Treatment Options

In order to better serve you, the following items are also available to you as a patient of Beth Israel.

Please feel free to ask our staff about the following aspects of our program:

Initial Infertility Consultation
You will meet with your physician for a thorough evaluation of your infertility (both female and male). Your previous tests and treatments are reviewed and the best individual plan of care is presented for future treatments.

Diagnostic Testing
If necessary your physician may order the following diagnostic tests: baseline hormone tests; day 3 hormone levels (FSH/estradiol) to check your ovarian reserve; day 21 progesterone to confirm your ovulatory status; hysterosalpingogram to evaluate your fallopian tubes and uterine cavity or sonohysterogram/hysteroscopy to evaluate your uterine cavity; semen analysis to rule out male factor infertility.

Ovulation Induction
Ovaries are stimulated to develop multiple mature eggs with use of oral medications such as clomiphene citrate (Clomid®, Serophene®) or injectable medications such as Follistim®, Gonal F®, Bravelle® or Repronex®. At the time of ovulation, either intercourse or intrauterine insemination can be done to achieve conception.

Intrauterine Insemination
At the time of ovulation, washed/processed sperm is placed through the cervix into the uterus of the woman in an attempt to conceive. Donor sperm can also be used.

Reproductive Surgeries
Operations such as laparoscopy and hysteroscopy can correct problems related to endometriosis, fibroids, polyps and pelvic adhesions. We offer the latest endoscopic techniques and minimally invasive surgeries.

Frozen Embryo Transfer
A cycle in which previously frozen embryos are thawed for embryo transfer in an attempt to conceive.

Male Factor Infertility
Any deficiencies in sperm quantity, motility and morphology may make it difficult for a sperm to fertilize an egg under normal conditions.

Male Consultation and Evaluation
Semen analysis with strict Kruger morphology, sperm wash for insemination, microsurgical repair of obstructions and vasectomy reversals, surgical repair of varicoceles, testicular biopsy, testicular epididyrnal sperm aspiration (TESA), and microepididymal sperm aspiration (MESA).

In Vitro Fertilization (IVF)

A procedure that involves removing the eggs from a woman’s ovaries and fertilizing them outside of her body. The resulting embryos are then transferred into her uterus through the cervix in an attempt to establish a pregnancy. It generally involves the following:

Ovarian Suppression
Ovulation suppression drugs (gonadotropin releasing hormone agonist or antagonist such as Lupron®/Antagon®/Cetrotide®) are used in order to control egg development and prevent ovulation. These drugs will require daily injections to be done by you or your partner from 5 to 21 days.

Ovarian Stimulation
Fertility drugs (i.e. clomiphene citrate, Bravelle®,Repronex®, Follistim®, Gonal-F®, or Fertinex®) are administered to increase the number of follicles/eggs available for collection during an IVF cycle. The dose and duration of each drug is tailored to each individual patient. These drugs will require daily injections to be done by you or your partner over a period of 10 to 14 days. The growth and development of follicles are monitored by ultrasound examinations using a transvaginal probe and by assay of estrogen levels in your blood. This will require frequent visits to the office. When your follicles have matured sufficiently, human chorionic gonadotropin (hCG) is administered by injection to initiate the final stages of egg maturation prior to egg retrieval. Your partner should ejaculate on the day of hCG and then abstain until the egg retrieval.

Egg Retrieval
This is done under anesthesia (intravenous conscious sedation) and takes approximately 20 minutes. A needle is passed through your vaginal wall into the ovarian follicle under direct visualization with sonogram. Suction is then applied to retrieve the follicular fluid. The embryologist examines the fluid obtained from each follicle in order to identify the eggs. On this day, semen is collected usually by masturbation. You will be given progesterone every day to help support the early pregnancy.

lntracytoplasmic Sperm Injection (ICSI)
In most cases (unless otherwise indicated), the egg(s)and sperm will be processed and placed together in a drop of culture medium in the laboratory to allow fertilization to occur. If indicated, ICSI will be performed instead. This procedure is routinely recommended in cases of: severe male factor (very low sperm count, motility and/or morphology), surgically obtained sperm specimens, previous history of poor fertilization rate or if there are less than six eggs. In these instances, this procedure has been shown to increase fertilization rates. Individual sperm is injected into each mature egg under the microscope with specially designed tools.

Embryo Culture
Normally fertilized egg(s) are transferred into culture dishes with culture medium necessary for growth until time of embryo transfer/cryopreservation.

Assisted Hatching
Using a microscope and specially designed tools, a small opening is created in the clear shell (known as the zona pellucida) of the embryo(s) in order to assist the normal hatching process of the embryo. At this time, embryoplasty™ is also performed if there’s fragmentation in the embryos (see below).

Embryoplasty™ — The Beth Israel Difference

Fragmentation occurs frequently in embryos produced by in-vitro fertilization.  The higher percentage of fragmentation is related to lower quality embryos, implantation and pregnancy rates. Studies have shown that fragmentation is the result of programmed cell death or apoptosis. Furthermore, these fragments have been shown to secrete apoptotic substances that can spill out onto surrounding healthy cells and cause damage. Thus, they may induce arrest and apoptosis of remaining cells, resulting in a poor grade embryo with lower implantation and pregnancy rates.

Fortunately, years of laboratory research and the development of custom micro-surgery instruments have given way to a highly advanced process of microscopic embryo manipulation, called Embryoplasty™. Using this method, we can remove from the embryo these microscopic fragments and lead to redintegration or restoration of the embryo to health. Studies have shown that the embryoplasty™ of embryos resulted in similar implantation and pregnancy rates compared to embryos initially without fragmentation.
Because of this technique’s complexity and the expertise required to conduct it correctly and effectively, we are one of the few embryology labs nationwide to employ this revolutionary method.

Embryo Transfer
After several cell divisions, the embryo(s) will be transferred into the uterus by means of a small catheter inserted through the cervix. Embryo transfer typically occurs 3-5 days following aspiration of the eggs. The number of embryos to be transferred will be determined on a case-by-case basis and the decision is made with your physician.

Cryopreservation

Some couples have more quality embryos than can be transferred. We offer the option of embryo freezing and cryopreservation for future frozen embryo transfer cycles. We also offer egg freezing and cryopreservation for future use.

Pregnancy Tests
A blood test will be performed during the second week after the embryo transfer to determine if pregnancy has occurred. If so, additional blood samples will be drawn at regular intervals to determine the progress followed by ultrasound exams to visualize the fetal sac(s) and fetal heart beat(s).

Egg Donation Program

Some women are unable to produce healthy eggs because of disease, ovarian failure or advanced reproductive age. For these women, we offer anonymous or directed egg donation program in order to help them achieve pregnancy. In this process, the patient (the recipient) uses the eggs donated by a young healthy woman (the donor) for insemination with her partner’s sperm. The resulting embryos are then transferred into the recipient’s uterus in an attempt to conceive. The donor relinquishes all parental rights to any resulting offspring. This is a highly successful alternative for women who are unable to get pregnant using their own eggs and allows them to experience pregnancy and childbirth.

Anonymous Donors
Young healthy donors are recruited through advertisement, public speaking and word of mouth. They are carefully screened to determine their physical, genetic and psychological suitability. All potential donors undergo a comprehensive screening process that involves the following:

1. Initial screening over the phone
2. Completion of application and questionnaire
3. Interview with the clinical coordinator
4. Comprehensive medical screening with the medical director
5. Genetic screening with geneticists
6. Psychiatric screening with psychiatric team
7. Screening for general and reproductive health including infectious and genetic diseases.

Directed Donors
The infertile couple is welcome to bring their own egg donor. This individual may be a relative, a friend or acquaintance. Although this donor is non-anonymous, our policy requires her to undergo the same comprehensive screening in order to determine suitability for egg donation. We do reserve the right to not use a particular donor.