Assisted hatching is a laboratory procedure designed to facilitate implantation or attachment of the dividing embryos to the wall of the uterus. In order for implantation and pregnancy to occur, the embryo must "hatch" out of the zona pellucida (the egg's outermost membrane). In some patients, failure to establish a pregnancy after IVF may be related to the inability of the embryos to get out of the zona. On the day of transfer, a small opening is created in the zona pellucida under microscopic control, thus aiding the hatching process.

Yes. Approximately 50% may be expected to survive the thawing process. When Blastocysts are used for frozen embryo transfer (FET) pregnancy rates may be expected to be approximately 20 to 30% per FET.

• Patients who have the highest risk for multiple pregnancy, such as those women who are young (less than 35) and those receiving eggs from a young donor.
• A couple who produces a large number of embryos.
• Any couple who cannot risk the chance of a having triplets or higher order pregnancy, regardless of the reason.
• Those for whom Selective Pregnancy Reduction is not an option.

In all cases, we do not culture embryos to the Blastocyst stage unless there are at least two or three good quality 8-cell embryos when the embryos are evaluated on day three.

Yes. Some embryos may not grow to the Blastocyst stage and as a result there may not be any embryos to transfer on day five. This result may explain why a particular patient is unable to conceive, but such an outcome is very disappointing and unsatisfactory for patients and also for all of the Reproductive Medicine & Fertility Center staff involved in their IVF treatment. This outcome can be avoided by selecting only those embryos which appear to be developing normally and are the best candidates for Blastocyst Culture.

No. Although all embryos have the potential to become Blastocysts only the best embryos will reach this stage of development. Poor quality embryos may stop growing at any point from fertilization through the first 5 or 6 days of development.

This is an embryo, which has been growing for at least five days. It is more developed than a day three embryo, and consists of a larger number of cells (approximately 60) that are to form a tiny fluid filled ball. There are now two cell types present, an inner cell mass destined to become the fetus, and an outer layer of cells that will attach to the uterine lining and form the fetal part of the placenta. This is the stage when the embryo would normally arrive in the uterus during a natural conception.

This is an embryo, which has grown either in the fallopian tube or in the laboratory for a period of three days. From fertilization when the sperm enters the egg until the third day of development the embryo divides in a predictable manner until it becomes a 6 to 10 cell embryo. Most IVF programs transfer these embryos into the uterus at the 8-cell stage. Embryos can be graded in terms of quality based on their appearance. Some factors influencing the grading are the number of cells present, size of the individual cells, and the presence or absence of cellular fragments.

If more eggs are normally fertilized and divide to form healthy-looking embryos than is advisable to replace during the treatment cycle, the additional embryos can be frozen and stored for replacement in the future. Once frozen, the embryos can be maintained in storage for several years, but we encourage replacement within 2 years of fertilization whenever possible. The consent form for embryo freezing requests that you indicate how you would like to dispose of the frozen embryo(s) in case of divorce and death. The options include donating the embryos anonymously for the benefit of another infertile patient or discarding them. There is an annual fee for your embryos to remain in storage.

IVF is a complex process consisting of several steps. First, Fertility drugs are given over a period of ten days to stimulate the ripening of multiple eggs. Several blood tests and ultrasound examinations are done for precise monitoring of egg development. At the appropriate time, the eggs are retrieved through the vagina. Egg retrieval is a non-surgical procedure performed under light sedation from which you return home after a couple of hours. Since the egg retrieval is performed in our outpatient surgery center, we can offer you the full range of anesthesia options with a maximum of safety. Once the eggs have been obtained, the sperm is then added to the eggs in the laboratory where the eggs develop for 3 to 5 days. In cases requiring ICSI individual sperm are injected directly into the egg. When embryos are transferred on day 3 after retrieval, the embryos undergo Assisted Hatching. The embryos (fertilized dividing eggs) are placed in the womb by a simple non-surgical procedure similar to a pelvic examination. If a large number of eggs fertilize and develop normally, transfer is often delayed until day 5 to allow better selection of embryos at the Blastocyst stage. When more embryos develop than are transferred, the additional embryos can be frozen and stored for replacement at a later date (cryopreservation). Two weeks after retrieval, a pregnancy test is done. At the end of the first trimester, pregnant patients are referred back to their obstetricians for prenatal care and delivery. If pregnancy does not ensue, treatment can be repeated with an equal chance of conception in subsequent cycles.

The assisted reproductive procedures have so far proven remarkably safe for both the would-be mother and her child, but long-term follow-up studies are not yet available. Occasionally, ovarian cysts may form in response to the Fertility drugs. Some concern has been raised that the use of Fertility medications may increase the future risk of ovarian tumor, including borderline tumors and cancer. However, this finding has not been confirmed and awaits further studies. Laparoscopy and anesthesia carry the same low risks as other surgical procedures, while ultrasound retrieval can occasionally result in a pelvic infection or bleeding. Apart from the increased chance of multiple birth, the risks of pregnancy and delivery are unchanged. With over forty thousand babies born with IVF procedures worldwide, there has been no increased risk of birth defects or abnormalities.

Assisted reproductive technologies (ART) include In Vitro Fertilization (IVF) which is the technique of fertilizing a woman's eggs in the laboratory for the treatment of Infertility. While it was designed originally for women with tubal disease, IVF has been extended with equal success to Infertility due to Endometriosis, poor cervical mucus and unexplained factors. A variant of IVF, the GIFT procedure is available to women with normal fallopian tubes. IVF has also been applied to male factor Infertility. While the success rates of standard ART in these cases used to be low, the recent advances in assisted fertilization through ICSI can succeed even in couples with severe sperm abnormalities. ART attempts using the woman's own eggs drastically drop above the age of 43 years. Fortunately, pregnancy initiation with donor oocytes has proven highly effective in women who are no longer good candidates for traditional ART as well as women with non-functioning ovaries.

Yes. Since 1981, when IVF was introduced in the USA, more than 30,000 American babies have been born from IVF and over 50,000 from all assisted reproductive technologies (ART).

In the treatment of significant male infertility ICSI is a method that involves the injection of a spermatozoon (a single sperm) directly into the oocyte ("the egg"). This procedure is accomplished outside of the body in the laboratory.

In infertile couples where women have blocked or absent fallopian tubes, or when men have low sperm counts, IVF offers a chance at parenthood to couples who would have no hope of having a "biologically related" child.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes.

ART is not considered "experimental" medicine. The American Society for Reproductive Medicine (ASRM) considers IVF, GIFT, ZIFT, donor oocytes, embryo cryopreservation and the use of ICSI for male infertility non-experimental. These procedures are considered acceptable medical practice and the standard of care in the United States and throughout the world.