About one quarter of infertility cases are due to ovulation disorders. If a woman has an ovulation disorder, she may ovulate infrequently or not all. Polycystic ovarian syndrome (PCOS) is one of the most common disorders impacting ovulation. Other causes of ovulation disorders include ovarian insufficiency and hypothalamic amenorrhea.

Polycystic ovary syndrome (PCOS) – is a very common endocrine condition in reproductive-aged women. It affects approximately 5-10% of young women and often leads to difficulty conceiving. Women with this condition can experience irregular periods, abnormal hair growth, acne, and can have ovaries containing multiple small cysts.

PCOS negatively impacts fertility because women with the condition do not ovulate, or release an egg, each month due to an overproduction of estrogen by the ovaries. Because ovulation does not occur regularly, periods become irregular and increased levels of hormones such as testosterone can affect egg quality, inhibit ovulation, lead to insulin resistance, and increase the risk disorders such as gestational diabetes.

Infertility due to age is one of the most common causes of female infertility. As a woman gets older, the number of her eggs decreases rapidly. Additionally, the quality of her eggs also decreases increasing the chance of chromosomal abnormalities. Studies have shown that approximately 70% of miscarriages are due to chromosomal abnormalities.

Tubal factor fertility is when there are problems in the fallopian tube(s), which prevent the sperm from fertilizing the egg.

Tubal factor infertility is when a woman’s fallopian tube(s) are blocked or damaged which prevents the sperm from reaching and fertilizing the egg, or the fertilized egg from reaching the uterus. One or both fallopian tubes may be impacted. In instances of partial blockages, this can increase the risk of ectopic pregnancy. Tubal factor infertility is responsible for 25-35% of infertility cases in women.

Endometriosis is when the tissue of the uterine lining grows outside of the uterus. It is a condition that affects approximately 5-10% of reproductive-aged women and up to one third of women with infertility.

Women with endometriosis can experience painful periods that often are not relieved with over-the-counter pain medications. Women with this condition may also suffer from pain with intercourse and/or bowel movements. Endometriosis is caused by cells from the lining of the uterus found in various locations in the abdomen and pelvis, commonly on the ovaries. Surgical visualization of endometriosis implants is the mainstay of diagnosis of the condition.

Endometrial polyps are growths found in the uterine cavity. Large polyps or multiple polyps can impact fertility by interfering with the ability of embryo to implant and should be removed. The impact of small or single polyps is more controversial.

Fibroids are noncancerous growths in the uterus. They are very common (approximately 40% of women have them). However, the presence of fibroids alone doesn’t necessarily cause infertility or predispose a woman to pregnancy loss. Fibroids that distort the uterine cavity have an impact on the ability of an embryo to implant and should be removed surgically. The impact of fibroids located elsewhere in the uterus are controversial and do not always require surgery.

Occurs when a man’s testes produce enough sperm, but there is a plumbing problem that prevents the sperm from traveling out of the testes and entering the ejaculate in the urethra/penis.

Is a set of disorders that cause a man to produce abnormal sperm. All of these disorders either decrease production or cause no sperm production at all.

Is a medical condition found in men, which is characterized by a low sperm count in their semen. To impregnate a woman, a healthy amount of sperm in a man’s semen is usually necessary.

A varicocele is a common cause of male infertility, and can lead to low sperm production and decreased motility and quality. Similar to a varicose vein in the legs, blood pools within veins in the scrotum, resulting in swelling and dilation.

We know that every parent wants a healthy baby. To help increase the likelihood of giving birth to a healthy child, we offer Preimplantation Genetic Diagnosis (PGD). PGD is often used in conjunction with IVF to help choose the healthiest embryos for implantation into a woman’s uterus. It is one of the best techniques available to assist doctors in identifying and avoiding certain serious genetic diseases, and allows your baby to have a healthy start.

PGD is a simple test to help diagnose genetic disorders in embryos before they are transferred to a woman’s uterus. The test helps identify genetic abnormalities that may lead to disease during or after a child’s birth. PGD testing is minimally invasive on the embryo and is used as a screening method to determine if a disease is present.

To perform PGD testing, a fertility specialist will remove one or more cells from the embryo using a high-powered microscope. These cells are then tested by our embryology team for specific genetic traits of interest that are linked to genetic disorders.

Many couples choose PGD because they are concerned about genetic disorders that could be passed along to their children. PGD is also an optional choice for couples who are experiencing repeat pregnancy loss (miscarriage) due to genetic disorders, and for couples who already have one child with a genetic disorder and are at high risk of having another child share the disorder. PGD testing makes it possible to decrease the risk of having a child who carries a genetic abnormality.

Our single gene analysis testing screens embryos for a number of inherited disorders including Cystic Fibrosis, Fragile X, Myotonic Dystrophy, Thalasaemia, Tay Sachs, and others. Every couple may have a different reason for choosing to pursue PGD. Our doctors can work with you to determine which type of PGD analysis is most appropriate.

First IVF wants to provide every patient with a successful pregnancy and a healthy baby. Preimplantation Genetic Screening (PGS) can provide peace of mind for women who have experienced repeat pregnancy loss (miscarriage), are of advanced age, or are concerned about their proposed IVF success rate. PGS helps doctors identify chromosomally normal embryos prior to transfer into the uterus.

PGS screens for a number of common embryonic chromosomal disorders, including a condition called aneuploidy – where embryos have too few or too many chromosomes. The technique can help identify abnormalities that can cause implantation failure during IVF, as well as uncover conditions like Down syndrome (which is caused by an extra chromosome).

Studies show that the overall rate of chromosomal abnormalities in embryos is about 50 percent. As women age, the risk of chromosomal abnormalities increases and so does the risk of miscarriage from these abnormalities. PGS can help improve the likelihood of a successful pregnancy by identifying the healthiest embryos prior to embryo transfer.

PGS is commonly offered to couples who are experiencing repeat pregnancy loss or when the woman is of advanced maternal age. We offer different levels of PGS testing based on individual risk factors and physician recommendations.

CCS allows doctors to choose the healthiest embryo from a group of embryos, helping to reduce some of the most common risks associated with IVF. CCS also helps to reduce the likelihood of multiple births because doctors are more confident in the health of the embryos, and do not need to transfer additional embryos to compensate.

In vitro fertilization is a Latin phrase that means “in glass.” The human body is magnificent but unpredictable. Even with the most sophisticated imaging technology in the world, it is not easy to see what is happening on the inside. When you are struggling to conceive, IVF is often the most effective way to help, whether or not we know what is causing your infertility.

In IVF, the sperm and the egg are combined in a laboratory dish—this is the “glass” in the name—incubated, and carefully monitored throughout the fertilization process. Over the course of 3 to 5 days, successfully fertilized eggs develop into embryos. Then the embryo quality is examined for transfer, freezing, or further culturing and development.

Intracytoplasmic Sperm Injection (ICSI) is a powerful assisted reproductive technology (ART) that is usually performed in cases of male infertility. It is a major advance in modern fertility treatment because it enables fertility specialists to directly address the problem of male factor infertility. The procedure directly introduces an individual sperm cell into each of the eggs obtained during the IVF process. The resulting embryo is then transferred to the uterus to initiate pregnancy. ICSI has proven to be a truly revolutionary technology, giving new hope to many couples who had previously been unable to conceive.

An IVF-ICSI procedure includes several steps that may vary per patient, according to the prescribed treatment plan.

At First IVF, our process commonly involves:

Ovarian Stimulation – Women usually produce one egg from their ovaries during normal ovulation. In order to increase the chances of fertilization, we give the patient fertility medication at the start of her menstrual cycle to encourage the release of multiple eggs.

Egg Retrieval – Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.

Sperm Collection & ICSI – On the day of egg retrieval, a semen sample is taken to fertilize the retrieved eggs. To increase chances of fertilization, a single sperm is injected into each egg using a precision needle.

Embryo Transfer – Finally, we transfer the embryo in a minor procedure that does not require sedation.

Intrauterine insemination (IUI) is most often prescribed as an infertility treatment in cases where couples have been unsuccessfully attempting to have a baby for at least a year and other causes of infertility have been ruled out. In IUI, semen is washed of its seminal plasma and injected directly into the uterus.

Because sexual intercourse only allows for a small percentage of the sperm to travel successfully through a woman’s genital and reproductive tract, artificial insemination by IUI was developed to dramatically increase the number of sperm reaching the fallopian tubes in order to increase the chances for fertilization. The IUI process bypasses the cervix, allowing the sperm to target the ovaries without being slowed or stopped by the lower portions of the reproductive tract. When IUI is used in conjunction with ultrasound to track follicular development, the procedure can be timed to maximize the chances for getting pregnant.

Fertility drugs are often employed during IUI treatment to produce a condition known as controlled ovarian hyperstimulation. Studies have shown that this substantially increases the success rate of the IUI procedure.

The process may vary on case-to-case basis but typically involves:

Ovarian Stimulation – Women usually produce one egg from their ovaries during normal ovulation. In order to increase the chances of fertilization, we give the patient fertility medication at the start of her menstrual cycle to encourage the release of multiple eggs.

Follicular Monitoring – An ultrasound will confirm your ovulation. Our specialist will provide you with a customized treatment plan, that includes the IUI timing, which usually occurs within a day or two of ovulation.

Sperm Collection – As ovulation occurs, the semen sample will be collected from your partner and will be washed and prepared in our laboratory for insemination.

Insemination – The sperm will be introduced into the uterus through a thin catheter. The entire process takes twenty minutes. After that you will be perfectly capable of continuing your day normally. Many women describe the experience as similar to a Pap smear.

Minimal stimulation IVF, also referred to as mini IVF, uses lower doses of fertility medication than traditional IVF during the egg stimulation process and sometimes at egg retrieval. During a traditional IVF cycle, patients use gonadotropin hormone injections to produce a number of eggs within the ovaries. However, unlike a typical IVF cycle’s injection, mini IVF primarily uses an oral medication (Clomid) to induce ovulation prior to an egg retrieval. This greatly reduces the number and dose of hormone injections.

Ovarian Simulation and Cycle Monitoring – On or near day three of your menstrual cycle, you will begin a daily course of an oral stimulant, as needed, until your follicles have developed sufficiently for ovulation. An assessment will be made through blood tests and ultrasound.

Egg Retrieval – Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.

Sperm Collection & ICSI – On the day of egg retrieval, a semen sample is taken to fertilize the retrieved eggs. To increase chances of fertilization, a single sperm is injected into each egg using a precision needle.

Embryo Transfer – Finally, we transfer the embryo in a minor procedure that does not require sedation.

Natural Cycle IVF is an IVF treatment without the use of stimulation drugs. During the Natural Cycle IVF, only the follicles naturally formed during the menstrual cycle are used for treatment.

This is an option for women who do not respond well to fertility medication or with poor ovarian reserve regardless of stimulation medication. During a Natural Cycle, the single natural egg created by the body is retrieved, injected with sperm and, if fertilized, the embryo is transferred to the uterus. No stimulation medication is prescribed during a Natural Cycle.

Ovarian Monitoring – On the 2nd or 3rd day of your menstrual cycle, an assessment is made through blood tests and ultrasound.

Egg Retrieval – Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.

Sperm Collection & ICSI – On the day of egg retrieval, a semen sample is taken to fertilize the retrieved eggs. To increase chances of fertilization, a single sperm is injected into each egg using a precision needle.

Embryo Transfer – Finally, we transfer the embryo in a minor procedure that does not require sedation.

In recent years, Platelet-Rich Plasma (PRP) has been used alongside conventional fertility treatments like IVF to improve egg quality, uterine lining thickness, and endometrial receptivity, primarily in the treatment of recurrent implantation failure experienced over multiple IVF cycles.

PRP is rich in several growth factors that have a significant role in tissue regeneration and remodeling.

• Epidermal growth factor (EGF)


• Vascular endothelial growth factor (VEGF)


• Transforming growth factor beta 1 (TGF-B1)


• Transforming growth factor beta 2 (TGF-B2)


• Several classes of platelet-derived growth factors (PDGF)


• Epidermal growth factor (EGF)


• Insulin like growth factor (IGF-1)


• Hepatocyte growth factor (HGF).

PRP has been used for at least a decade in many fields, including dermatology, cosmetic surgery, cardiology, dentistry, orthopedics, and even for hair regeneration. Using this technology for infertility is rather new, but it is promising.

This revolutionary technique allows us to freeze and later thaw your eggs for use in IVF cycles, offering you new options in fertility preservation. This “flash-freezing” technique allows the delicate eggs to be frozen quickly enough to prevent damage.

Why freeze your eggs?
Many women are delaying pregnancy until their late thirties and early forties. Often, they are surprised and distressed when they learn they no longer have eggs that will produce a pregnancy because they waited too long. They are in their early forties, they look great and feel great; they see celebrities having babies at forty-eight, and they are faced with deep disappointment.

Cryo-vitrification gives women the chance to freeze their eggs while younger, preserve their fertility, and reduce the chances of miscarriage and birth defects associated with “egg age.”
Radiation therapy, chemo and surgery can all cause infertility by destroying a woman’s eggs. Depending on the type of cancer being treated, egg freezing may be an option that gives a woman facing cancer the opportunity to preserve her fertility before she undergoes therapy.

Couples preparing for IVF may need to store semen specimens in advance of the procedure. Others may want to freeze semen due to upcoming cancer therapy, military service, occupational risks, or for other personal reasons.

It’s simple. Our fertility doctors are among the best in their field, and our assisted reproductive technology lab is state-of-the-art. Couples who have had difficulty getting pregnant have had success conceiving with eggs or sperm that have been frozen using our lab and cryopreservation techniques.

Testicular sperm aspiration (TESA) is a method where sperm is retrieved directly from the testicles and is commonly used for men with non-disruptive azoospermia. With this condition, no sperm can be retrieved from the epididymis.

It involves passing a fine needle through the skin directly into the testes and retrieving a small number of the seminiferous tubules themselves. The tubules are then dissected in the laboratory and the contents searched for the presence of sperm.

This procedure can be performed under either local anesthetic or sedation.

Percutaneous epididymal sperm aspiration (PESA) is a method where sperm is collected from the epididymis inside the scrotum using a syringe and fine needle. The epididymis is a narrow, tightly-coiled tube that is attached to each of the testicles and is where sperm cells mature and are stored. The sperm is looked at under a microscope in a laboratory, where it may be used right away to fertilize eggs or frozen for future infertility treatment.

This method is often used when there is no sperm found in the ejaculate due to hindrance in the passages. Reasons for this include vasectomy reversal, damage to the vas deferens from infection, or bilateral congenital absence of vas deferens.

MicroTESE is a procedure performed for men who have a sperm production problem and are azoospermic. MicroTESE is performed in the operating room with general anesthesia under the operating microscope. MicroTESE is carefully coordinated with the female partner’s egg retrieval, and is performed the day before egg retrieval. This allows for each partner to be there for the other’s procedure. Patients frequently have donor sperm backup in case sperm are not found in the male partner. MicroTESE has significantly improved sperm retrieval rates in azoospermic men, and is a safer procedure since less testicular tissue is removed. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI.

Testicular Mapping is a minimally invasive procedure during which a fine needle is placed in different areas of the testes to obtain small samples of testicular fluid. The aspirate is fixed on a slide and checked for sperm following the procedure. If sperm is found, a future sperm retrieval will be scheduled during an IVF-ICSI Cycle and will be carried out from the sites where sperm was found during the original mapping.

A varicocele, or dilated complex of veins in the scrotum, can overheat the testicle(s), negatively impacting sperm production and quality. Varicocele surgery involves tying off or ligating the abnormally dilated veins, thus allowing for a healthy sperm production environment. This surgery seems to be most effective in men whose varicocele is of significant size; and in cases where sperm count and motility are not too severely impaired.

Procedure
Varicocele surgery is performed under local anesthesia and light (‘twilight’) sedation, usually taking a little over an hour. The patient will return home and may be advised to take it easy for a day.

Men who have had a vasectomy may be candidates for a vasectomy reversal. This procedure involves reconnecting the ends of the vas deferens (the tube that carries sperm from the testis and epididymis to the outside during an ejaculation). The vas deferens is cut and tied during a vasectomy procedure.

The vasectomy reversal can be affected by the length of time that has passed since the vasectomy was performed. Vasectomy reversals are more successful the closer they are performed to the actual time of the vasectomy. A vasectomy reversal performed in less than 10 years from the original procedure would have a 60-80% chance of success if there are no other factors affecting fertility. This estimate can drop to 10 to 40% if the vasectomy was performed more than 10 years ago. The main reasons for the decline in fertility in a vasectomy reversal are from obstruction of the epididymis and from anti-sperm antibodies. Obstruction of the epididymis can usually be identified and corrected at the time of surgery. This is an important reason to use a skilled and experienced surgeon if you are considering this option. If this is not properly corrected, the pregnancy rates can drop as low as 10%.

The first step in understanding male infertility is the semen analysis. The analysis is generally performed on a specimen that has been produced by means of masturbation into a sterile specimen container. Our Semen Collection Room that is designed with your safety, privacy and comfort in mind.
The semen analysis will provide information on:

• Basic measurements of the volume (in milliliters)


• The percentage of the sperm which are moving (motility) and the quality of the movement.
  


• The quality of the movement of the sperm, described as the “progression”.


• The shape of the sperm (morphology).

Semen analysis can help clarify if a male reproductive problem is causing infertility and can be used to find a solution that suits you best.