Fertility preservation is a hot service offered by many fertility clinics today. The most common and successful means to preserve fertility is through egg freezing (also known as oocyte cryopreservation). More than 500 babies have been born from this technique worldwide. Egg freezing is a process whereby eggs are stimulated in the woman’s ovaries and [...]
Infertility is a couple’s problem, and is commonly due to some contribution from both the male and female partners. Approximately 40% of the time, the male contributes a significant part of the fertility problem. At the Xpert Fertility Care, Dr. Ho thoroughly investigates both male and female causes of infertility in a comprehensive manner.
Female Causes: [...]
Today NBC show is airing an interesting segment about the complimentary approach to the treatment of infertility. Many western fertility specialists are now embracing the idea. At at Xpert Fertility Care, we strongly believe that, “keep your mind open” and “do whatever works to achieve the goal” for our patients.
In keeping with our commitment to providing comprehensive personalized care, our fertility experts customize each patient’s infertility treatment plan. Dr. Ho has extensive experience in diagnosing the many possible causes of infertility and treating them through a broad range of advanced surgical and noninvasive services at the most economical cost:
|
In-Vitro Fertilization (IVF) |
 |
|
Step 1: Ovulation Induction – Injectable hormone medications such Follistim or Gonal F are given with a thin, small needle just underneath the skin for several days to stimulate the ovaries to produce multiple follicles. The development of these follicles is monitored by frequent vaginal ultrasounds and blood tests. Once the follicles have matured to the appropriate size, an injection of another hormone medication such as Ovidrel is given, which works like luteinizing hormone (LH) to release the egg. It is usually given the day after the last dose of Follistim and given at a specific time as instructed by the nurse. It is extremely important to adhere to the time the nurse states. The in-vitro fertilization (IVF) scheduled time is dependent to the proper dosing time of the Ovidrel, usually 36 to 37 hours before the time of egg havesting. |
 |
|
Step 2: Semen Collection/Processing – Shortly before the egg retrieval, a semen sample will be collected and processed to isolate the strongest most active sperm. These sperm will be placed with each aspirated egg. We strongly encourage patients to consider freezing a semen specimen several weeks in advance of the egg retrieval date for several reasons. Coordinating work and surgery schedules can prove difficult and illness can occur unexpectedly. Also, the expectation of producing a sample on demand the day of the egg retrieval can be stressful. |
 |
|
Step 3: Egg Retrieval – Under light sedation given by a licensed Anesthesiologist, in a special air filtration egg retrieval suite, the doctor aspirates each mature follicle with a needle guided by ultrasound. This is usually done through the back of the vaginal wall but on rare occasions can be done through the abdomen. The aspirated eggs are then passed on to the Embryologist to identify and fertilize. This is the stage where additional micromanipulation can occur if needed such as ICSI. ICSI involves an embryologist injecting a single sperm directly into a mature egg under a microscope. This procedure is done to increase probability of fertilization when there is a male factor problem such as low sperm count, poor motility/morphology, or when the sperm aspiration techniques TESA/MESA are used to obtain a sperm specimen. ICSI is also recommended if fertilization did not occur in previous IVF attempts. |
  |
|
Step 4: Fertilization Evaluation – 14 to 18 hours after the sperm and egg are placed together; they are evaluated by the Embryologist to confirm fertilization. If fertilization occurs, the zygotes (fertilized eggs) are cultured in preparation for embryo transfer. Continued observation will occur over the next few days by the Embryologist, who will determine the quality of the embryo. The quality of the embryo will determine when the embryo transfer will take place and the number of embryos to transfer. Depending on the number of fertilized eggs, some may be frozen for use in a later cycle. |
 |
|
Step 5: Assisted Hatching (AH) – This technique is used to improve the probability of the embryo’s implantation. Assisted Hatching involves the Embryologist opening a small hole in the outer membrane known as the zona pellucida of the embryo. This opening improves the ability of the embryo to leave its “shell” and implant into the uterine lining. Patients that may benefit from Assisted Hatching (AH) include those with previous In vitro Fertilization (IVF) failure, poor embryo growth rate, moderate to excessive cytoplasmic fragmentation and women with advanced maternal age. |
 |
|
Step 6: Embryo Transfer – This brief, painless procedure involves the doctor placing a catheter that has been loaded with a selected number of embryos by the Embryologist, through the cervix and into the uterus to deposit the embryos. When possible Blastocyst transfers are done, which occur around day five of embryonic growth. Blastocyst transfers allow a more mature embryo to be transferred, allowing the Embryologist to select fewer embryos for transfer, achieving a high pregnancy rate with a lower risk of multiple gestations above twins. Occasionally, cleavage stage, day three of embryonic growth transfer are done at they recommendation of the Embryologist based on the quality of the embryo. |
 |
Blastocyst Culture
In the past most embryos produced with IVF were transferred on day three of development. When an embryo reaches five days of development it is called a blastocyst. Currently, with advances in understanding of the needs of developing embryos, the ability to produce blastocysts in the laboratory has increased. Culturing and transferring blastocysts on day five of development allows the transfer of fewer embryos while still maintaining a high pregnancy rate. Normally only two blastocyst stage embryos are transferred, thus reducing the risk of multiple gestations higher than twins.
Co-Culture of Embryos
The embryos of some couples have cytoplasmic fragmentation resulting in poor quality embryos. By culturing these embryos with cells similar to those that line the woman’s fallopian tubes and uterus the fragments can be reduced and the quality of the embryo improved.
Preimplantation Genetic Diagnosis (PGD)
PGD allows couples at high risk for passing along genetic disease or conditions to offspring the opportunity to test individual eggs or embryos for specific genetic abnormalities. PGD involves taking a single cell from a developing embryo and analyzing its genetic makeup. After testing, only healthy embryos are transferred back into the woman to avoid miscarriage or birth of a baby with these genetic complications. PGD can be used for couples that are at risk for transmitting a genetic disease to their children such as Cystic Fibrosis, Sickle Cell, Tay Sachs, etc. It can also screen for chromosomal abnormalities that can cause miscarriage or prevent pregnancy from occurring while also checking for certain genetic diseases, such as Down’s syndrome-much like the amniocentesis test, PGD does confirm the sex of the embryo as part of the complete chromosome report but is not generally used for this purpose.
MicroSort® - Gender Selection
For decreased prevention of X-Linked Genetic Diseases and increased ability of Family Balancing (Gender Selection). The male’s sperm determines the sex of the baby, male or female. MicroSort is a patented process that separates the male and female sperm prior to fertilization. After separation, the sperm is used in conjunction with an IVF/ICSI procedure at our facility.
Assisted Hatching
This technique is used to improve the embryo’s implantation. Assisted Hatching involves opening a small hole in the outer membrane known as the zona pellucida of the embryo. This opening allows the embryo to leave its “shell” and implant into the uterine lining.
Embryo Cryopreservation
Cryopreservation (freezing) of embryos (fertilized eggs) is utilized when the number of embryos produced during an IVF cycle exceeds the number of embryos placed in the uterus on day three or five embryo transfer. Once frozen, these embryos may be thawed and transferred in another cycle at a later time. Gamete cryopreservation (freezing) is used to freeze sperm so that it can be used at a later time.
Egg Donors
Eggs are donated for patients who have lost their ovaries, have premature ovarian failure or advanced maternal age. These donors are screened for genetic, emotional and physical health abnormalities, sexually transmitted diseases including HIV, smoking, drinking and recreational drug use. Physical characteristics are provided to help match various traits if desired.
If you are interested in becoming an egg donor and are between the ages of 21 and 30, and a non-smoker, please call or email our patient advocate to see if you qualify. Compensation of $3,500.00 and up is paid to our egg donors.
Surrogate Carriers
Women who may have the ability to produce eggs but are unable to use their uterus or don’t have a uterus, may consider a gestational surrogate carrier. A donated egg may also be used with gestational surrogate in the event a woman can’t produce her own eggs or her uterus is not intact or insufficient to carry a pregnancy. In either case, the husband’s sperm may be used. Using an egg donor unrelated to the surrogate carrier eliminates any biological tie.
If you are interested in becoming a surrogate carrier and are between the ages of 21 and 35, and a non-smoker, please call or email our patient advocate to see if you qualify. Compensation of $15,000.00 is paid to our gestational surrogates.
Intrauterine Insemination (IUI) using husband or donor sperm
For Intrauterine Insemination, sperm that has been processed, concentrated in a small volume of sterile medium. It is placed directly into the uterine cavity at the time of ovulation. This is done in conjunction with a natural cycle or a cycle induced using fertility drugs (clomiphene citrate or gonadotropin). Through the process of Intrauterine Insemination, sperm are placed high in the female reproductive tract to enhance the chance of successful fertilization.
Sperm Wash
This is a process to remove the sperm from the ejaculate. This provides a highly concentrated amount of sperm that can then be introduced into the cervix or the uterus.
Sperm Freezing and Storage
Sperm can be frozen and stored in the frozen state for an indefinite period of time. This frozen sperm can be thawed and used for future pregnancy attempts.
Semen Analysis
A semen analysis measures the quantity and quality of the sperm. Several characteristics are examined, including the ability of sperm to move (motility), forward progression (the quality of movement), sperm count (the number of sperm), volume of semen (the total amount of ejaculate), as well as the size and shape of the sperm (morphology).
The semen analysis must be collected within 1 hour prior to reaching the laboratory or be collected onsite. The laboratory should provide a sterile container and instructions on masturbation collection. The specimen must be processed immediately. Many laboratories do not have the ability to perform the semen analysis onsite and may ship the specimen to another city or state, thus not processing the specimen until several hours later or even the next day. This delay would severely impact the accuracy of the results.
Sperm Function Testing
Several different tests are available to determine if the sperm is capable of fertilizing an egg. These studies vary from laboratory to laboratory and are not part of the routing semen analysis.
Urological Consulting Services for Sperm Retrieval/Aspirations - TESA, MESA, PESA
Urologists specializing in sperm retrieval/aspiration techniques are available to perform these procedures at ICH in order to obtain sperm that can not be otherwise ejaculated in a patient’s semen due to obstructions, illnesses, previous vasectomies, congenital disorders etc. Sperm retrieved in this manner is generally used in conjunction with IVF/ICSI procedures.
Ovulatory Dysfunction
A problem with the ovary where the egg is not matured or released properly. Many things can cause ovulatory dysfunction including, Hypothalamic Hypogonadism, Polycystic Ovarian Disease, Hyperandrogenism, Hyperprolactinemia, Hyperthyroidism, Luteal Phase Defect, and Premature Ovarian Failure.
Endometriosis
UterIne lining tissue found outside the uterus, often inside the peritoneal cavity on the ovaries, fallopian tubes, uterus, bowels and bladder. It is one of the most common causes of female infertility. At Xpert Fertility Care, Dr. Ho offers a variety of solutions ranging from hormone therapy to surgical infertility treatments with laser surgery by Laparoscope to help women with endometriosis conceive or manage their symptoms.
Recurrent Miscarriages
Any woman who has had three or more first trimester pregnancy losses. Recurrent pregnancy loss can have many different causes. Dr. Ho is able to use his wealth of resources and expertise to determine the reasons behind repeated miscarriage. Based on these findings, Dr. Ho will devise a course of action to help reduce the possibility of subsequent pregnancy loss.
Polycystic Ovarian Syndrome (PCOS)
The formation of cysts in the ovaries that occurs when the follicle stops developing. This is due to a hormonal imbalance in the ovary. At Xpert Fertility Care, Dr. Ho offers multiple medical and infertility treatment options to help women manage PCOS. Treatments may include the administration of Glucophage® (metformin), traditionally a medication used in the treatment of diabetes which has been demonstrated to improve symptoms of PCOS and to help women with PCOS conceive.
Hirsutism
Women who experience excess hair production on their face, chest, abdomen, legs, and back. Treatments include medical management.
Congenital Pelvic Abnormalities
Some patients may be born with structural birth defects of the vagina or uterus. Some of these defects can be easily corrected with minor surgery prior to achieving pregnancy.
Menstrual Disturbances
Any menstrual bleeding pattern that does not follow the typical twenty eight day cycle. This can include frequent bleeding occurring more often than twenty eight days, bleeding less frequent than twenty eight days, or no menstrual bleeding at all.
Advanced Laparoscopy
An out-patient surgical procedure where a surgeon with advanced surgical skills and training in pelvic reconstruction (board certified Reproductive Endocrinologist) inserts a mini-telescope into the abdomen to view the pelvic organs. Surgical instruments can be inserted with the mini-telescope to perform surgical removal of adhesions, cysts, endometriosis and to reconstruct pelvic structures such as the fallopian tubes that have been damaged, infected or tied in the past.
Tubal Reversal - Fallopian Tube Reconstruction
A surgical procedure to repair tubes that have been damaged. The most common form of damage is secondary to a previous tubal ligation.
Microsurgical Tubal Anastamosis/Tubal Reversal
A surgical procedure to repair tubes that have been damaged. The most common form of damage is secondary to a previous tubal ligation.
Adhesiolysis
Surgical removal of adhesions, usually during an out-patient Laparoscopy procedure. Adhesions are scar tissue that forms around reproductive organs following a previous surgery, infection or injury.
Located in San Diego and Orange County, Southern California, XPert Fertility Care® is a leading fertillity center for infertility treatment, including ICSI, IVF - in vitro fertilization, PGD - preimplantation genetic diagnosis, egg donation and egg freezing. Our fertility specialists are among the Top Fertility Doctors in the United States for both female and male fertility treatment. For Southern California residents, XFC is easily accessible from Los Angeles, Long Beach, Fountain Valley, Hunington Beach, Irvine, San Diego, Riverside, Corona, Temecula and La Jolla.
Orange County Fertility Clinic | 11180 Warner Avenue, Suite 461, Fountain Valley, California 92708 | 714.429.5848
San Diego Fertility Center | 5555 Reservoir Drive, Suite 205 San Diego, California 92120 | 619.286.5054
©2008 Xpert Fertility Care of California. All Rights Reserved.
