The Medical Process

Gestational surrogacy always involves the close coordination of a surrogate, the intended mother (or egg donor) and the intended father (or sperm donor). At the center of the medical process is the in vitro fertilization (IVF) laboratory, which brings together the eggs and sperm, fertilizes the eggs, creates embryos, and allows for optimal embryo selection and transfer.

IVF involves a series of complex procedures, including the administration and monitoring of medications which stimulate the ovaries to produce multiple eggs; the retrieval, fertilization and laboratory culture of these eggs; and the growth and eventual transfer of viable human embryos into the uterus. IVF requires a meticulously controlled laboratory environment that allows for maximal interaction between as many eggs and sperm as possible, and fosters the creation of multiple embryos, which can then be graded, optimized, and introduced directly into the uterus of the gestational carrier under highly optimized conditions.

CT Fertility specializes in several laboratory techniques that may increase your chances of success, including:

• Intracytoplasmic Sperm Injection (ICSI)
• Assisted Hatching (AH)
• Blastocyst transfer
• Pre-implantation genetic diagnosis (PGD)
• Embryo cryopreservation

Intracytoplasmic Sperm Injection (ICSI) is a new micromanipulation technique developed to help overcome male infertility. Male infertility can include any of the following problems:

• Low sperm counts
• Poor motility or movement of the sperm
• Poor sperm quality
• Sperm that lack the ability to penetrate an egg

With ICSI, a single sperm is injected directly into the egg. Doing this, bypasses the male infertility problems of poor sperm motility and low count. Additionally, it is also successful with sperm that are considered less than ideal for an IVF process.

Assisted hatching is a procedure that we believe helps the embryo to implant in the uterus. It involves making a small opening in the outer coating of the embryo, called the zona pellucida, which is thought to assist embryos in hatching out of their shell. This hatching process is necessary for implantation and the establishment of pregnancy.

CT Fertility also offers blastocyst transfer, which is a new technique based on the fact that extended embryo development can be used to maximize pregnancy rates while minimizing the risk of a multiple births. Typically, an IVF laboratory grows embryos for about three days. However, with blastocyst transfer, a laboratory would grow embryos for five days. After five days of growth, the cells of the embryo should have divided many times over, and have begun to differentiate by function. The embryos (called blastocysts) that survive to this stage of development are usually strong and healthy. This "extended culture" is made possible by using different cultures, each one designed to meet the requirements specific to each stage of growth. Blastocyst culture and transfer allows clinicians to determine, with greater certainty, which two or three embryos are the best ones to transfer back to the mother, for the most likely potential for implantation. Doing this reduces the occurrence of potentially risky multiple births.

Pre-implantation genetic diagnosis (PGD) is a medical option that has been very effectively used at CT Fertility for over a decade. PGD relies on the use of embryo biopsy to evaluate the chromosomes of the embryos, and screens them for the most common abnormalities associated with infertility and miscarriage. Healthy, chromosomally normal embryos can then be distinguished from nonviable and diseased ones, so that only embryos free from disease can be selected and preferentially transferred back to the patient. The specific gender of each embryo can also be determined for parents who are interested in knowing that or using that information in deciding which embryos to transfer.

Embryo Freezing: In almost all IVF cycles, the number of embryos which are produced is far more than the number which are actually transferred. In these cycles, it may be desirable to cryopreserve (freeze) these "extra" embryos, provided that they are of high enough quality. Such frozen embryos have a very good chance of success in subsequent treatment cycles, and enable many couples to conceive on multiple occasions from one IVF egg retrieval, since frozen embryo cycles do not require the time or expense of additional fertility medications, egg harvestings, or laboratory procedures. At CT Fertility, all embryos that are frozen are done so with the vitrification technique, which results in the survival of over 98% of embryos when they are eventually thawed at a later date. Vitrification is a "quick -freeze" technique that minimizes the formation of ice crystals. This is achieved by using high concentrations of cryoprotectant with rapid freezing to solidify the cell. The frozen embryos are then flash-frozen in a tiny droplet of media on a very thin plastic stick. Not only do the embryos survive in over 98% of thaws, but also implantation rates with fresh embryos (provided that they were of high grade when they were frozen) are essentially the same as with fresh embryos.