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IVF Program Description
Infertility Solutions, P.C. has been doing in vitro fertilization for since 1994.
We feel that our program offers patients some advantages over many programs in the United States.
- Some of these advantages are derived from the fact that we are a small program and have a close integration between the laboratory and medical aspects of this procedure.
- In many programs, physicians are not involved in evaluating laboratory issues.
- Dr. Rose has extensive interest and experience in the laboratory aspects of IVF.
Small and comfortable
We are not a large volume practice. As such, there are relatively few different people that patients will be working with and fewer different people will be working with their laboratory specimens. This provides a setting that is much more comfortable than a large program where patients may, at times, feel like a number. Our laboratory is located in our main office in Allentown. We do not contract out our embryology to another location, nor do we allow outside doctors to use our facility. This enhances our control over the quality of the laboratory. We also think that because of our size we can individualize our treatments to a much greater extent than a larger program.
Because we are a small program, there is potential for our results to vary more from year to year based on factors in the particular patients who we are taking care of. The most uniform subgroup of patients to look at are those under age 35. For women under age 35, our ongoing or delivered pregnancy rate per embryo transfer has been about 35%. We are confident that we can maintain this level of success and this confidence is the basis for our risk sharing IVF refund program. In this program, which is basically an insurance program for patients, we would lose money if we can not achieve this level of success with IVF. Our current results are posted on-line to enable potential patients to assess our current effectiveness with this complex procedure.
Advanced techniques
Intracytoplasmic sperm injection or ICSI is a process by which a single sperm is injected into an egg in order to cause fertilization. This procedure was primarily developed for those couples that had infertility on a male factor basis. It also also used in the many settings in which we are concerned that there might be an egg problem. With this procedure virtually any male factor problem can be overcome. It is a very dependable method for forcing fertilization to occur. We have been doing ICSI since 1996. All procedures are performed by Donna Lakey, our embryologist, who has extensive experience with this delicate procedure.
Today we can even treat some men who have no sperm by utilizing a testicular biopsy specimen (TESE). This harvesting procedure is also done in our office. We most commonly use this technique to help couples achieve pregnancy when the husband has had a prior vasectomy.
Recent innovations
The latest innovation in IVF is PGD, which involves having DNA studies done on cells biopsied from the early embryo. This is available to our patients though one of the most established DNA laboratories in the country. We utilize an experienced outside embryologist for this procedure. PGD is useful in helping to decide which embryos to transfer in a patient who produces many normal appearing embryos, but has not gotten pregnant in several cycles. It has been shown to improve the delivery rate in patients with otherwise unexplained recurrent pregnancy loss. It can be used for sex selection (choosing a boy or girl) embryo. It can be used for embryo selection in patients with certain genetically inherited diseases.
A recent advance in laboratory procedures includes culturing embryos in reduced oxygen environments. Culturing embryos in a reduced oxygen environment increases the number of cells in a blastocyst's inner cell mass. Since each cell in the inner cell mass has the theoretical potential of becoming a baby, having more cells with this potential should enhance the pregnancy rate.
We have recently moved from programed slow freezing of blastocysts to vitrification of blastocysts. Vitrification is a process of more rapid freezing in an attempt to avoid damage of cells due to ice formation and long exposure to cryoprotectants. It is the preferred approach for freezing unfertilized eggs which contain a delicate chromosome spindle array. Embryos can tolerate repeated cycles of vitrification and defrost much better than repeated cycles of standard slow cryopreservation and defrost. Once embryos are frozen, they are stored in liquid nitrogen which is at a temperature below that required for chemical reactions. Once frozen, embryos essentially do not age.
Our professional society, SART, has issued a statement saying that egg (as opposed to embryo) freezing is an experimental procedure and should not be performed outside of research protocols. In part, this is because only a limited number of babies have been born after egg freezing and the safety of the procedure is difficult to assess. We are prepared to undertake egg freezing (vitrification) one it had been more adequately evaluated.
We believe that we remain on the forefront of what is being done in IVF from a science viewpoint.
Our IVF Laboratory
Laboratory quality plays a major role in distinguishing IVF programs from one another. Our laboratory integrates a PhD-MD with experienced embryologists. Our embryologists are hands-on experts rather than supervisors of technicians.
Human embryos are sensitive to contaminants at the molecular level. Appropriate screening and quality control of air, media and any equipment that comes in contact with the embryos need to be constantly undertaken. For example, we are especially concerned about molecular contamination of our air and the laboratory utilizes redundant systems to provide a clean air environment for our patient's embryos. The laboratory utilizes multiple different filters to optimize air quality.
We probably have one of the highest incubator to patient ratios in the country. We do this to maximize our control of our embryo's environment. We have both reduced oxygen controlled and regular incubators. We compulsively and redundantly assess laboratory temperatures and media pH. We do not contract out to have our embryology done in other locations and we do not have doctors for other practices use our laboratory. All IVF laboratory procedures are done in Allentown. We strongly feel that our ability to improve and control the laboratory environment is important for achieving superlative results.
Donna Laky is our primary embryologist and the supervisor of all our associated labs. She has been working in reproductive technology labs since 1994. Her experience encompasses both small and large laboratory settings. She is experienced in embryo micromanipulation, including ICSI, assisted hatching and embryo biopsy.
In order to optimize laboratory results and try to benefit from the advantages of both small and large laboratory experience, we frequently also utilize other embryologists in our lab who are primarily based at other programs. We do this to keep our approach to IVF "fresh" and to benefit from the experience gained by seeing large number of patients. Some of the embryologists used in this way include: Lynette Scott, PhD, Joe Sokoloski, Ric Ross, and Gail Overby.
In addition, Joe has been involved in a long term consultant role. Joe acts as a senior associated embryologist. Joe participates in many of our retrieval weeks. Joe enables us to build on our strengths as a small IVF program, providing individualized treatment in a more personal environment, while giving us some of the strengths of a much larger program (such as a greater wealth of experience and contacts with individuals in touch with the pulse of this specialty). Joe set up his first IVF program in 1983. He has participated in thousands of embryology cases and has helped start many IVF programs. He has worked with many of the early leaders of American IVF such as Martin Quigley and Don Wolf. He has written many papers, abstracts, book chapters, and video presentations.
Our laboratory has been licensed by annual inspection performed by the state of Pennsylvania under CLIA regulations since its inception. JACCO, known to many for its hospital accreditation program, working with the Society of Advanced Reproductive Technology (SART), has developed an accreditation inspection specifically for IVF labs. Our lab has also been accredited by this on-site inspection process.
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