Patient Services

Diagnosis & Treatment:

The formal definition of infertility is failure to conceive after one year of unprotected intercourse. Usually, conception will take place within 6 months of trying and the full year allows for those cycles in which either ovulation did not take place or sperm were too late or too early for conception.

Gynecologists will recommend that the patient monitor her cycles with temperature charts or over-the-counter ovulation predictor kits to check whether ovulation is taking place. This also serves to verify whether the couple is having intercourse at the right time of the month. If pregnancy is still not achieved, it is usually at this point you will be referred to our practice for further diagnosis and treatment.
Fertility problems that can be diagnosed and treated with In Vitro Fertilization (IVF) which may include ovulation therapy, artificial insemination, surgery, in vitro fertilization and/or donor insemination for male infertility:

• Damaged or absent fallopian tubes.
• Unexplained infertility that is unresponsive to other treatments.
• Endometriosis which has failed surgical or medical treatment.
• Male Factor infertility with low counts, motility and/or morphology.
• Presence of anti-sperm antibodies in males.

IVF (In Vitro Fertilization):

To achieve a pregnancy as a result of IVF several steps are needed:

• Use of fertility drugs to stimulate the ovary to produce several oocytes (eggs).
• Retrieval of the oocytes from the ovary by transvaginal aspiration.
• Fertilization of the oocytes and culture of the embryos in the IVF laboratory.
• Transfer of the embryos into the uterus.

All of these procedures are accomplished in our facility. For patient comfort and safety, all transvaginal aspirations of ovarian cysts are done with conscious sedation administered by an anesthesiologist.

IVF or In Vitro Fertilization (“In Vitro”-Latin for-“in glass”) is a procedure that can be used to treat infertile couples with blocked tubes and low sperm counts. Many steps are involved in this treatment. The woman undergoes controlled ovarian hyperstimulation (COH) and ovulation induction (OI).

 The next step in IVF is the retrieval of the oocytes from the ovary by ultrasound guided transvaginal aspiration. All ultrasound guided transvaginal aspirations of oocytes are done with conscious sedation administered by an anesthesiologist. 

The partner’s sperm is processed and prepared for use on the day of the egg retrieval.

The oocytes that have been removed from the ovary of the woman are placed in a Petri dish with her partner’s sperm. The oocytes (eggs) are later checked to see if they have fertilized and made zygotes (embryos). 

In patients with a severe male-factor infertility, ICSI (Intra Cytoplasmic Sperm Injection) is used to fertilize eggs. This involves the injection of a single normal sperm into a single egg. Patients with sperm that have no or very low motility can benefit from ICSI.

The embryos are cultured for six days. The growth pattern is carefully followed. This allows us to pick the best embryos to be placed in the uterus. The physicians will inform the patients of the best time to replace the embryos.

Embryo transfer is done on day 2, day 3 or day 5 of embryo culture. Our physicians follow strict guidelines laid down by SART and ASRM when deciding the number of embryos that are replaced.

Any embryos that remain in culture after the best embryos have been placed in the uterus are cultured till day 6 and frozen through a slow cooling method. This is called cryopreservation of embryos. These embryos can be thawed at a later stage and transferred to the patient’s uterus in a frozen embryo transfer.

ICSI (Intracytoplasmic Sperm Injection):

The technique involves the injection of a single sperm into an egg. For couples with severe male factor infertility or couples with prior In Vitro Fertilization attempts in which failure to fertilize occurred, ICSI has proved to be successful. In cases where the sperm must be taken directly from the testes, ICSI will be used to achieve fertilization. The procedure involves the processing of sperm from a semen specimen or testicular biopsy. A single live sperm is then injected directly into egg with a glass needle. The fertilization and pregnancy rates are comparable to those seen with IVF couples with no male factor infertility problems.

Cryopreservation of Embryos and Sperm:

Our IVF/Andrology Laboratory is licensed by the New York State Department of Health as a tissue bank facility and andrology laboratory.

Embryo cryopreservation is a method used to preserve embryos by cooling and storing them at low temperature. They can be thawed at a future date and transferred to the uterus in an unstimulated cycle.

Embryos that are thawed for embryo transfer are placed in culture media and incubated. The embryos are then transferred into the uterus within 24-48 hrs.

Sperm samples can also be preserved by cooling and they can be stored at low temperatures. Semen cryopreservation maybe used to ensure that enough sperms are available on the day of IVF or IUI in the case of male patients who have low sperm counts. It is also recommended for patients undergoing chemotherapy or radiation as a means to preserve fertility.

Testicular Biopsy:

Testicular Biopsy and ICSI is resorted to when there are no sperm in the ejaculate. The patient is usually referred to a urologist. The urologist performs a surgical procedure which removes a small amount of testicular tissue. This tissue is then transported to our lab and sperms are extracted and cryo-preserved for use in an IVF procedure at a later date.

Known Egg-Donor Program:

Donor
Our Known Egg-donor program allows patients who cannot conceive using their own eggs, to use eggs from another woman who is known to the recipient personally. The egg donor will have to undergo screening before proceeding with the egg donation.

A staff member will contact the egg donor candidate to obtain medical and social history. At this time, lifestyle patterns and risk factors will be reviewed along with any questions and concerns about becoming an egg donor. If it is mutually decided by the recipient and the donor that they wish to proceed, the donor will fill out medical and risk factor questionnaires. An appointment will be scheduled with one of our physicians to discuss the procedure and sign the consent form. If the donor is accepted, she will be contacted by our IVF nurses.

Recipient
The recipient in our known egg-donor program will need to undergo certain tests and meet criteria of our program. The tests include evaluation for the IVF procedure including normal laboratory results. Recipients must be between ages of 21 and 45 with BMIs in the normal range and also be a non-smoker. The IVF nurses will schedule the patient for a detailed instruction class (a teach) regarding all medications you will need and address any questions you may have. The IVF nurses will also go over the embryo transfer procedure. A mock transfer will be scheduled at this time along with a sonohysterogram. This will allow the physicians to measure the depth at which the embryos will be replaced at the time of embryo transfer. It also allows our physicians to address any other issues that may interfere with embryo transfer.

IUI (Intra Uterine Insemination):

Intrauterine insemination (IUI) is also known as artificial insemination. A large number of sperm (millions of sperm) are placed directly in the uterus just before and during ovulation.

Sperm samples are first washed with media and then concentrated to increase the number of sperm to be used for IUI, thus increasing the chances for conception.

IUI can be used in conjunction with controlled ovarian hyperstimulation (COH) and ovulation induction (OI). In this, the woman uses medication to induce ovulation. IUI and COH also increase chances for conception. Generally, if no pregnancy is achieved after three to six treatment cycles, our physicians may recommend IVF, and/or surgery to diagnose and possibly correct a condition contributing to a couples infertility. We recommend that our patients schedule a consult with our physicians after three treatment cycles.

Success with IUI depends the woman's age, total motile sperm count of her partner and other factors related to the woman’s reproductive health such as the health of her fallopian tubes.

AID (Anonymous Donor Insemination):

Intrauterine insemination (IUI) is usually performed by using the sperm sample of the male partner. In some couples, when the sperm quality is compromised, the couple may decide to use sperm from an anonymous sperm donor. In addition, single women might achieve pregnancy with donor insemination sperm samples can be ordered from a variety of sperm banks or cryo-banks. The frozen sperm are sent to our Infertility Clinic or IVF Center and processed for use in conjunction with IUI cycles or IVF cycles.

Male Factor Infertility:

Approximately forty percent of all infertility is due to male factor infertility. Male sexual dysfunction or abnormal ejaculation, previous surgeries or injuries may lead to problems in semen transport and production. The medical history of the male partner of an infertile couple provides important clues to the cause of fertility.

The first step in the diagnosis of male infertility is the semen analysis. It is an important part of the evaluation of the couple. The analysis is generally performed on a sample obtained by masturbation into a sterile specimen container. For those men who are unable or unwilling to masturbate, a sterile condom kit is available in our office. Ideally the male should abstain from ejaculation for 2-4 days prior to the analysis. The specimen must be analyzed within one hour of collection. The count (number of sperm per ml), the motility, progression and the normal forms are assessed using the strict Kruger method. Agglutination and the viability of sperm are also assessed. Viability of sperm is evaluated in cases when there is no motility in the sperm samples.

Surgical Treatments:

Patients going through infertility assessment and treatment may require surgery to address some of their medical issues either prior to or during their fertility treatment programs. Various conditions that can affect a woman’s fertility are, endometriosis, adhesions, fibroids, polycystic ovaries, ovarian cysts and congenital abnormalities of the female anatomy. Some of the surgical procedures performed by our physicians are:

• Hysteroscopy - for the removal of intrauterine adhesions, polyps and fibroids.
• Advanced Laparoscopy - to diagnose and treat both pelvic adhesions and various stages of endometriosis.
• Microconservative surgery for endometriosis - to remove advanced stages of endometriosis and, at the same time, retain or enhance a woman’s chance of conceiving.
• Myomectomy (removal of fibroids) - to resolve severe bleeding and to remove fibroids that may be interfering with conception or the ability to maintain a pregnancy.
• Tubal reversal-rejoining fallopian tubes in patients who have had a previous tubal ligation.
• Correction of certain congenital female anomalies.
  
  Since 2007 Dr. Sperrazza has had over a 90% pregnancy success rate with Tubal Reversal. ( excluding patients age 40 and patients with abnormal ovarian function) Dr Sperrazza selects patients based on age and the type of tubal occlusion they have had.

Out of Town Management:

We provide out-of-town monitoring to patients from other centers who are not able to make frequent trips to the clinic where they are currently undergoing infertility treatment. For more information on this service, please contact our office.