New York Fertility Clinic - Assisted Reproductive Technologies, IVF

Generally, the term ART refers to using advanced technologies, such as ovarian stimulation with medication, egg retrieval, combining the egg with sperm in specially prepared media, maintaining the embryos in culture, and transfer to the mother. Sometimes intrauterine insemination (IUI) is included as an ART procedure because similar fertility medications are used and the specially washed/prepared sperm are mechanically placed inside the uterus.

In vitro fertilization (IVF) is a common ART procedure, which Dr. Goldstein has employed in New York since its inception. In 1978 Drs. Edwards and Steptoe presented their data on the first IVF child born in Cambridge, England. Since their presentation to the Royal College of OB/GYN in London, major advances in IVF technology have been made. Dr. Goldstein has followed these improved technologies and implemented them in his New York fertility practice.

IVF is no longer considered an experimental procedure by the American Medical Association because of the dramatic improvements in IVF success rates. IVF is often considered a "first line" therapy in women with damaged fallopian tubes, older females, those with polycystic ovarian syndrome, moderate to severe male infertility, and infertility of unexplained causes.

IVF requires numerous eggs so the female receives injections of fertility drugs (follicle stimulating hormone (FSH)). FSH is normally produced by the pituitary gland and directly stimulates the recruitment and development of follicles each of which contains an egg. Women experiencing ovarian failure will have to use an egg donor.

It is extremely important to prevent an IVF patient from ovulating early, which could mean the loss of a stimulation cycle. Lupron is given to "down-regulate" the hormonal system thus preventing the surge of luteinizing hormone (LH) that signals ovulation. Ganirelix and Cetrotide are also fertility drugs that can be given to downregulate patients. These products produce a "more complete" suppression because they block the effect of GnRH at the pituitary gland. Sometimes additional FSH is required in Ganirelix or Cetrotide downregulated cycles. Thirty-six hours prior to egg retrieval an injection of hCG is given to trigger ovulation (mimic normal cycle).

Dr. Goldstein closely monitors each patient's stimulation cycle with follicular ultrasound and estradiol blood level measurements at our NY IVF clinic offices. He makes dosage adjustments when indicated. Once the eggs mature, the IVF patient is scheduled for her hCG injection and retrieval. During the egg retrieval, the IVF patient receives mild intravenous sedation as the eggs are withdrawn transvaginally (through the vault of the vagina) and passed to the embryologist.

The embryologist separates the eggs from the follicular fluid using specially prepared solutions. The eggs are then exposed to sperm within a Petri dish where fertilization occurs. Sometimes the sperm and eggs will undergo additional ART procedures such as ICSI. In ICSI, one sperm is drawn into a micropipette, inserted through the egg membrane (zona pellucida) and released inside the egg, thus facilitating fertilization. We conduct the ICSI procedure at our NY IVF clinic locations.

After fertilization, the embryos are placed in an incubator and cultured for 3-5 days, or until Dr. Goldstein and the embryologist judge they are mature. The mature embryos are inserted via a catheter into the mother's uterus in a painless procedure requiring less than fifteen minutes.

Other ART procedures include preimplantation genetic diagnosis (PGD), intracytoplasmic sperm injection, testicular sperm aspiration (TESA), microsurgical epididymal sperm extraction, and gamete intrafallopian transfer. PGD is used in an IVF cycle to screen embryos for certain genetic diseases and for gender selection.