Infertility & IVF

Our team leverages many different tests and technologies to help identify the underlying causes of difficulty conceiving.  These tests are discussed at Consultation and can include:

Pelvic ultrasound

A pelvic ultrasound is an exam that allows our physician to assess a female patient’s reproductive anatomy: ovaries (include her antral follicle count), uterus, cervix, fallopian tubes, and other pelvic organs and structures.

Hormone blood testing and monitoring

Our physicians routinely use blood testing to assess the levels of hormones essential to the proper functioning of the reproductive and endocrine systems.

Sonohysterogram (saline infusion sonogram) or SIS

During a sonohysterogram, saline is infused into the uterus in order to allow the physician to see the endometrium, or uterine lining, and identify any abnormalities.

Endometrial biopsy

An endometrial biopsy requires a small sample of the endometrium (uterine lining), which will then be assessed for inflammation, infection, or other reproductive issues.

Semen analysis and post-coital testing

An investigation into male factor infertility involves a careful analysis of a semen sample, including sperm concentration (count), motility (movement), and morphology (shape). Post-coital testing refers to semen analysis performed after sexual intercourse.

Hysterosalpingogram (performed at an outside facility)

A hysterosalpingogram (HSG) is an fluoroscopic x-ray imaging test of a female patient’s fallopian tubes and uterus. During the procedure, iodine contrast is gently infused into the uterus to identify any abnormalities or blockages in the reproductive system that might affect fertility.

Depending on the results of your diagnostic testing, our physicians may recommend the use of fertility medications, including:

• Oral medications to increase ovarian stimulation (such as Clomid or letrozole)
• Injectable medications to increase ovarian stimulation (gonadotropins, such as Menopur and/or Follistim/Gonal-F)
• Hormone manipulation for cycle regulation

These medications may be used on their own or in conjunction with other fertility treatments, such as intrauterine insemination or in vitro fertilization, to improve the chances of conception.

Before undergoing an IUI, a female patient may also be placed on a treatment of hormone medication and monitored with sonograms and/or blood work, to ensure she is ovulating and/or to enhance her ovulation. The timing of ovulation is pinpointed precisely in order to maximize chances of success. Additionally, the sperm from the male patient or a sperm donor is prepared through a process called “sperm washing,” which isolates healthy sperm from the remainder of the seminal fluid to improve chances of fertilization.

In vitro fertilization, also known as IVF, is a treatment in which a female patient’s eggs are fertilized with a male patient’s sperm (or a sperm donor) in the lab before being transferred back to the uterus. This procedure allows doctors to bypass the fallopian tubes, making it an excellent choice for patients with blocked, damaged, or absent fallopian tubes. It also requires just one sperm cell for each egg, enabling successful fertilization even in cases of the most severe male infertility. And generally, because it allows for the simultaneous use of multiple eggs without an inherent risk of multiple pregnancy, it is the most powerful and successful treatment for all forms of infertility, including age-related infertility and unexplained infertility.

Because IVF is most successful when doctors can attempt fertilization on a larger number of eggs, a female patient is typically placed on a course of ovary-stimulating medications to prompt her body to produce multiple eggs in one cycle. The patient is monitored over a period of 8–11 days with ultrasounds and blood work. Then, when the eggs are sufficiently mature, they are retrieved from the patient’s ovaries in a brief surgical procedure during which she is placed under sedation.

The sperm from the male patient or a sperm donor is prepared through a process called “sperm washing,” which isolates healthy sperm from the remainder of the seminal fluid in order to improve chances of fertilization. The sperm is then combined with the egg in the laboratory under careful observation to promote fertilization. In some cases, the doctors may recommend a procedure called intracytoplasmic sperm injection, or ICSI, in which a single sperm is injected directly into the egg.

After the eggs are fertilized to create one or more embryo(s), they are incubated in a specialized, finely tuned environment in the lab for 5–7 days. Embryologists will monitor and support them to ensure they are developing properly.

At this stage, patients may opt for a “fresh embryo transfer,” which means that one or two of the healthiest-looking embryos will be transferred back into the female patient’s uterus. If the procedure is successful, an embryo will implant into the uterus and the patient will be pregnant. If there are additional normal-appearing embryos available, they can be preserved for future use via a specialized process of cryopreservation called embryo freezing.

Frequently, patients opt to have test embryos for normal genetics and identify abnormalities, such as Down syndrome, before embryo transfer. This process is known as preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD). If PGD/PGS is being implemented, after visual inspection and assessment under the microscope, all viable-appearing embryos undergo a procedure called trophectoderm biopsy, in which a microscopic amount of material is obtained and sent to the genetics lab for analysis. Typically, all embryos biopsied will be frozen immediately, before the results of the PGD/PGS testing are available; the embryos will then be selected for embryo transfer in the context of a frozen embryo transfer (FET).

For women who froze their eggs at Extend Fertility, we offer the opportunity to use those frozen eggs with the same physicians and laboratory team with whom you froze— for a seamless, high-quality experience.

For women who froze their eggs at another clinic, we arrange for safe and expeditious transport of your frozen eggs to our facility, and communicate with your previous provider to gather all of the necessary information to ensure clinical and scientific excellence.

First, the eggs are carefully thawed in a highly controlled lab environment. Then, they are combined with sperm from a partner or a sperm donor in individual culture dishes. Their
fertilization and development into blastocysts, or mature embryos, is supported in a highly specialized, incubated environment over the next 5–7 days. At that point, the blastocysts can be analyzed to verify that the embryos are genetically normal and capable of resulting in a healthy pregnancy. Ultimately, the blastocysts deemed healthy are ready for transfer back into the female patient’s body via embryo transfer.

Preparing for the embryo transfer typically requires about two weeks of hormonal preparation using oral medication and vaginal suppositories (no shots!). During those two weeks, the patient completes 4–5 quick monitoring visits (ultrasound and blood test) to confirm the body is ready to accept the embryo. In a quick non-surgical procedure (no anesthesia required), a doctor will use ultrasound guidance to insert a soft catheter through the cervix and into the uterus. The embryos—usually no more than one or two—flow through the catheter and into the uterus. If the procedure is successful, an embryo will implant in the lining of the uterus, and a blood test will confirm pregnancy about 9 days later.