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“I just had to let you know just how much I appreciate all that you have done for me. I don’t think you’ll ever know just how much all this has meant to me. This has meant more to me than any words can ever express. Your kindness will never be forgotten.” -Misty and Johnathan
“Dear Dr. Ramirez. Just wanted to show you how some of your early work has turned 2 and update you on all of our changes. Well, I just wanted to keep you updated on our whereabouts in case you ever plan on having a reunion. I also wanted to show off our precious children. We are just so lucky to have found you and are glad to be some of your first successes. Thank again and may all of your patients be as blessed as us.” -Cindy
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ART Services
Assisted reproductive technologies (ART) involve retrieval of one or more eggs to increase the chance of successful conception. ART services include in vitro fertilization; blastocyst transfer; assisted hatching;
intracytoplasimic sperm injection; transepididymal sperm extraction; Preimplantation diagnosis; donor egg IVF; gestational surrogacy; and cryopreservation.
A team of specialists including physicians, nurses and embryologists work together with each patient to decide on which treatment is best, both medically and emotionally.
Intracytoplasmic Sperm Injection (ICSI)
During ICSI, each of the retrieved eggs is placed in a dish and held still with gentle suction while a single sperm is carefully inserted into the cell using a needle. The next day it is possible to determine which eggs have been successfully fertilized. ICSI is useful for couples where the male patient has low sperm count or poor sperm morphology, since only one sperm is required to fertilize each egg. It may also be recommended for couples who have had low or no egg yield or poor fertilization success in the past, since there is greater control of fertilization.
Blastocyst Transfer
For some patients it is preferable to continue to monitor the developing embryo in the laboratory for about 4-5 days after fertilization before selecting the best embryos and thus increase the chance of achieving a successful pregnancy. By this time the embryo has divided further and is known as a blastocyst. There are several advantages to blastocyst transfer, including the ability to choose a better embryo and a lower risk of multiple pregnancy by replacing less embryos. A drawback is that some embryos do not survive to the blastocyst stage even in the most optimal lab conditions. Embryo coculture techniques (the addition of fallopian tube or endometrial cells into the culture) can be used to nurture the blastocysts.
Ultrasound Guided Embryo Transfer
Retrieved eggs are fertilized and monitored in the lab for about 1-3 days, or 4-5 days for blastocyst transfer. Typically one or two of the best embryos are selected for transfer, and are placed via an ultrasound-guided needle into the uterus.
Assisted Hatching (AH)
The embryo is held with gentle suction while a tiny needle delivers an acid solution that wears away an area of the outer shell (the zona pellucida). This helps the embryo “hatch” out of the shell and implant in the uterine wall. Shortly after the procedure, the embryo is transferred to the uterus. Assisted hatching is often recommended for couples who have had unsuccessful IVF cycles or where the female partner is over 37 or has high FSH levels, poor quality embryos or embryos with thick shells.
Donor Egg IVF
Women who are unable to produce healthy eggs, but have a healthy uterus are candidates for egg donation with IVF. This procedure is the same as IVF, except a donor's eggs are used to create the embryos. We assist in the finding, screening and preparation of the donors. Donors can be anonymous or known donors.
Preimplantation Genetic Diagnosis (PGD)
PGD allows us to test embryos for genetic disorders before performing the transfer. This is especially helpful for expectant parents whose child is at high risk of inheriting a genetic defect. One cell from each of the fertilized embryos is tested for the DNA mutation responsible for the condition(s). It is currently possible to test for over 100 genetic disorders, including cystic fibrosis, sickle cell anemia, Tay-Sachs disease, Huntington disease, hemophilia, and some types of leukemia. In addition, the proportion of embryos that test genetically normal with PGD appears to be around 45% under age 35, 20% at age 37 and this percentage drops to somewhere between zero and 10% after age 40. There are individual instances where patients, at all ages, may have either no normal embryos or more than the expected percentage for their age.
Surrogacy
Embryos created from the eggs and sperm of both members of the infertile couple are transferred to the uterus of a third party, or surrogate. The surrogate provides a host womb for the offspring, and does not contribute genetic material.
Embryo Freezing/Cryopreservation
Cryopreservation involves the careful freezing and storage of untransferred embryos. After undergoing IVF and embryo transfer, couples may choose to preserve any remaining healthy embyros in case the pregnancy is not successful, they decide to have another child later, or they wish to donate one or more embryos to other hopeful parents. Cryopreservation is hard on the embryos and only the healthiest samples are likely to survive the freezing and thawing process. Very often one or more cells in the embryo rupture. Typically, though, the embryo is considered viable if half the cells survive. The process can be very successful – thousands of babies have been born from frozen embryos since 1984.
Male Factor TESE
Testicular Sperm Extraction (TESE). Under local anesthesia, a small amount of testicular tissue is removed. Sperm are then isolated and a single sperm injected into each egg. Fertilization rates with testicular sperm are no different from ejaculated sperm.
Male factor ICSI and TESE have all but eliminated the need for vasectomy reversal and have significantly reduced the need for donor sperm.
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