Leading Fertility Care in NYC

Learn about the health of your reproductive system by scheduling a comprehensive fertility screening. This screening will include bloodwork to assess your Anti-Mullerian Hormone (undefinedAMHundefined) and Follicle-Stimulating Hormone (undefinedFSHundefined) levels, both of which are good indicators of your ovarian reserve. It will also include an ultrasound to evaluate your Antral Follicle Count (the number of follicles contained within your ovaries helps your physician to determine how many eggs may be produced in any given month) and a Semen Analysis (if appropriate).

NYU Langone Fertility Center provides state of the art fertility treatment and care in a compassionate, patient-focused environment. Depending upon the results of your fertility health screening, you may discuss many different options with your physician: clomid, IUI, IVF, PGT, the list goes on! Your physician will work with you to design a fertility plan that meets your needs.

Intrauterine insemination (IUI) is a relatively simple procedure that enables conception by directing sperm to the right place at the right time. In this process, a thin tube called a catheter is placed directly into the cervix, and a carefully prepared sperm sample is injected directly through the catheter into the uterus.

IUI increases the chances of becoming pregnant by injecting an optimal sperm sample directly into the uterus at a time when the woman is most fertile. Studies have shown that pregnancy is more likely to occur if timing of exposure to sperm is controlled in this way, and if sperm is placed in higher numbers closer to the egg or eggs.

When is IUI recommended? IUI is often recommended for women or couples who:

-Have been unsuccessful with other infertility treatments, such as medications

-Are unable to have appropriately timed intercourse due to travel distances, or in cases of sexual dysfunction

-Have unexplained infertility or mild male factor infertility

-Are women using donor sperm

In the course of a natural menstrual cycle, the brain produces hormones that stimulate one of the ovaries to release an egg. During an ovulation induction cycle, you are prescribed those same hormones, known as fertility medications, to stimulate the ovaries to mature numerous eggs at once. If more eggs are matured, more can be retrieved and used to create embryos. Most often, this improves the chances of fertilization, and ultimately pregnancy.

Around a month after the initial consultation , or when your targeted cycle starts, egg production will be stimulated with fertility medications. Frequent lab work and ultrasounds are done to monitor egg growth over the next 10undefined12 days. Then a final injection will be given to mature the eggs and prepare them for retrieval. Between 34-36 hours after the injection, the eggs will be retrieved under anesthesia. After the eggs are retrieved, they are evaluated; about three-quarters are generally considered mature enough for fertilization.

Approximately 18 hours after the egg and sperm were combined in the incubator, the embryology team evaluates the successful fertilization of each mature egg. If fertilization has indeed occurred, the embryology team monitors embryo development for an additional 2-4 days to assess embryo morphology (the shape and appearance of cells within the embryo).

There are two types of embryo transfer: fresh or frozen. In a fresh embryo transfer cycle, an embryo is transferred to the uterus after 3-5 days of observation in the embryology laboratory, and any additional embryos are frozen for future use. In a frozen embryo transfer (FET) cycle, all embryos are frozen after 3-5 days of development in the laboratory. If you wish to perform preimplantation genetic testing (PGT) , embryos will be biopsied, then frozen while a culture of cells is sent to the genetic testing lab for analysis. Whether you proceed with a fresh embryo transfer or an FET, the embryo transfer process itself is very simple, and rarely requires sedation or anesthesia.

Egg freezing provides a great option for future family buildingundefinedbut it is truly the first step in a care continuum that may include egg thawing, embryo creation, embryo transfer, and attempted pregnancy. At NYULFC, our outcomesundefinedfrom thousands of eggs safely frozen to hundreds of healthy babies born years laterundefinedspeak to our expertise at each step.

At NYU Langone Fertility Center, your care team will include your physician, our Donor Egg undefined Third Party Reproduction specialists, an onsite psychologist, and nurses, coordinators, medical and administrative assistants, all of whom are here to help you navigate every step of your journey to parenthood using donor eggs and/or sperm.

• Dr. Elizabeth Fino is the Director of the Donor Egg/Third Party Reproduction at NYU Langone Fertility Center.
• Our dedicated team of Donor Egg support specialists includes:
  • Andria Besser, Genetic Counselor
  • Aleksandra Kostyra, RN, Donor Egg Program
  • Dr. Shelley S. Lee, PhD, Psychologist
  • Caroline McCaffrey, Lab Director
  • Nancy McGeoff, RN, Donor Egg Program
  • Jean Ann McKiernan, RN, Donor Egg Program
  • Dr. Mindy R. Schiffman, PhD, Psychologist
  • Alyssa Vargas, Donor Coordinator
  • Sylvia Wadowiec, Medical Secretary, Donor Gamete undefined Genetics

If you are unable to carry a pregnancy for any reason, the NYU Langone Fertility Center can work with you to identify a gestational surrogate to carry your baby.

A gestational surrogate is a woman who agrees to become pregnant by receiving an embryo transfer from an individual or couple who created an embryo using their own gametes (undefinedautologous IVFundefined), donor eggs, donor sperm, or some combination of autologous and donor tissue.

Prior to any embryo transfer into a gestational surrogate, the U.S. Food and Drug Administration (FDA) mandates extensive screening for both the sperm and egg source, involving a questionnaire, physical exam, and blood tests. The gestational surrogate must also pass a physical and psychological examination.

To learn more about coordinating a gestational surrogacy cycle, please contact our Third Party Coordinator, Alyssa Vargas, via phone via phone at 212-263-0011 or via email at [email protected].

Preimplantation genetic testing for aneuploidy (PGT-A) allows us to count the number of chromosomes in an embryo biopsy. A euploid or undefinednormalundefined embryo contains 23 pairs of chromosomes, though abnormalities in chromosome number (i.e. too many or too few, or structural defects) are common and their incidence increases as women age. In some cases, these abnormalities can lead to miscarriage and other health concerns. PGT-A testing reduces the risk of miscarriage by reducing the chance of transferring a genetically abnormal embryo.

For patients with specific inherited genetic or chromosomal conditions that may impact a pregnancy, preimplantation genetic testing for monogenetic disorders (PGT-M) or structural rearrangements (PGT-SR) may be considered. These tests use customized approaches, tailored to identify specific genetic variants (mutations) or chromosomal imbalances ahead of implantation, ultimately increasing the chance of a successful pregnancy.

In most cases at NYU Langone Fertility Center, sperm are combined with the eggs and fertilization occurs naturally. In situations where low sperm count or low sperm motility (movement) is a factor, a single sperm is injected directly into each mature egg in a process called intracytoplasmic sperm injection (ICSI).

In standard (non-ICSI) IVF, about 50,000 sperm are added to each egg in a petri dish, allowing the sperm to penetrate the eggs undefinednaturally.undefined In cases where the sperm are unable to fertilize the egg on their own, the embryologist can employ ICSI to inject the sperm directly into the egg. If a sperm sample is considered undefinedborderline,undefined some eggs may be injected while others are given the chance to fertilize naturally in the petri dish.

In cases that require ICSI, the male partner provides a sperm sample (this usually occurs on the same day as the egg retrieval procedure; however samples can be collected in advance and stored frozen until needed). An embryologist analyzes the sample and isolates the strongest and best swimming (motile) sperm to be used for insemination. To perform ICSI, each egg is held by gentle suction in a glass pipette, and a single sperm is injected through the zona (shell) of the egg using a tiny, glass microneedle. The sperm is deposited deep into the innermost part of the egg (cytoplasm) and the needle is withdrawn.

Sperm freezing preserves sperm now for use later, giving patients the opportunity to build a family when the time is right.

Through a process called cryopreservation, you can preserve your sperm until needed for assisted reproductive procedures such as IVF (in vitro fertilization), IUI (intrauterine insemination), or sperm donation.

If you are considering undergoing a medical procedure that may put your reproductive health at risk, it may be a good idea to consider preserving your sperm. Some common interventions that may put you at risk include chemotherapy, pharmaceuticals, and vasectomies. Sperm banking may also be a good idea if you are in a profession that puts your fertility at risk.

The cryopreservation of eggs or embryos begins with undefinedvitrificationundefined or undefinedfreezing.undefined Vitrification is an ultra-rapid freezing process performed in our embryology laboratory, wherein the eggs/embryos are rapidly cooled to subzero temperatures. This rapid cooling process prevents the formation of ice crystals, which can cause cell damage.

The process of vitrification has three critical components. First, eggs/embryos are exposed to high concentrations of cryoprotectants to allow rapid dehydration of cells. Second, the eggs/embryos are loaded into tiny storage devices (usually straws) that will facilitate ultra-rapid cooling. Third, the straws containing the eggs/embryos are cooled as fast as possible, typically at thousands of degrees per minute.

In practice, this means that eggs and embryos are vitrified very quickly in the laboratory. A typical embryo vitrification protocol is complete in about 10 minutes. Embryos are removed from the incubator in the laboratory and exposed to an equilibration solution for 8 minutes to begin the dehydration process. After 8 minutes in equilibration solution, the embryos are moved into a vitrification solution for 60 seconds. Then, they are quickly loaded into straws and plunged into liquid nitrogen at a temperature of -196undefinedC. The tiny straw will cool from room temperature (about 25undefinedC) to -196undefinedC in two to three seconds, giving a cooling rate of 4420-6630undefinedC per minute.

This high cooling rate combined with the use of high concentrations of cryoprotectants allows the contents of the straw (embryos plus surrounding fluid) to turn to a glass like substance instead of ice. Avoiding ice formation in this way successfully protects the embryos from damage and allows them to be warmed later giving survival rates consistently above 90%.

For egg vitrification, the process is similar, but the exposure to the equilibration solution is slower, usually about 15 minutes, and it is broken up into 4 steps. This stepwise approach is designed specifically for the egg and achieves the same level of dehydration as can be obtained with embryos in a shorter time. These steps, however, are critical to the survival of the eggs and must be followed exactly. Moving the eggs into vitrification solution, loading and cooling the straws is the same as is done for embryos.

This high cooling rate, combined with the use of cryoprotectants, allows the contents of the straw (embryos plus surrounding fluid) to turn into a glass-like substance instead of ice. Avoiding ice formation in this way successfully protects the embryos from damage and allows them to be warmed later, delivering embryo survival rates consistently above 90%.

When our patients return to use their vitrified embryos, the vitrification procedure described above is reversed to allow warming back to room temperature for rehydration. The procedure undefinedwarmsundefined the tissue in just 20 minutes, and it is placed back in the incubator at 37undefinedC in the laboratory. Embryos can be transferred back to the uterus immediately and eggs can be fertilized with sperm 3-4 hours later.

Following ovarian stimulation and in vitro fertilization (IVF) patients have two options: a fresh embryo transfer, which takes place after 5 days of embryo development, or a frozen embryo transfer (FET), which takes place at the patientundefineds convenience during the appropriate time in the patientundefineds menstrual cycle. Frozen Embryo Transfer (FET) is a relatively simple procedure in which a previously frozen embryo is thawed and inserted into a uterus using a catheter. In most cases, medication will be prescribed for 2-3 weeks prior to transfer and may be continued for several weeks post-transfer. Patients who choose to perform preimplantation genetic testing (PGT) will be candidates for frozen embryo transfer.