In Vitro Fertilization
The Embryology Laboratory at the Strong Fertility Center is a state-of-the-art facility accredited by the NYS Department of Health. We offer a wide variety of laboratory techniques to help patients achieve success with assisted reproduction. These include in vitro fertilization with standard insemination, Intracytoplasmic Sperm Injection (ICSI), Assisted Hatching (AHA), embryo cryopreservation, blastocyst culture, TESE and MESA for male factor, and embryo biopsy for pre-implantation genetic diagnosis. Following are step-by-step descriptions of the IVF procedures.
Step 1: Control Ovarian Hyperstimulation (COH)
COH is done using different protocols. The most common one is a long GnRH-Agonist (Lupron) protocol where the secretion of gonadotropin hormones is suppressed in order to prevent premature ovulation. Once optimal suppression is achieved, the next step is the recruitment of multiple follicles by daily injections of gonadotropins. Ultrasound imaging and hormone assessments are used to monitor follicular development. When the lead follicles have reached the appropriate size, the final maturation of eggs is done by HCG administration. Egg retrieval is scheduled 34-36 hours after HCG injection.
(Below scheduled for Thursday September 27, 2007 - Lindsay's Birthday)
Step 2: Egg Retrieval
Egg retrieval is performed in a surgical suite under intravenous sedation. Ovarian follicles are aspirated using a needle guided by trans-vaginal ultrasonography. Follicular fluids are scanned by the embryologist to locate all available eggs. The eggs are placed in a special media and cultured in an incubator until insemination.
Step 3: Fertilization and Embryo Culture
If sperm parameters are normal, approximately 50,000 to 100,000 motile sperm are transferred to the dish containing the eggs. This is called standard insemination.
WE ARE DOING ICSI - The ICSI technique is utilized to fertilize mature eggs if sperm parameters are abnormal. This procedure is performed under a high-powered microscope. The embryologist picks up a single spermatozoa using a fine glass micro needle and injects it directly into the egg cytoplasm. ICSI increases the chance that fertilization will occur if the semen sample has a low sperm count and/or motility, poor morphology or poor progression. If there are no sperm in the ejaculate, sperm may be obtained via a surgical procedure. ICSI is always used to achieve fertilization if the sperm is surgically retrieved.
A normally fertilized egg is called a zygote. Two pronuclei are seen in the center. Intracytoplasmic Sperm Injection (ICSI) procedure where a single spermatozoa, as shown by an arrow, is in the process of being injected into a mature egg's cytoplasm.
Fertilization is assessed 16-18 hours after insemination or ICSI. The fertilized eggs are called zygotes and are cultured in a specially formulated culture medium that supports their growth. They will be assessed on the second and third day after retrieval. If sufficient numbers of embryos exhibit good growth and development, they may be selected to grow to the blastocyst stage in a specially designed culture medium. Blastocyst culture has several advantages. Embryos at this stage have a higher potential for implantation, therefore fewer embryos can be transferred on day 5 to reduce the chance of multiple pregnancies. Low numbers of embryos and poor embryo quality reduce the chances for good blastocyst development. A day 3 embryo transfer is recommended for cycles with low numbers and/or poor quality.
Below will take place either Sunday September 30th or Tuesday October 2nd (our 3 yr dating anniversary).
Step 4: Embryo Transfer
Embryos are transferred on day 3 when they are at the cleavage stage (6-8 cells) or on day 5 when they have reached the blastocyst stage. Embryo transfer is a simple procedure that does not require any anesthesia. Embryos are loaded in a soft catheter and are placed in the uterine cavity through the cervix.
http://www.stronghealth.com/services/fertility/IVF/index.cfm