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| Treatment Options > Laboratory |
laboratory Treatment Options
Assisted Hatching
Assisted Hatching is a procedure that "thins" the outer coat (zona) of the embryo immediately prior to transfer to the uterus. This thinning helps the embryo "hatch" once it is placed back in the patient's uterus. Hatching must occur prior to embryo implantation; pregnancy begins after the embryo implants in the uterus.
Under certain circumstances, some embryos may need help escaping ("hatching") from the zona. Assisted hatching is a technique whereby a small hole is created in the zona pellucida by the controlled exposure of small area of the zona to an acidic culture media solution.
Assisted hatching is not routinely used in our lab, but there are some general guidelines where it may prove helpful in encouraging implantation. Assisted hatching is recommended for older patients (40 and older), for patients with thickened zonas (often appreciated at the time of ICSI), for patients who have had several unsuccessful cycles with no clear-cut reason and for patients undergoing thawed embryo.
Intra-Cytoplasmic Sperm Injection (ICSI)
What is ICSI?
ICSI is a micromanipulation technique performed by an embryologist using very precise instruments and a specialized microscope. A single sperm is selected, isolated and drawn into a micropipette. It is then injected directly through the outer layers of the egg into its core (the cytoplasm). The micropipette is quickly withdrawn and the egg is allowed to fertilize and divide.
In contrast to standard IVF techniques, which rely on the ability of the sperm to bind to and penetrate the egg's membrane, ICSI eliminates the need for sperm binding and only requires that there be as many live (but not necessarily motile) sperm present as there are mature eggs. Using a sophisticated microscope with state of the art optics, each oocyte is stripped of its surrounding cumulus cells and held in place with a glass micropipette (the “holding” pipette). The embryologist then takes a second, smaller pipette (the “ICSI” pipette) and draws up one sperm from the processed semen sample. The ICSI pipette containing the sperm then pierces the outer zona pellucida and oocyte membrane and, with the aid of fine mechanical controls, the sperm is deposited near the middle of the oocyte. The ICSI pipette is then removed from the oocyte.
Who is a candidate for ICSI?
Most couples undergoing ICSI suffer from male infertility that involves severely depressed sperm count, morphology and/or motility, although there may be other contributing factors as well. A standard semen analysis done as part of the couple's infertility work-up will usually reveal any potential problems with the sperm so that the embryologist knows what to anticipate on the day of the oocyte retrieval. Some men who were previously considered to be completely sterile (azoospermic) actually have some mature sperm and, since only a few are necessary to perform IVF with ICSI, they are candidates for ICSI. In the most severe forms of male infertility, where there are no sperm at all in the ejaculate, ICSI can sometimes be done successfully with sperm retrieved from the ejaculatory ducts or testicle MESA or TESA. On occasion, as when previous IVF cycles have resulted in poor fertilization, ICSI is recommended despite the lack of a clearly identified male problem.
Outcome
Once fertilization has occurred by ICSI, the outcome of the IVF procedure is not significantly different from conventional IVF. That is, the success rate then depends on other factors relating to the couple's fertility, such as the female partner's age and embryo quality. Pregnancy outcome after ICSI is comparable to that after standard IVF.
BlastoCyst Culture
Blastocyst embryo transfer helps to improve pregnancy rates, as well as reduce the incidence of multiple births. It accomplishes this by growing embryos to a more advanced stage, very similar to the stage in nature when embryos implant in the uterus. Fewer embryos need to be transferred, typically only two or three, which minimizes multiple births. Pregnancy rates are improved because only embryos that have survived to the blastocyst stage of development are transferred.
Reducing multiple births has multifaceted beneficial consequences by reducing high risk pregnancies, premature births, developmental delays in the children, and the high costs of delivering and raising multiples, to name a few of the positive effects.
There are certain patients for whom it might be beneficial; this includes younger patients who produce many eggs and embryos, patients who make a lot of embryos but with repeatedly failed IVF cycles, and patients at risk for a multifetal gestation who would not or could not consider fetal reduction. By the same token, there are patients for whom extended culture would probably not be beneficial. Patients who produce very few or poor-looking embryos are not good candidates for this methodology because they may end up with no blastocysts formed and therefore not have a transfer at all. Older patients (40 years and older) also tend not be good candidates, given the observations from many labs of a negative correlation between blastocyst formation and maternal age. The bottom line is that extended culture does not make good embryos out of bad ones.
Cryopreservation
Embryo crypreservation is an established technique in our IVF program. While the stage at which embryos are frozen may differ from program to program (zygotes, cleaved embryos, blastocysts), the process of saving spare embryos from a stimulated cycle has become routine for several reasons. First, the use of frozen embryos alleviates the need for the patient to go through another cycle of ovarian stimulation. Second, the replacement of fresh embryos in a stimulated cycle may be contraindicated because of patient illness or an elevated estradiol level, which may predispose the patient to hyperstimulation. Third, it is often more cost-efficient to pursue banked embryos that have already been created than to initiate another entire cycle of medications and oocyte retrieval. Embryo cryopreservation maximizes the stimulation and retrieval process without the transfer of too many fresh embryos, thereby lowering the risk of a multifetal gestation. GENESIS will freeze extra cleaved embryos or blastocysts created during a fresh cycle, that are of good quality. If the fresh cycle fails, the frozen embryos can be thawed at a later date in hope of establishing a pregnancy.
Laboratory services
GENESIS maintains three state-of-the-art laboratories with facilities for hormone testing, sperm testing, and embryology. The laboratories are licensed by the New York State Department of Health (NYSDOH) and accredited by the College of American Pathologists (CAP). In addition to providing direct testing and IVF-related services, special licensure from the NYSDOH permits the laboratories to perform freezing and long-term storage of sperm and embryos.
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| Phone: (718) 283-8600 |
Genesis Fertility & Reproductive Medicine
1355 84th Street, Brooklyn, NY 11228 |
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