In Vitro Fertilization (IVF) and Assisted Reproductive Technologies (ART)

Assisted Reproductive Technology (ART) refers to a range of laboratory techniques that combine sperm and egg for fertilization. Since its beginnings in 1978, ART has evolved to become the foundation for highly successful fertility treatments. In recent years, tens of thousands of babies have been born to women who previously could not conceive.

Greenwich Fertility Center's affiliation with the New York University Fertility Center gives our patients access to some of the most accomplished and world renowned fertility specialists in the field. A wide range of advanced ART services are also available, including:

• In vitro fertilization (IVF)
• Intracytoplasmic sperm injection (ICSI)
• Assisted hatching
• Blastocyst culturing
• Embryo cryopreservation
• Preimplantation genetic diagnosis (PGD)
• Donor oocyte (egg) services
• Oocyte cryopreservation (egg freezing) services

In Vitro Fertilization (IVF)

IVF is a common component of an ART cycle. It is the process by which eggs are fertilized outside the body. With IVF, hormonal medications are often used to stimulate a woman's ovaries to produce multiple eggs. When mature, these eggs are retrieved or removed from the ovaries and taken to an embryology laboratory. There, they are placed in a petri dish containing a nourishing medium and combined with sperm. If fertilization occurs, a healthy embryo - or embryos - are transferred to the uterus 3-5 days later for implantation and pregnancy.

IVF is often recommended when other treatment options have failed. It may be indicated when a patient has a tubal factor, ovulatory dysfunction, diminished ovarian reserve, endometriosis, uterine factor or male factor. While IVF may be a more aggressive method of clinical treatment, it is also very effective. The success of an IVF cycle is often related to the age of the patient as well as to the program expertise and specific laboratory and clinical protocols.

We are proud of our pregnancy and live birth success rates.

Embryology Lab

Greenwich Fertility Center's state-of-the-art embryology lab is located at Greenwich Hospital. It offers a convenient option for our Fairfield and Westchester county patients who prefer not to travel to New York City for their egg retrievals and embryo transfers. Managed by the same laboratory director and staffed by the same embryology lab team as the NYU Fertility Center, the Greenwich Fertility Center's pregnancy success rates are equal to those of NYU's.

In the embryology lab, oocytes, or eggs, are combined with sperm from a patient's partner or donor.

If necessary, sperm is injected directly into the eggs using a highly specialized technique called intracytoplamic sperm injection (ICSI). This procedure is recommended when a severe male factor such as low sperm count or motility is present, or when poor fertilization has been observed in a previous IVF cycle.

Additional laboratory techniques may be performed including extended culturing to the blastocyst stage, assisted hatching, preimplantation genetic diagnosis (PGD), and embryo cryopreservation.

After fertilization, embryos are cultured in the embryology laboratory. This is done under very strict conditions in specialized media in an incubator. Embryos are typically transferred back into the uterus at either the cleavage stage (on day 3 after retrieval) or the blastocyst stage (on day 5 after the retrieval).

The embryologist grades the embryos on these days so that the best embryos can be chosen for transfer. The advantage of "extended culture" to the blastocyst stage is that it may allow for better embryo selection and for fewer embryos to be transferred. If there are very few embryos available on day 3, this option has limited benefit and the transfer is usually done that day.

Day 3 embryos consist of 4-10 relatively equivalent cells. Day 5 embryos are comprised of 50-100 cells that have already begun to differentiate. In the case where there are many embryos, typically some of them will grow more quickly and exhibit better form or structure. Selecting these over the poorer quality embryos improve the implantation success rate.

The cells that make up the early embryo are enclosed within a "shell" called the zona pellucida. During normal development, a portion of the zona dissolves, allowing the embryonic cells to escape or "hatch" out of the shell. Only upon hatching can the embryonic cells implant within the wall of the uterus to form a pregnancy. Assisted hatching is the laboratory technique in which an embryologist makes an artificial opening in the zona pellucida in order to help the embryo hatch out of the zona. The hatching is typically performed on the day of transfer, prior to inserting the embryo into the transfer catheter. The opening can be made by mechanical or chemical means. Assisted hatching may be beneficial in improving IVF success in certain cases and is usually performed for transfers done on day 3 of development, at the cleavage stage.

Preimplementation Genetic Diagnosis (PGD)

The term "preimplantation genetic testing" describes procedures involving the removal of one or more cells from the embryos for genetic testing before selecting them for transfer back to the uterus.

This includes "preimplantation genetic diagnosis" (PGD) which is used when one or both parents carry a gene mutation (cystic fibrosis, for instance) in order to determine whether that specific mutation has been transmitted to the oocyte or embryo.

Preimplantation genetic testing also includes "preimplantation genetic screening" (PGS) which is performed in order to screen embryos for chromosomal abnormalities or aneuploidy (like trisomy 21 or Down Syndrome) before transfer.

Patients who may be carriers of a genetic disorder are advised to receive genetic counseling prior to PGD to review the specific genetic disease, its effects on the development of a child, and the procedures that are used to try to prevent having a child with that disease. PGD can reduce the risk of conceiving a child with a genetic abnormality carried by one or both parents. Prenatal diagnostic testing to confirm the results of PGD is strongly encouraged because the methods used for PGD have technical limitations that include the possibility for a false negative result.

Procedures for screening embryos for aneuploidy (abnormal chromosome numbers) are still undergoing development. Some procedures are only able to screen for 9 or 12 of the 23 chromosomes, while more recent procedures are able to screen all of the chromosomes. Studies are ongoing to determine who are the best candidates for PGS.

Embryo Cryopreservation

It is our medical goal to transfer the fewest embryos possible to minimize the chance of a multiple pregnancy and maximize the chance for conception and live birth. We adhere to the guidelines set forth by the ASRM, which are based on a patient's age and mitigating factors. When indicated, a single embryo transfer may be recommended. If there are several good quality embryos, patients are given the option to cryopreserve or freeze any additional, good quality, viable embryos for future use. Embryo cryopreservation is an option to consider to help reduce both the emotional and financial strains of any future IVF cycles a patient may be anticipating.

Donor Oocyte (Egg) Services

For a variety of reasons including age, genetic abnormalities, ovarian failure or prior surgeries, some women are unable to produce healthy eggs for fertilization. Utilizing donor eggs from either a known or recruited donor in conjunction with IVF, can be a pregnancy option for these women. Donors are carefully screened and matched as part of NYU's NY State-licensed and recognized program. Read more.

Fertility Preservation - Oocyte Cryopreservation (Egg Freezing)

Fertility preservation through oocyte (egg) freezing allows women to store eggs at a younger age for use when they are older. It is now an important part of modern day culture. Whether eggs are being cryopreserved because of a medical emergency such as a newly-diagnosed cancer or for personal reasons, the technology holds great promise for women of reproductive age. Read more.