images of organs and systems within the body. An ultrasound machine creates images that allow various organs in the body to be examined. The machine sends out high-frequency sound waves, which reflect off body structures. A computer receives these reflected waves and uses them to create a picture.