Assisted Reproductive Technologies (ART)
Atlanta Center for Reproductive Medicine (ACRM) provides state-of-the-art treatment for infertility through the use of Assisted Reproductive Technologies (ART) such as in vitro fertilization (IVF). Participants in our program are cared for by a highly skilled and experienced team of Board Certified physicians, embryologists, nurses, and infertility counselors.In Vitro Fertilization
In Vitro Fertilization (IVF) is the fertilization of an egg by sperm outside the body. Once fertilization has occurred and normal embryo development is confirmed, it is transferred to the uterus. If implantation occurs, the remaining development of the embryo occurs naturally within the mother.Atlanta Center for Reproductive Medicine (ACRM) employs state-of-the-art techniques for sperm preparation, ovarian follicle stimulation, egg retrieval, cryopreservation (embryo freezing), micromanipulation procedures including intracytoplasmic sperm injection (ICSI) and preimplantation diagnosis.
Eligibility
IVF therapy may be appropriate for those who are infertile due to one or more of these problems:- absence, blockage, or irreparable damage of follopian tubes
- male infertility
- endometriosis
- unexplained infertility
- immunologic infertility
Cryopreservation
With IVF, it is possible that multiple eggs will be retrieved. Since replacement of up to four embryos maximizes the chances of success while minimizing the risk of multiple gestation, it may be advantageous to store excess embryos through cryopreservation. If conception does not result from the treatment cycle, the stored embryos can be thawed and transferred to the patient during a natural cycle without her having to undergo ovulation induction and egg retrieval.Advances in IVF Technology
Micromanipulation, the handling of egg and sperm by microscopic instruments, is used to improve the chances of fertilization in cases with impaired sperm function. ACRM offers the most advanced micromanipulation technique, called Intracytoplasmic Sperm Injection (ICSI), in which a single sperm is injected directly into the egg using a glass micro-needle.
ICSI has revolutionized the treatment of male infertility by overcoming barriers to sperm entry into the egg. Fertilization is possible even in cases with scant sperm or compromised sperm function. ICSI has largely replaced Partial Zona Dissection (PZD) and Subzonal Insertion (SUZI), the first of the micromanipulation techniques used to treat male factor infertility.
As much as one third of the infertility cases in the United States may be attributed to a male factor, which may take the form of: 1) a low sperm concentration or "low sperm count"; 2) low sperm motility (few sperm which swim); 3) antibodies against sperm which impair their ability to swim or to fertilize eggs; 4) sperm which are not able to fertilize eggs because they are not functional due to some abnormality in their structure or biochemical make-up (they do not contain the enzyme, or have enzymes in too low a quantity to allow fertilization); 5) combinations of some of these factors.
In-vitro fertilization (IVF) has proven to be a very good therapy for some forms of male factor. This is because the motile (swimming) sperm can be collected and concentrated from the husband's semen and placed in direct contact with the egg in a culture environment in the IVF laboratory. Through the increased number of swimming, and presumably functional, sperm around the egg, the chances of fertilization are improved over intercourse or intrauterine insemination.
There are cases of male factor infertility, however, which cannot be addressed even through IVF. In these cases, there are so few sperm or sperm which are completely immotile (not swimming at all), that even if they are placed in culture with the egg, no sperm cell would be able to penetrate and fertilize the egg. In addition, there are men who only have immature sperm available, and these may not be fully functional.
An ideal approach to these severe forms of male infertility is to directly inject a single sperm cell into the egg. In this way, the sperm cell is relieved of the work of penetrating the several layers which surround, nourish and protect the egg. It is also apparent that relatively few sperm are needed since only one sperm cell is required for each egg.
Scientists in Belgium under the direction of Dr. André Van Steirteghem, developed a method of injecting a sperm cell into the egg and called it, appropriately, Intra-Cytoplasmic Sperm Injection (ICSI - pronounced ick-see). This technique allows fertilization in cases that would have been virtually hopeless.
It is essential to recognize, however, that even though the sperm is placed inside the egg by the injection procedure, the fertilization process may not be completed. Fertilization is a complex continuum of sperm and egg interaction, not simply the entry of the sperm into the egg. If this interaction does not ensue following delivery of the sperm into the egg, fertilization failure may still result.
ICSI is performed using instruments called micromanipulators. These allow the biologist to "handle" the cells under microscopic observation with magnification of 200 to 400 times. The egg is gently held steady using an instrument called a holding pipette. Using a glass micro-needle, a single sperm is aspirated into the tip of the needle and then carefully injected into the egg. The egg can be examined 15 to 18 hours later to determine if fertilization has occurred.
Fertilization has been achieved in cases of extremely low sperm concentrations, absence of motility, sperm collected directly from the testis (immature) and in cases in which fertilization failure was experienced in previous IVF therapy. The incidence of fertilization using ICSI has been reported in the range of 40-60%, depending on the experience of the laboratory and the overall sperm and egg quality. Our experience thus far has been consistent with these reports.
The pregnancy rates achieved through ICSI are comparable to those observed with IVF. As in IVF, the incidence of pregnancy is dependent upon a number of factors: the wife's age, any infertility factors she may have, the number of embryos transferred to her uterus and uterine receptivity.
No increase in congenital malformations in the children conceived through ICSI has been observed.
Assisted Hatching
A technique for improving the implantation of embryos obtained through IVF is assisted hatching. With assisted hatching, an opening is introduced into the zona pellucida, which is the protein layer surrounding the egg. This aids the escape of the growing embryo. This stimulates the natural preimplantation process in which the embryo develops and expands in size until it "hatches" out of the zona pellucida.Preimplantation Diagnosis
We are now able to determine if an embryo is carrying a specific genetic disease. Through preimplantation diagnosis, a single cell from an embryo can be analyzed for almost all genetically transmitted diseases, enabling patients at risk to have unaffected children, and in many cases prevent further transmission of that genetic disorder.Success Rates
Since reported pregnancy rates from established programs may vary, it is important to understand how various statistics are computed and presented. Efficacy rates depend not only on the skills of the practitioners, but on individual patient characteristics such as age, indication for IVF and number of eggs retrieved and fertilized. Reported results may include patients of all ages and indication, or they may be categorized by age and indication.Counseling and Support
Embarking on a program involving the Assisted Reproduction Techniques (ARTs) is a major decision. Many people see it as renewed hope for conception as well as their last resort. While the ARTs have helped many couples overcome their infertility, they are not the answer for everyone. For those who choose the ARTs, the process can be emotionally, physically and financially draining, and carries with it a tremendous amount of anxiety.We regard emotional support and counseling as an important adjunct to treatment. We want to help patients maximize their coping skills during this stressful time, and for this reason have included a session with a counselor in the initial evaluation. This session offers couples assistance with decision making and an opportunity to explore their feelings. Additional sources of support and information are also available.
Resources
Please see upcoming events and seminars on our Website.Resolve Of Gerogia
www.resolveofgeorgia.org
phone: 404.233.8443
PO Box 343 2480-4 Briarcliff Road
Atlanta, Georgia 30329
American Society for Reproductive Medicine
www.asrm.org
e-mail: asrm@asrm.org
phone: 205.978.5000
fax: 205.978.5005
1290 Montgomery Highway
Birmingham, Alabama 35216-2809