In Vitro Fertilization (IVF) in AtlantaIn 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 (freezing), micromanipulation procedures including intracytoplasmic sperm injection (ICSI) and preimplantation genetic diagnosis.
IVF Atlanta EligibilityAtlanta 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
- unexplained infertility
CryopreservationWith IVF infertility treatment, it is possible that multiple eggs will be retrieved. To limit the risk of multiple gestation, it may be advantageous to store excess embryos through cryopreservation, also known as egg freezing. If conception does not result from the "fresh" treatment cycle, the stored embryos can be thawed and transferred to the patient during a subsequent cycle without her having to undergo ovulation induction and egg retrieval again.
ICSI: Intracytoplasmic Sperm Injection
Advances in IVF Technology with ICSIMicromanipulation, 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.
Male Factor InfertilityAs 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) 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); or 5) combinations of some of these factors.
In-vitro fertilization (IVF) has proven to be a very good therapy for most 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.
Male Infertility TreatmentThere 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.
About ICSIScientists 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.
The ICSI ProcedureICSI 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.
ICSI SuccessThe pregnancy rates achieved through ICSI success 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.
Assisted HatchingA 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 from its shell. This stimulates the natural preimplantation process in which the embryo develops and expands in size until it "hatches" out of the zona pellucida.
Preimplantation DiagnosisWe 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.
Pregnancy Success RatesSince reported pregnancy success 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.
Fertility Counseling and Infertility SupportEmbarking 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 infertility anxiety and, sometimes, infertility depression.
We regard emotional support and fertility 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 infertility support and information are also available.
Fertility ResourcesPlease see upcoming events and seminars on our Web site.
Resolve Of Georgia
PO Box 343 2480-4 Briarcliff Road
Atlanta, Georgia 30329
American Society for Reproductive Medicine
1290 Montgomery Highway
Birmingham, Alabama 35216-2809