Assisted Reproductive Technologies
For the one in 12 American couples who are unable to conceive a child, in vitro - meaning literally in glass - fertilization brings additional hope. Women & Infants offers experience with the most reliable techniques available today with one of the most successful in vitro fertilization (IVF) programs in New England and among the most successful in the nation.
Women & Infants offers advanced IVF techniques and, where appropriate, other IVF variations such as GIFT (gamete intrafallopian transfer), Blastocyst transfer, TET (tubal embryo transfer) and ZIFT (zygote intrafallopian transfer). GIFT, TET and ZIFT techniques are similar to IVF, differing only in the timing and method of transfer. Male infertility problems are also addressed through the division.
A number of health problems may cause infertility and require further evaluation and infertility treatment, such as:
Women who have fallopian tube damage due to an ectopic pregnancy or infection or those who wish to have a tubal ligation reversed may pursue surgical treatment through the division. Corrective surgery may take the form of either laparoscopic or major surgery, depending on the severity of the damage. Laparoscopy, which produces dime-sized incisions and can be performed on an outpatient basis, has a recovery period of only a few days to a week. For patients who have proximal tubal obstruction, transcervical tubal canalization is available and performed on an outpatient basis.
When fertility cannot be restored successfully through surgery, the patient may wish to pursue her suitability for in vitro fertilization.
A gynecologic disorder that affects an estimated one in seven American women of reproductive age, endometriosis is a condition in which the tissue, similar to the uterine lining, attaches to other tissues or organs in the pelvic cavity. It can cause severe menstrual cramps, pain with intercourse and pelvic discomfort. Left undiagnosed or untreated, endometriosis can lead to chronic pain, infertility and other serious reproductive health problems.
Treatment of endometriosis may be either medical (drug) or surgical (laparoscopic or traditional surgery.) Either, or a combination of the two, can attempt to restore fertility as well as relieve pain and other symptoms.
The Center for Reproduction and Infertility at Women & Infants performs fertility evaluations on the male partner and often works in conjunction with the Urology Department at Rhode Island Hospital in treating male-factor conditions and performing services, such as artificial insemination or intracytoplasmic sperm injection.
Treatment for male-factor conditions may coincide with drug therapy for the female partner.
In vitro fertilization (IVF)
In vitro fertilization involves regulation of the menstrual cycle, stimulation of the ovaries, surgical removal of eggs from a woman's ovaries, fertilization of the eggs by the partner's sperm in a small petri dish, early development of the fertilized egg in an incubator and transfer of the egg - called a pre-embryo at this stage - back into the woman's uterus.
IVF is the most commonly performed procedure in Women & Infants' assisted reproductive technologies program; and, for women with damaged, abnormal or absent fallopian tubes, it is generally the only advanced treatment option. The IVF procedure does not require general anesthesia, necessary with the other three techniques.
In Vitro Maturation (IVM)
The newest addition to or modification of IVF treatment involves a safer, simpler, and less costly approach called in vitro maturation (IVM) of human eggs. The term “in vitro” refers to a process that takes place in the laboratory as opposed to one’s body (in vivo), so IVM refers to the process of maturation of human eggs in the laboratory. In this way, hormones necessary to accomplish egg maturation are applied in the laboratory environment instead of being given as injections to the woman undergoing treatment. The end result is a reduction in cost, inconvenience, and risks of taking hormonal injections for ovarian stimulation while still taking advantage of IVF technology.
In the one-day GIFT (gamete intrafallopian transfer) procedure, the eggs and sperm, which were obtained earlier in the day, are placed through laparoscopic surgery into one or both of the fallopian tubes where it is hoped that fertilization will occur. If the patient has had corrective surgery to repair or reconnect fallopian tubes, the chances of tubal or ectopic pregnancy are unacceptably high, therefore, ruling out GIFT, ZIFT, and TET as treatment options. Also, if there is any question whether the husband's sperm can fertilize the eggs, the GIFT procedure would not be appropriate.
Similar to GIFT, the ZIFT (zygote intrafallopian transfer) procedure differs in the timing of transfer, with laparoscopy being performed 24 hours after the egg retrieval. Like IVF, fertilization takes place in the laboratory. The advantage of ZIFT and TET over GIFT is that you can confirm fertilization has occurred before the pre-embryo is implanted. With ZIFT and TET, however, you must go into the operating room twice, once for egg retrieval and again for the embryo transfer which is done through laparoscopic surgery.
The TET (tubal embryo transfer) procedure is similar to ZIFT except the timing of the laparoscopic transfer occurs approximately 48 hours after the egg retrieval.
Good candidates for GIFT, ZIFT and TET are women who have normal fallopian tubes and unexplained infertility as well as those patients who have an abnormal cervix (opening to the uterus) which would make embryo transfers difficult. Although studies indicate that the pregnancy rate for each technique is similar, the division's physicians consider GIFT, ZIFT and TET procedures to be of benefit only to a select group of women.
A blastocyst is the embryo stage where the cell number can no longer be counted and where an invagination or blastocoel starts to form. To reach the blastocyst stage, embryos need to be cultured for five days. For standard ART the embryos are cultured for two to three days and then transferred back to the patient at the early cleavage stage cryopreserved. Blastocyst culture allows the determination of the best quality embryos. Culturing five days permits the embryos to self-select. It is believed that this will allow the transfer of fewer embryos, with the same or better pregnancy rate and a lower number of multiple pregnancies.
Donor sperm/male infertility
Women & Infants offers the option of using donor sperm, which can be explored with your IVF physician. In addition, Women & Infants' Division of Reproductive Medicine and Infertility offers treatment for male infertility in conjunction with a urologist affiliated with Rhode Island Hospital.
ICSI assisted hatching
Particularly for those couples with male-factor fertility issues, the Division's capability in micromanipulation offers new hope. Through the use of specialized microscopic tools in a procedure called ICSI (intracytoplasmic sperm injection), the physicians are able to isolate a single sperm and to insert it directly through the membrane of the female egg (oocyte).
In those fertilized eggs that undergo cell division, a micromanipulation technique (Assisted Hatching) can be used to potentially assist implantation of the embryo into the uterus. Here embryologists use ultra-fine micro tools to create a hole in the zona pellucida or egg shell. This is thought to help the embryo break out of the egg shell and become implanted in the uterus.
The division's donor egg program gives women with absent or poorly functioning ovaries and a healthy uterus the opportunity to carry a pregnancy and have a child. The treatment team will help determine if you are a candidate for this program.
Women & Infants' IVF success rate is due in large part to its experienced, compassionate team of physicians, nurses, and support staff who work with you to determine the best solution for your individual needs.
Preimplantation Genetic Diagnosis (PGD)
Preimplantation Genetic Diagnosis is a procedure where eggs or embryos are tested for certain genetic disorders – both inherited and non-inherited – prior to being transferred in the uterus. It is most beneficial for couples with known chromosomal or genetic abnormalities who are at risk of having an affected child; couples without genetic disorders by testing age-related chromosomal abnormalities in women 35 years and older or women with recurrent IVF failure; or couples with a history of recurrent pregnancy loss with or without a genetic basis.
The ultimate goal PGD analysis is the selection of only chromosomally “normal” embryos for transfer. For more information about PGD, call 401-453-7500.
To schedule an appointment with one of Women & Infants' infertility specialists, please call 401-453-7500.