Pre-implantation Genetic Diagnosis
Preimplantation genetic diagnosis (PGD) is a procedure used prior to implantation to help identify genetic defects within embryos created through in vitro fertilization. In most cases, the female, male, or both partners have been genetically screened and identified to be carriers of potential problems and PGD is used to prevent certain diseases or disorders from being passed on to the child.
ICSI (Intra-cytoplasmic sperm injection) or micromanipulation involves injecting a single sperm directly into an oocyte (egg) in order to fertilize the oocyte. The resulting embryo (fertilized egg) is then transferred to the woman’s uterus.
Alcune uova, specialmente quelle di donne di età ? 38 anni, hanno zone pellucidi più spesse (involucri esterni) e gli embrioni non sono in grado di schiudersi e impiantare. La schiusa assistita comporta l’esecuzione di un piccolo foro nella zona pellucida dell’uovo fecondato per consentire l’apertura dell’embrione e, quindi, una maggiore probabilità di impianto nell’utero.
People who undergo IVF often have more embryos than can be transferred at one time. These embryos can be stored using cryopreservation. The process of cryopreservation involves the freezing and storage of embryos at a very low temperature in liquid nitrogen. While frozen, the embryos remain in a suspended state of development and will not resume development until thawed. When the couple decides to have another chance at pregnancy, the frozen embryos can be thawed and prepared for uterine transfer. While not all embryos survive the freezing and thawing cycle, the majority survive and can be stored for years before being used.
Oocyte (egg) Cryopreservation
Oocyte cryopreservation (egg freezing) is a method to preserve reproductive potential. Eggs are retrieved, frozen, and stored at a very low temperature in liquid nitrogen. This treatment may be chosen by women who are undergoing chemotherapy or radiotherapy for cancer and other medical diseases, women with certain genetic conditions that are associated with a high risk of ovarian cancer, or women who choose to delay childbearing.
Sperm cryopreservation is a method of preserving fertility for men who are undergoing chemotherapy or radiotherapy for cancer treatment or men who choose to delay childbearing. The sperm sample is collected, analyzed and then frozen for future use.
Ovulation induction involves stimulating the ovary to produce one or more eggs. Throughout the use of ovulation inducing drugs, the patient’s estrogen levels and follicle development are monitored to follow the response of the patient. When the follicles are ready to release their mature egg(s), depending on treatment direction, patients may do either timed intercourse or intrauterine inseminations that coordinate with the release of the egg(s), thus increasing the chance of becoming pregnant.
The goal of intrauterine insemination (IUI) is to increase the number of sperm at this site of fertilization. Sperm are separated from semen and placed in a sterile medium. The sperm are then concentrated in a small volume of medium and are injected directly into the uterus. IUI is often used in conjunction with ovulation induction drugs to enhance the fertilization success rates.
Advanced Laparoscopic surgery
Outpatient laparoscopic and hysteroscopic surgery allows the surgeon to view the pelvis, uterus, ovaries, tubes. Using laser technology, the surgeon is able to address the problems caused by scar tissue, adhesions and endometriosis. During the same procedure, valuable information can be obtained about the uterus, tubes and ovaries that will guide recommendations for the future therapies.
Comprehensive fertility workup
Typically, after review of the health history for both partners, a basic screening comprised of hormone values and a complete pelvic exam for the female and semen analysis for the male will be obtained. If sub fertile sperm parameters are discovered, referral for urological consultation will be made. Transvaginal sonograms (ultrasound examinations) are essential in the beginning evaluation for the female as well as during many treatment modalities. Saline enhanced sonograms (sonohysterograms) are commonly used to evaluate the uterine cavity and rule out abnormal masses that could interfere with conception. It is critically important to determine if the fallopian tubes are open and this is commonly accomplished by a simple, outpatient procedure in the Radiology Department of a hospital. This procedure is called a hysterosalpingogram.
Semen analysis determines the volume of semen a man produces and the quantity and quality of sperm in the semen sample.
Pelvic pain is pain that occurs in the area below your bellybutton and between your hips. It can be a symptom of another disease or a condition in its own right. If the source of the pain can be determined, treatment focuses on the cause.
Recurrent pregnancy loss
Recurrent pregnancy loss is defined by two or more failed pregnancies. Each pregnancy loss is carefully reviewed to determine if specific evaluation is appropriate. Approximately 25% of all recognized pregnancies result in miscarriage, less than 5% of women experience two consecutive miscarriages, and only 1% experience three or more. Couples who experience recurrent pregnancy loss will benefit from a medical evaluation and are offered psychological support.
PCOS (polycystic ovarian syndrome)
Polycystic ovarian syndrome is a medical condition present in 4 to 12% of the female population, characterized by irregular menstrual periods and elevated androgen (male-type) hormone levels. Women with PCOS have enlarged ovaries which contain multiple small cysts. Women with PCOS rarely ovulate on their own which often leads to infertility.
Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus (the endometrium) grows outside your uterus. Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. In addition to pain, fertility problems may develop.
Uterine fibroids (leiomyomas or myomas) are growths that develop from the muscle tissue of the uterus. The size and shape of the fibroids can vary greatly and may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure (pedunculated). Fibroids may cause changes in menstruation, pain, pressure, an enlarged uterus, pregnancy loss, or infertility.
Surgical intervention for fertility enhancement
Advanced laparoscopic and hysteroscopic surgery can be utilized to treat conditions such as PCOS (polycystic ovarian syndrome), endometriosis, fibroids, pelvic pain, etc. that contribute to infertility.