Frequently Asked Questions

Infertility is a disease of the reproductive system that impairs one of the body’s most basic functions: the conception of children.

Conception is a complicated process that depends upon many factors:

  • On the production of healthy sperm by the man and healthy eggs by the woman
  • Unblocked fallopian tubes that allow the sperm to reach the egg
  • The sperm’s ability to fertilize the egg when they meet
  • The ability of the fertilized egg (embryo) to become implanted in the woman’s uterus
  • Sufficient embryo quality

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman’s hormonal environment adequate for its development. When just one of these factors is impaired, infertility may result.

What is IVF?

In Vitro Fertilization (IVF) is a procedure in which oocytes (eggs) are surgically retrieved from a woman’s ovaries and fertilized in the laboratory. The fertilized eggs are then allowed to grow into embryos and then transferred to the woman’s uterus through the cervix. The term Assisted Reproductive Technologies (ART) is also frequently used and simply refers to all fertility treatments in which both egg and sperm are handled. IVF is the most common ART procedure that is used in the United States.

All IVF procedures involve egg retrieval and embryo transfer. Depending upon the individual case, specialized procedures are offered in our center:

  • Assisted Hatching (AH) – treatment of the embryo prior to transfer to improve the chance of implantation
  • Blastocyst Culture – growing embryos 2-3 additional days in the lab prior to transfer
  • Intracytoplasmic Sperm Injection (ICSI) – injecting a single sperm into the egg
  • Preimplantation Genetic Diagnosis (PGD) – biopsy of an embryo prior to embryo transfer to minimize the risk of genetic disorders or pregnancy loss

Egg Retrieval

Injectable medications are used to stimulate the woman’s ovaries to produce eggs. Patients are closely monitored through ultrasound and blood tests in order to optimize follicular development while minimizing the incidence of hyperstimulation of the ovaries. Eggs are then surgically retrieved during a brief outpatient procedure in which the woman is sedated using medicines given through an intravenous (IV) line by an anesthesiologist.

Micromanipulation

This term refers to the microscopic procedures using the sperm, eggs, and/or embryos that are designed to improve fertilization, implantation, or reduce the risk of genetic disease or recurrent pregnancy loss. There are three types of micromanipulation offered:

  • Intracytoplasmic Sperm Injection (ICSI)This procedure involves direct injection of a single sperm into a mature egg. This procedure is selectively used in cases involving significant decreases in sperm counts, motility, or morphology. This procedure may also be used in cases where there is a history of previous failed fertilization despite normal sperm testing.
  • Assisted Hatching (AH)
    This procedure involves making a small hole in the zona pellucida (sugar-protein membrane) that surrounds the pre-embryo at the 6-8-cell stage approximately 1 hour prior to embryo transfer. As the embryo continues to grow, the hole becomes larger, making it easier for the embryo to “hatch” out of its shell, which is necessary for implantation to occur. This procedure is performed in patients with a thickened zona pellucida, as well as in patients over 35, or with other histories.
  • Preimplantation Genetic Diagnosis (PGD)
    A small hole is made in the membrane surrounding a 6-8-cell embryo (similar to assisted hatching). A single cell is aspirated from each embryo and is evaluated for various genetic abnormalities. Embryos with normal results are transferred, thus reducing the risk of genetic disease, recurrent pregnancy loss, or implantation failure. Most specific genetic diseases may be specifically screened through the use of PGD to ensure the next generation will be free of the specific inheritable genetic disorder.

Microepididymal Sperm Aspiration (MESA)/Testicular Sperm Extraction (TESE)

This is a procedure in which sperm are aspirated or extracted from the male reproductive tract (testes or epididymis). The retrieved sperm are immediately taken by our embryologist and then used to fertilize an egg, or frozen for future use. This procedure is performed by a urologist with specialized training in male infertility.

Embryo Transfer

Embryos are transferred to the uterus by passing a small catheter through the cervix to a distance approximately 1-1.5 cm from the top of the uterus. A trial embryo transfer (mock embryo transfer) is usually performed prior to the actual embryo transfer to measure the distance from the outside of the cervix to the top of the uterus for proper placement. This procedure usually does not take very long to perform, and requires no anesthesia. In our program, ultrasound-guided placement of embryos is routinely performed.

What causes infertility?

No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases may be attributed to male factors and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners. Of this last one-third, about 20% of cases are categorized as ‘unexplained’.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

How is infertility diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy with unprotected intercourse after six months for women over 35 and after a year for women under 35. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place at the correct time in order for conception to occur.

If no cause can be determined at this point, more specific tests may be recommended. For women, these include a hormone analysis and a hysterosalpingogram (HSG) to determine if there are blocked fallopian tubes. For men, a semen analysis is performed.

How is fertility preserved?

Whether our bodies are ready to reproduce or not, we may be able to preserve our fertility for future use with any number of options.

Reproductive science is a dynamic field, presenting new options for delaying our child-bearing years has been at the forefront in the field for several years. One way that couples may choose to preserve their fertility is through the use of sperm freezing. Sperm may be frozen for an indefinite length of time. However, the integrity of the sperm may be compromised over time and it is recommended that sperm be used before reaching the ten-year mark after freezing. Sperm banks will complete a semen analysis prior to freezing in order to determine the quantity and quality of the sperm. Understanding the viability of the sperm prior to freezing helps couples with information about the quality of sperm that they will be able to use once thawed. Not all sperm will survive thawing, but with sperm that appears to be of excellent quality, with great motility and sound physical structure, the odds are positive for survival and usability.

Egg freezing has become a trend that is now supported by employers as prominent as Apple and Facebook. Women that are focused on their careers, that are not yet ready to begin a family, or have not settled in with a partner that they would want to start a family with, are choosing to freeze their eggs in the event that these situations will change. The procedure for freezing eggs is called “vitrification” – described as the rapid freezing of the eggs which does not allow for ice crystals to form on the eggs, which may be damaged during the thawing process. The advances made through vitrification have changed the way women and their partners may see the future in terms of reproduction. It provides an alternative for starting a family when the timing is right for all involved.

Finally, embryo freezing makes it possible for couples to create the biologically linked sperm and egg for future implantation. Any number of reasons for choosing to freeze embryos may exist. The couple may not be ready physically due to illness, cancer treatment, deployment for the armed services, or other circumstances that do not allow for immediate implantation. Prior to freezing embryos, couples may choose to have pre-implantation genetic testing done on the embryos to determine if there are any pre-existing genetic conditions associated with the embryos. In addition, the couple may choose to only use a few embryos at a time if they are undergoing fertility treatment such as in vitro fertilization (IVF). The benefits of having the frozen embryos is evident for couples that choose to delay their reproduction, in completing medical treatments and in knowing that they have contained their genetically produced joining of egg and sperm for use at a time that will be in line with their future goals.

What is cryopreservation?

Cryopreservation of Embryos

Excess embryos may be cryopreserved (frozen) for transfer in a subsequent cycle. We recommend freezing at either the fertilized egg stage or the blastocyst stage. Frozen embryo transfer (FET) cycles require less medication, minimal monitoring and are much less expensive than a fresh cycle, while still providing good pregnancy rates.

A note on Egg Freezing:

Egg freezing may be used as a way to preserve fertility sometimes for patients who are planning to undergo cancer treatments. However, egg freezing is still considered an experimental procedure.  It is more difficult to freeze eggs than it is to freeze sperm or embryos because of eggs’ high water content.  We recommend that you fully discuss the benefits, risks, advantages, and disadvantages with our physician prior to making the decision to freeze your eggs.

What is egg donation?

Donor eggs may be used in IVF for women that have been unable to achieve a pregnancy with their own eggs. The eggs may come from a known or anonymous donor. Donor eggs are then fertilized with the sperm of the recipient partner (or with donor sperm as indicated), with subsequent embryos transferred to the recipient’s uterus. For anonymous egg donation (recipient couple does not know the identity of the egg donor), RFC has its own affiliated egg donor agency. To find out more about our programs, please click here. All donors undergo a thorough medical, genetic, psychological and laboratory screening prior to donation and are contractually bound by legal documentation on their agreement in order to protect all parties involved.

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