Services and Explanations

Intrauterine Insemination (IUI)
Also called artificial insemination, intrauterine insemination (IUI) involves sperm inserted into the woman's uterus at the proper time. IUI is an inexpensive alternative to In Vitro Fertilization.  The sperm may come from the male partner, from a sperm donor, or some from both. The IUI process is easy, quick, and usually painless, but may work best if a regiment of medications is employed first to promote the development of more ovarian follicles.

In Vitro Fertilization (IVF)
In vitro fertilization involves the removal of eggs (called oocytes) from a woman, fertilization of those eggs with sperm, and transfer of the fertilized embryos back to the uterus. 

IVF starts with ovarian stimulation.  The patient’s ovaries are stimulated with drugs that cause many follicles to develop.  The eggs in these follicles are then matured, removed, and fertilized with sperm in the laboratory.  The fertilized embryos are then grown in culture media in carefully controlled laboratory conditions until they are ready to be returned to the woman’s uterus.  At that time, the embryos are graded under a microscope, and the best embryos are carefully transferred to the uterus.  Any remaining viable embryos may be frozen for later use.

IVF is a very versatile procedure.  The eggs may come from the intended parent or an egg donor.  The sperm may come from her male partner or a sperm donor.  The embryos may be transferred to the uterus of an intended parent or a gestational carrier (sometimes called a surrogate) who carries the pregnancy for the parent(s).  The embryos may be fresh or frozen.  IVF has been successfully used to provide children to women with no male partner, men with no female partner, and same-sex couples (gay and lesbian couples).

Intracytoplasmic Sperm Injection (ICSI)
The eggs may be fertilized conventionally by placing them in a dish with sperm and waiting for a sperm to enter each egg.  However, in many infertile or subfertile couples, male factor contributes to the problem, and the sperm may not be as effective as they should be.  Male factor might include low sperm count, low motility, or other features.  A technique called intracytoplasmic sperm injection (ICSI) is used to inject one selected sperm directly into each egg.  At The Fertility Center of Las Vegas, we prefer to provide ICSI for all patients to minimize issues from poor sperm performance.

Assisted Hatching
Assisted hatching may improve pregnancy rates in some women undergoing IVF. In assisted hatching, an opening is formed in the shell (the zona) surrounding the embryo before the embryo is transferred into the uterus. This may increase the chance the embryo will hatch or may help the embryo to hatch a little sooner, and these factors might help the embryo to implant in the uterus during the implantation window.

Extended Culture and Blastocyst Transfer
Once the eggs are fertilized, they are grown in special culture media.  Nationwide, the most common transfers are on day 3, but blastocyst (day 5) transfers are becoming more popular each year. The Fertility Center of Las Vegas was among the first centers in the world to standardize blastocyst transfer in 1997, and we have performed thousands of blastocyst transfers.  Advantages of blastocyst transfers are:

• Many embryos are genetically flawed and many of those will not form good blastocysts.  Blastocyst transfer avoids the transfer of embryos that can’t reach the blastocyst stage.  Less guessing.
• Removing the “guesswork” means the transferred embryos are more likely to implant.
• Higher implantation rates mean higher pregnancy rates.
• Higher implantation rates also mean we don’t need to transfer as many embryos to get a high chance of success.  In this way, we can reduce the risk of too many embryos implanting. 

Embryo Cryopreservation (Freezing) and Frozen Embryo Transfer (FET)
Embryo cryopreservation involves the freezing of embryos for later use.  This is most often done with excess embryos remaining after the transfer of fresh embryos.  If the fresh transfer fails, or if it succeeded and the patient wishes to return to try to have more children, then the frozen embryos may be thawed and transferred.

In many cases, all of a patient’s embryos may be frozen.  It has been shown that many patients can have improved success rates with transfer of frozen-thawed embryos than fresh embryos.

When the patient is ready, their uterus will be prepared with hormones (usually estrogen and progesterone).  At the right time, their embryos will be thawed, examined, and transferred if they appear to have survived adequately.  

Pre-Implantation Genetic Diagnosis (PGD)
PGD is the genetic evaluation of embryos before they are transferred.  It involves removing one or more cells from the embryo and analyzing the chromosomes in that cell (or in those cells). 

• To identify embryos with genetic disorders, particularly in couples with a family history of genetic disease (like cystic fibrosis) or in older couples with elevated risk of Down syndrome, in order to promote the birth of a healthy child.
• In couples with recurrent pregnancy loss (recurrent miscarriage), PGD may be used to promote the transfer of a viable embryo.

With improving technology, PGD may also be able to improve IVF success rates per transfer by eliminating the transfer of some non-viable embryos.  However, PGD cannot give patients viable embryos.

Egg Freezing and Fertility Preservation
The biological clock ticks away.  The ovaries can decline at any time, even in our 20s, but for the average woman, the decline starts around age 33 to 35.  By their early 40s, most women’s ovaries have declined greatly.

Many professional women pursue career choices rather than family, and find themselves in their 30s without children and without certain knowledge who their future male partner will be.  Egg freezing is an important option for these women to preserve their fertility.

Egg freezing involves stimulating the ovaries to produce many follicles and many eggs, removing these eggs, and freezing them.  Multiple egg retrievals may be employed to get a large set of frozen eggs to increase the chance of later success.  Frozen eggs may be safely stored for many years without any known harm.

The eggs may be thawed, fertilized with sperm from a male partner or donor sperm, and transferred to the uterus when the woman is ready.

Couples who wish to preserve fertility, but are not ready to have children, may choose to freeze eggs or embryos.

Egg freezing or embryo freezing are also used by women before cancer treatments that might harm their ovaries. 

Gestational Carrier (Surrogacy)
Sometimes a woman cannot carry a pregnancy.  In these cases, she may choose to have another woman carry the pregnancy and deliver the baby for her. The gestational carrier, sometimes called a “host uterus” or a “surrogate mother”, must have a good uterus.  Both the parents and the gestational carrier must be screened for infectious diseases, and the carrier is also psychologically screened.

The mother and the gestational carrier undergo a synchronized cycle, exactly like an egg donor IVF cycle, so that the mother’s embryos are ready to transfer when the carrier’s uterus is ready to receive them.

Egg Donor IVF (Oocyte Donation, Ovum Donation, Donor Egg)
Some women cannot produce good eggs, or cannot produce enough good eggs to have a good chance of success with IVF with their own eggs.  One excellent option for these women is to use eggs from an egg donor (oocyte donor).

Oocyte donors are young women who choose to provide their eggs so that other women can have children.  In some cases, the egg donor is a family member of the patient, but more often the donor is anonymous.  All donors are screened for infectious diseases to reduce the risk that their eggs could transmit a disease to the patient.

The Fertility Center of Las Vegas maintains a ready set of anonymous donors so that there is usually no waiting to get a good donor.

In an egg donor cycle, the donor is stimulated so that they will produce many follicles and many eggs.  The eggs are collected and fertilized, and the best embryos are transferred to the patient.  The two cycles are synchronized so that the embryos are ready for transfer when the patient’s uterus is ready to receive them.  Any viable remaining embryos may be frozen for future use.

The success rates with egg donor cycles are excellent.  Live birth rates at The Fertility Center of Las Vegas have been near 80% per transfer in recent years.

Donor Egg Bank
The Fertility Center of Las Vegas has a small number of sets of frozen eggs from previous egg donor cycles.  These are frozen eggs from the cohorts of egg donors who produced far more eggs than the original couple could reasonably use, so the extra eggs were frozen.  The choice is limited. 

If you choose to use eggs from our donor egg bank, the eggs would be thawed and fertilized with your partner’s sperm or sperm from a sperm donor.  The best resulting embryo(s) would be transferred to your uterus, and any remaining viable embryos could be frozen for your later use. 

Embryo Donation (Donor Embryo)
Many couples have a baby with their first transfer and do not return to use their frozen embryos.  These couples might choose to donate their embryos for use by other couples. 

This option is less much less expensive than an egg donor cycle, yet can still have a good chance of success.

The use of donor embryos is relatively simple.  The patient’s uterus is prepared with hormones and the embryo(s) are thawed and the proper time, assessed, and transferred to the uterus if they have adequately survived thaw.