Micromanipulation/Genetics

Advanced IVF - ICSI, Genetic Testing with Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS) and More

With the use of advanced technology and specialized equipment, we are able to perform micromanipulation techniques on embryos created through in vitro fertilization (IVF). Sometimes called "cell surgery," micromanipulation involves the use of special instruments and magnification in order to perform procedures on individual cells. This technology allows us to offer advanced IVF treatment techniques at our Chicago-area practice, such as genetic testing with Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS), ICSI (intracytoplasmic sperm injection), and assisted hatching. These procedures can be instrumental in overcoming many types of infertility or preventing the transfer of a genetic disorder.

ICSI (INTRA-CYTOPLASMIC SPERM INJECTION)

Although in vitro fertilization is a very successful treatment method in the majority of cases, some couples who suffer from moderate to severe male factor infertility may not be able to achieve successful fertilization through standard IVF techniques. In these cases, intracytoplasmic sperm injection, or ICSI, can be an effective way to overcome obstacles to conception. By injecting a single sperm directly into an individual egg, we can bypass a number of fertility problems that impede fertilization. ICSI is also an option for couples who have unexplained infertility and have not been able to achieve fertilization through standard IVF. Many IVF labs now routinely do ICSI for all couples to improve fertilization.

The ICSI process begins in the same way as an ordinary IVF treatment, with ovarian stimulation and an egg retrieval procedure. Once the eggs are collected, they are treated with an enzyme solution that gently breaks up the covering of cells around each egg. The mature eggs are selected and each is carefully injected with an isolated healthy sperm cell. The fertilized eggs are monitored until normal embryonic development is confirmed and then they are transferred into the uterus, or frozen (vitrified).

The rates of successful embryonic development, implantation, and pregnancy after ICSI are similar or better than those associated with standard in vitro fertilization. Embryonic and fetal development after ICSI occurs in exactly the same way as it does after IVF or natural conception.

ASSISTED HATCHING

For several days following conception, the early embryo is enclosed in a protein shell known as the zona pellucida. As the embryo grows, the zona pellucida becomes thinner and thinner until the embryo "hatches" or escapes from this shell and then becomes implanted in the uterine lining, or endometrium. If the embryo is unable, for whatever reason, to escape the zona pellucida, it will not implant and pregnancy will not occur.

With IVF treatment, it is possible to make a tiny opening in the zona pellucida that can assist the embryo in escaping, before transferring the embryo into the uterus. There is currently no documented evidence to prove how effective this procedure is at increasing the chances of implantation. However, we know that it is in no way harmful to the developing embryo, and it seems to be most helpful to women who are in their later reproductive years and who have diminished ovarian reserve, unexplained infertility, or have had unsuccessful IVF treatment cycles.

GENDER SELECTION / SEX SELECTION FOR GENETIC DISEASES AND/OR "FAMILY BALANCING"

It has been known for many years that the gender of a child is determined by the sex chromosome carried by the sperm. Sperm bearing an "X" chromosome (men have both "X" and "Y" bearing sperm), when united with the "X" chromosome from the female's egg (females only produce "X") will result in an "XX" pregnancy that produces a female. If a sperm bearing a "Y" chromosome unites with the "X" chromosome from the female, an "XY" pregnancy will give rise to a male. Therefore, with a natural pregnancy or with assisted reproductive technologies, such as IUI or IVF, each pregnancy has a 50% (or one in two) chance to be male and a 50% chance to be female. Gender selection/sex selection may be used when parents need or want a child of a specific sex. Gender selection can also help prevent the transmission of certain genetic diseases. Genetic diseases carried on the X or Y chromosome are termed "sex linked" genetic diseases. Most commonly, gender selection is performed in instances where serious sex-linked diseases, such as hemophilia or muscular dystrophy are a concern; or when some couples have children of one gender, and choose elective "family balancing" to help them have a child of the other gender.

Successful gender selection "methods," performed by a reproductive endocrinologist, include PGS. Unproven therapies such as 'coital timing,' varying sexual positions, or vitamin programs do not work and should not be relied on.

Sperm separation techniques in the lab to safely separate sperm (various methods) are no longer done. None of the older traditional sperm separation techniques, such as Erickson, have been able to achieve consistent gender outcome success rates over 60-75%; even the best separation methods of today, such as MicroSort® sorted sperm, combined with IUI or even traditional IVF, are generally under 80% gender success rates. MicroSort®, now in Mexico, is not approved by the FDA.

Therefore, if you want to be sure that your next child will be the gender you need or desire, note that no other gender selection method comes close to the success or reliability of IVF with PGS (greater than 99.9%). Using IVF and preimplantation genetic screening (PGS) for gender selection, male and female embryos are identified and only embryos of the desired sex are transferred to the uterus. At our Chicago area IVF clinics, this is the method of sex selection we recommend. Whether doing PGS gender selection for prevention of sex-linked genetic diseases or for 'family balancing', the embryos can also be screened by our genetics team for aneuploidy (see above). The aneuploidy (abnormal chromosome count) screening process, employed at the time of PGS gender determination, allows for the detection of various genetic count abnormalities, such as Down syndrome (one "extra" chromosome 21). PGS for gender selection IVF pregnancy success rates are similar to regular in vitro fertilization success rates and sex selection rates approach 100%.

CONTACT OUR CHICAGO-AREA OFFICES FOR ICSI AND GENETIC TESTING WITH PGD

Contact our offices in and around Chicago to learn more about ICSI, genetic testing with PGS, or assisted hatching. We will be happy to answer any questions you have.