With the use of advanced technology and specialized equipment, we are able to perform micromanipulation techniques on embryos created through in vitro fertilization (IVF). Sometimes called “cell surgery,” micromanipulation involves the use of special instruments and magnification in order to perform procedures on individual cells. This technology allows us to offer advanced IVF treatment techniques at our Chicago-area practice, such as genetic testing with PGD / PGS, ICSI (intracytoplasmic sperm injection), and assisted hatching. These procedures can be instrumental in overcoming many types of infertility or preventing the transfer of a genetic disorder.
Although in vitro fertilization is a very successful treatment method in the majority of cases, some couples who suffer from moderate to severe male factor infertility may not be able to achieve successful fertilization through standard IVF techniques. In these cases, intracytoplasmic sperm injection, or ICSI, can be an effective way to overcome obstacles to conception. By injecting a single sperm directly into an individual egg, we can bypass a number of fertility problems that impede fertilization. ICSI is also an option for couples who have unexplained infertility and have not been able to achieve fertilization through standard IVF. Many IVF labs routinely do ICSI for all couples to improve fertilization.
The ICSI process begins in the same way as an ordinary IVF treatment, with ovarian stimulation and an egg retrieval procedure. Once the eggs are collected, they are treated with an enzyme solution that gently breaks up the covering of cells around each egg. The mature eggs are selected and each is carefully injected with an isolated healthy sperm cell. The fertilized eggs are monitored until normal embryonic development is confirmed and then they are transferred into the uterus.
The rates of successful embryonic development, implantation, and pregnancy after ICSI are similar to those associated with standard in vitro fertilization. Embryonic and fetal development after ICSI occurs in exactly the same way as it does after IVF or natural conception.
Genetic abnormalities, whether the result of an inherited condition or DNA damage in the egg or sperm, can prevent couples from being able to have and raise a healthy child. Fortunately, a genetic testing procedure known as preimplantation genetic diagnosis / screening (PGD / PGS) offers such couples a chance to become biological parents with minimal risk of passing on a serious genetic disorder.
Like ICSI, PGD requires just one extra step in the IVF treatment process. Once the eggs have been fertilized and embryonic development begins, an embryo biopsy is performed. We remove one to two cells from each embryo on day three of development, perform the biopsy in our laboratory, and then send the biopsy to our reference genetics laboratory where genetic specialists can determine which embryos carry a genetic anomaly and which are normal. Only the normal, healthy embryos are transferred to the uterus or cryopreserved for later use.
PGD is not a general screening procedure. It is recommended for couples who know they have the potential to pass on a serious genetic condition like Tay-Sachs or sickle cell anemia. PGS is a screening procedure for those couples with advanced age, and those who have failed two of more IVF cycles or who have suffered multiple miscarriages. Aneuploidy (abnormal chromosome numbers) such as Downs Syndrome (Trisomy 21) is the most common reason for couples of advanced age to have PGS performed. Genetic testing also makes gender selection possible for couples carrying X-linked recessive genes or those simply interested in "family balancing."
PGD / PGS is a well-established genetic testing procedure that dramatically reduces the risks of having a child with a known hereditary disorder, as well as reducing certain birth defects (Downs Syndrome) and miscarriages by not transferring genetically abnormal embryos. However, further testing once the pregnancy has been established is recommended, just to be sure. A chorionic villi sampling (CVS), performed at about 9 to 12 weeks, or an amniocentesis, performed after at least week 14, can confirm that no genetic abnormalities are present.
Two newer technologies, called MicroArray and Comparative Genomic Hybridization (CGH)
allow for the assessment of all 23 chromosome pairs instead of the 9 or 10 chromosomes
currently tested.
At Fertility Centers of Illinois (FCI), we use two excellent genetics labs for our PGS/PGD testing. For more information, you can go to our FCI website (www.fcionline.com) or to the websites of our genetics labs:
For more information, Read Dr. Jacobs' article about PGD / PGS (PDF).
Preimplantation genetic screening / diagnosis (PGS / PGD) consists of the biopsy and genetic diagnosis of a single cell per embryo, followed by the replacement to the patient or freezing of only those embryos classified by genetic diagnosis as normal. Since the early 1990s, the standard preimplantation genetics testing methods, using PGS / PGD techniques, have only allowed for the evaluation of 9 to 12 chromosomes out of a total of 23 chromosome pairs in the human embryo cell. However, Comparative Genomic Hybridization (CGH) solves this problem by evaluating all 23 chromosome pairs, allowing completely screened normal embryos to be identified and transferred or frozen. The field of preimplantation genetics has been recently revitalized with the appearance of this new CGH technology.
The future of preimplantation genetic testing is now available at both our Fertility Centers of Illinois (FCI) Chicago-area IVF clinics: FCI Highland Park IVF and FCI River North IVF! Due to our long-standing relationship with ReproGenetics (reprogenetics.com ) and our excellent day five blastocyst culture methods, and embryo freezing (vitrification) techniques, FCI is one of only a handful of IVF programs world-wide able to offer this major breakthrough.
For more information, read Dr. Jacob’s article about Comparative Genomic Hybridization (CGH) (PDF).
For several days following conception, the early embryo is enclosed in a protein shell known as the zona pellucida. As the embryo grows, the zona pellucida becomes thinner and thinner until the embryo “hatches” or escapes from this shell and then becomes implanted in the uterine lining, or endometrium. If the embryo is unable, for whatever reason, to escape the zona pellucida, it will not implant and pregnancy will not occur.
With IVF treatment, it is possible to make a tiny opening in the zona pellucida that can assist the embryo in escaping, before transferring the embryo into the uterus. There is currently no documented evidence to prove how effective this procedure is at increasing the chances of implantation. However, we know that it is in no way harmful to the developing embryo, and it seems to be most helpful to women who are in their later reproductive years and who have diminished ovarian reserve, unexplained infertility, or have had unsuccessful IVF treatment cycles.
It has been known for many years that the gender of a child is determined by the sex chromosome carried by the sperm. Sperm bearing an "X" chromosome (men have both "X" and "Y" bearing sperm), when united with the "X" chromosome from the female’s egg (females only produce "X") will result in an "XX" pregnancy that produces a female. If a sperm bearing a "Y" chromosome unites with the "X" chromosome from the female, an "XY" pregnancy will give rise to a male. Therefore, with a natural pregnancy or with assisted reproductive technologies, such as IUI or IVF, each pregnancy has a 50% (or one in two) chance to be male and a 50% chance to be female. Gender selection/sex selection may be used when parents need or want a child of a specific sex. Gender selection can also help prevent the transmission of certain genetic diseases. Genetic diseases carried on the X or Y chromosome are termed “sex linked” genetic diseases. Most commonly, gender selection is performed in instances where serious sex-linked diseases, such as hemophilia or muscular dystrophy are a concern; or when some couples have children of one gender, and choose elective “family balancing” to help them have a child of the other gender.
Successful gender selection “methods,” performed by a reproductive endocrinologist, include various sperm separation techniques and/or IVF with PGD. Unproven therapies such as ‘coital timing,’ varying sexual positions, or vitamin programs do not work and should not be relied on.
Sperm separation techniques in the lab safely separate sperm (various methods) to allow the majority of the sperm capable of producing the desired gender ("X" sperm or "Y" sperm) to be recovered and utilized for IUI or IVF. None of the older traditional sperm separation techniques, such as Erickson, have been able to achieve consistent gender outcome success rates over 60-75%; even the best separation methods of today, such as MicroSort® sorted sperm, combined with IUI or even traditional IVF, are generally under 85% gender success rates.
Therefore, if you want to be sure that your next child will be the gender you need or desire, note that no other gender selection method comes close to the success or reliability of IVF with PGD (greater than 99.9%). Using IVF and preimplantation genetic diagnosis (PGD) for gender selection, male and female embryos are identified and only embryos of the desired sex are transferred to the uterus. At our Chicago area IVF clinics, this is the method of sex selection we recommend. Whether doing PGD gender selection for prevention of sex-linked genetic diseases or for ‘family balancing’, the embryos can also be screened by our genetics team for aneuploidy (see above). The aneuploidy (abnormal chromosome count) screening process, employed at the time of PGD gender determination, allows for the detection of various genetic count abnormalities, such as Down's syndrome (one "extra" chromosome 21). PGD for gender selection IVF pregnancy success rates are similar to regular in vitro fertilization success rates and sex selection rates approach 100%.
Contact our offices in and around Chicago to learn more about ICSI, genetic testing with PGD, or assisted hatching. We will be happy to answer any questions you have.
Buffalo Grove
135 N. Arlington Heights Rd., Suite 195
Buffalo Grove, Illinois 60089
Phone: 847.215.8899
Fax: 847.215.8996
Consultation Office Hours:
Monday through Friday 7:00 am to 6:00 pm
Saturday morning - 9:00 am to 12:00 pm
Crystal Lake
5911 Northwest Highway, Suite 105
Crystal Lake, Illinois 60014
Phone: 815.356.7034
Fax: 815.356.7064
Consultation Office Hours:
Monday through Friday 7:00am to 6:00 pm
Wednesday evening hours to 8:00 pm
Sundays 9:00 am to 12:00 pm
Glenview
3703 W. Lake Ave., Suite 106
Glenview, Illinois 60026
Phone: 847.998.8200
Fax: 847.998.6880
Office Hours:
Monday through Friday 7:00 am to 5:00 pm