Many couples who have fertility problems have been able to conceive a child through the use of In Vitro Fertilization (IVF).
At Long Island IVF, our In Vitro Fertilization Program treats couples whose fertility has been impaired by conditions such as tubal problems, endometriosis, male factor infertility, unexplained infertility, and for those who have failed prior treatments.
At Long Island IVF, our In Vitro Fertilization program treats couples whose fertility has been impaired by conditions such as tubal problems, endometriosis, male factor infertility, unexplained infertility, and for those who have failed prior treatments. Our IVF program, the first successful IVF program on Long Island, was established in 1988 and has success rates that surpass the national average. We are an active member of the Society of Reproductive Technologies (SART) under the auspices of the American Society for Reproductive Medicine. Our Reproductive Endocrinology and Infertility Laboratory meets the standard requirements of the Clinical Laboratory Improvement Act (CLIA). Our laboratory is also accredited by the College of American Pathologists (CAP).
During traditional IVF, you take several medications so you will develop multiple ovarian follicles that contain mature eggs capable of fertilization. We closely monitor this process using blood tests and vaginal ultrasounds. Mature eggs are retrieved through a simple procedure under ultrasound guidance. We then expose the retrieved eggs to sperm and transfer the resulting embryos back into your uterus.
The success of IVF largely depends on growing multiple eggs at the same time. Injections of the natural hormones FSH and/or LH (gonadotropins) that are normally involved in ovulation every month are used for this purpose.Additional medications are used to prevent premature ovulation.
Some of the medications that may be used are:
- Gonadotropins,or injectable "fertility drugs" - (Follistim®, Gonal-F®, Bravelle®, Menopur®)
- GnRH-agonists - (Lupron®)
- GnRH-antagonists - (Ganirelix®, Cetrotide®)
- Human chorionic gonadotropin (hCG) - (Profasi®, Novarel®, Pregnyl®, Ovidrel®)
- Progesterone, and in some cases, Estradiol – (Endometrin®, Crinone®, Prochieve®, Prometrium®)
- Oral Contraceptives
A patient will begin stimulation with medication to produce multiple follicles (fluid filled sacs that contain eggs). When the eggs are thought to be mature, the patient takes the medication HCG, which readies the eggs for ovulation. Eggs are retrieved before ovulation occurs, about hours after HCG is administered.
After eggs are retrieved, they are transferred to the embryology laboratory where they are kept in conditions that support their needs and growth. Then, sperm are placed in the culture medium with the eggs, or individual sperm are injected into each mature egg (ICSI). Over the next few days they are examined for signs that the process of fertilization is successful and embryos are formed.
Embryos are then transferred trans-vaginally with a thin catheter introduced into the uterus through the cervix utilizing ultrasound guidance.
Approximately 12-14 days after your transfer, you will be scheduled for a blood pregnancy test to determine if you are pregnant. Should your blood tests indicate you are pregnant, you would continue medications, and schedule an ultrasound with your physician.
We also perform the following ancillary services as part of the IVF Program:
Intracytoplasmic Sperm Injection (ICSI)
ICSI, or assisted fertilization, is a procedure in which a single sperm can be injected into the egg resulting in a significantly higher likelihood of fertilization. This process is used in conjunction with IVF.
Assisted hatching is a procedure in which a small opening is made in the shell surrounding the embryo just prior to transfer of the embryo into the uterus. This increases the likelihood that the embryo will implant into the wall of the uterus, thus resulting in a successful pregnancy.
Cryopreservation, or freezing of embryos, allows you to store excess embryos for later use.
IVF success is dependent on many factors: egg and embryo quality, the placement of the embryo into the uterus, and the environment surrounding implantation. These factors are all paramount to the ultimate goal of creating a pregnancy that leads to a live baby.
Typically, patients present with their own gametes (eggs) so the genetics and pregnancy potential of the eggs and sperm is usually predetermined when patients first walk in the door to an IVF program. Long Island IVF works to optimize those other factors that we may influence.
The greatest improvement in pregnancy rates for the past several years has been due to a culture revolution in IVF: The media environment bathing and feeding the embryos. These advances have had a great impact on IVF success rates to the point that greater than 50% of retrievals will result in a pregnancy. Unfortunately, older patients and some younger ones have yet to share in this success.
How Co-Culture Works
Many IVF programs have reintroduced the concept of utilizing a co-culture medium to improve the quality and implantation of embryos. Co-culture is a procedure whereby "helper" cells are grown along with the developing embryo. Today, the most popular cell lines include endometrial cells (from the endometrium, or uterine lining) and cumulus cells from women’s ovaries. Both cell lines are derived from the patient, thereby eliminating any concerns regarding transmission of viruses. Endometrial cells are much more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during IVF retrieval.
Cumulus cells play an important role in the maturation and development of oocytes. After ovulation, cumulus cells normally produce a chemical called Hyaluronan. Hyaluronan is secreted by many cells of the body and is involved in regulating cell adhesion, growth and development. Recentevidence has shown that Hyaluronan is found normally in the uterus at the time of implantation.
Co-culture of cumulus cells provides an opportunity to detoxify the culture medium that the embryos are growing in and produce growth factors important for cell development. This may explain why some human embryos can experience improved development with the use of co-culture.
Preparation of co-culture cells starts with separation of the cumulus cells from the oocytes after aspirating the follicles. These sheets of cells are washed thoroughly and then placed in asolution that permits the sheets to separate into individual cells. The cells are then washed again and transferred to a culture dish with medium and incubated overnight.
During this time, individual cells will attach to the culture dish and create junctions between adjoining cells. This communication is important for normal development. The following morning, cells are washed again and all normally fertilized oocytes (embryos) are added to the dish. Embryos are grown with the cumulus cells for a period of three days to achieve maximum benefit.
Co-culturing embryos has improved implantation and pregnancy rates for some women especially over 38 years of age and those with prior IVF failures.
EmbryoGlue® contains hyluronan and nutrients designed with the hope to increase the chance that an embryo will implant in the uterus. It is added to the embryo transfer medium minutes prior to embryo transfer. Some IVF programs have performed studies utilizing embryo glue demonstrating enhanced pregnancy rates for women over 38 or with prior failed IVF cycles.