Micromanipulation

The Fertility Center’s Embryologist Susan Walker regularly performs advanced procedures on eggs, sperm and embryos under a high-powered microscope to help ensure the best odds for conception.

ICSI – Intracytoplasmic sperm injection is a way to micromanipulate or “force” fertilization. A glass needle is used to inject a single sperm into the cytoplasm of a mature egg. This process bypasses reproductive barriers (such as low sperm concentration, poor sperm motility, issues with sperm binding to or penetrating the egg, and antisperm antibodies) to allow fertilization to occur. If a couple’s infertility is unexplained or if pre-implantation genetic diagnosis is being used to screen embryos, the ICSI procedure often is recommended or required for fertilization. Currently, ICSI is the most successful fertilization approach for male-factor infertility. Because of its proven reliability, the procedure is often used even for couples without sperm quality issues. Sometimes half of the eggs retrieved from a cycle may receive ICSI while the rest undergo conventional
in vitro fertilization.

PGD – Pre-implantation genetic diagnosis has been a breakthrough in helping couples at risk of carrying life-threatening or debilitating genetic diseases to avoid passing those afflictions to their offspring. Used only in conjunction with in vitro fertilization, this remarkable procedure allows for sample cells to be taken from an embryo (which includes genetic material from both the egg and the sperm) while in the laboratory and prior to transfer into a womb. For single-gene disorders, the cell can be used to test for one of more than 200 abnormalities such as sickle cell anemia and cystic fibrosis. Aneuploidy testing looks at nine out of 23 sets of chromosomes; those nine are linked to the majority of early miscarriages and to the most common birth defects including Down and Edward's syndromes. As a result, only the embryos without irregularities are transferred for uterine implantation, increasing the possibility that couples will have healthy babies. The effectiveness of PGD for genetic screening is unquestionably successful; debate and research continues regarding using PGD for treating women with recurring miscarriages in hopes of identifying embryos with normal chromosomal structure and number for implantation. Prior to PGD, the diagnosis of genetic disease was limited to testing a fetus through amniocentesis or chorionic villus sampling, in which cells from the placenta are sampled and tested early in a pregnancy.

ASSISTED HATCHING – The outer protective layer of an embryo is called the zona pellucida. Normally, the embryo sheds its surrounding zona to be able to implant in the uterus. However, if the outer layer is thickened or toughened, the embryo may not be able to “hatch” out. In these cases, a small opening can be created in the zona under a microscope to help the embryo break out and implant in the uterus after being transferred.