Assisted hatching (AH) is a procedure performed prior to embryo transfer in selected cases. An embryo needs to escape or “hatch” from its protein shell—called the zona pellucida—before it can implant in the uterus. In AH, an embryologist uses a laser to dissolve part of the zona to facilitate the hatching process. This technique is often used for patients with prior unsuccessful IVF cycles, in women over the age of 38, and for embryos with abnormally thick zonae.
In many situations, especially when a woman is in her late 30s or early 40s, infertility may result from a decrease in ovarian function and a subsequent fall in egg quality. In the event of a severe compromise in ovarian function, successful pregnancy is very unlikely. A treatment that often offers an excellent chance of success is to use eggs from a donor who is capable of producing good-quality eggs. While donor egg treatment is more complex from medical, psychological, and ethical viewpoints, it’s one that provides a very good chance for a healthy pregnancy.
In addition to the ability to utilize fresh donor eggs in a cycle, Shady Grove Fertility is one of more than 20 practices that have collaborated to freeze and “bank” eggs from unidentified egg donors. The eggs are then cataloged to provide patients with a diverse range of donors to choose from.
INTRACYTOPLASMIC SPERM INJECTION (ICSI)
An embryologist can perform intracytoplasmic sperm injection (ICSI) as part of your IVF procedure, should the need arise. ICSI is a process that involves an embryologist injecting a single sperm into the cytoplasm (center) of each egg. Our physicians often recommend ICSI in cases of male factor infertility and/or diminished egg quality.
PESA AND TESE
Percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE) are techniques used when a man presents with no sperm in his ejaculate but still produce sperm in their testes. This may occur due to:
- A vasectomy
- A congenital (present at birth) obstruction of the sperm ducts leaving the testes
- Inadequate development of the sperm such that they cannot leave the testes
In these situations, one of our urologists can remove sperm by placing a needle into the testes or the tubes that drain it and remove the sperm at that location. These procedures are done under anesthesia and can be very effective when combined with ICSI. Occasionally, a urologist will use a testicular biopsy for sperm extraction with what is known as microdissection—using a microscopic examination of the testicular tissue to identify viable sperm.
GENETIC TESTING OF EMBRYOS: PGD AND PGS
Shady Grove Fertility offers two different types of preimplantation testing that can look for chromosomal abnormalities or specific diseases within the embryos.
Preimplantation Genetic Testing for Monogenic/Single Gene Defects (PGT-M), previously known as preimplantation genetic diagnosis (PGD), is used in cases if both partners are known carriers of an inheritable genetic disorder or for patients with infertility related to chromosomal abnormalities such as recurrent pregnancy loss or repeated unsuccessful IVF cycles.
Preimplantation Genetic Testing for Aneuploidies (PGT-A), previously known as preimplantation genetic screening (PGS), is used to look for abnormalities in chromosome number, such as trisomy 21, which causes Down syndrome, and many others that are likely to result in implantation failure or miscarriage.
Embryos that are not transferred but continue to thrive in the laboratory can undergo cryopreservation (freezing) using a specialized technique known as vitrification. We recommend freezing for any high-quality embryos that survive to the blastocyst stage of development. We store these embryos in liquid nitrogen and can thaw them at a later date. The procedures involved in preparing for an FET are much simpler and less expensive, and pregnancy rates with frozen embryos are nearly identical to cycles with fresh embryos. Freezing only embryos that survive to the blastocyst stage maximizes the chance for success in a thaw cycle. Further, having embryos frozen can be a great way of “preserving fertility,” especially for women who are in their 30s.