NICS

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NICS Q&A

by Sam Najmabadi, MD

Noninvasive chromosome screening (NICS) is a method based on sequencing the genomic DNA secreted into the culture medium from the human blastocyst. We are using this new method as it is highly accurate and far less invasive than Preimplantation genetic screening (PGS).

PGS has been widely used to select in vitro-fertilized embryos free of chromosomal abnormalities and to improve the clinical outcome of in vitro fertilization (IVF). The main disadvantage of PGS is that it requires a biopsy of the preimplantation human embryo, which can limit the clinical applicability of PGS due to the invasiveness and complexity of the process.

Patients that are interested in NICS will first come in for a consultation with Dr. José Luis Rivas. Once the patient has started IVF, the ICSI technique is used to fertilize an egg with sperm. We will grow the embryo to blastocyst, then once it reaches the blastocyst stage we collect the liquid from the dish the embryo has been cultured in and we test the liquid. Chromosome screening can be done with this liquid instead of biopsying the embryo. Previously biopsying an embryo was the only option, but this requires cutting cells out of the embryo and potentially decreasing the embryo quality. This invasive approach can have negative influences on development of the embryo.

Previously biopsying an embryo was the only option. But when you biopsy an embryo you have to cut cells out of the embryo and potentially decrease the embryo quality, once the quality of an embryo has been decreased it can have negative influences on development of the embryo and possibly in the womb.

Please give our offices a call today if you would like to set up a consultation for this procedure or have any additional questions.

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LGBT

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LGBT Services

LGBT COMMUNITY

Its our goal to help our LGTB community have equal opportunity in their reproductive choices. We have state-of-the-art reproductive technology within a fully equipped office, laboratory and surgery center. We offer donor insemination, egg donation, gestational carrier and surrogate arrangements with vetted providers tailored to your needs.

Your fertility journey with Punta Mita Hospital Fertility Center will begin with an initial consultation with Dr. José Luis Rivas to discuss medical history, testing, potential treatment, and financial options. The next step is diagnostic testing here in our Center to discover the level of fertility in either partner. Once testing is complete, you and Dr. Rivas  will discuss a fertility plan that is right for you.

Let our Fertility Center help you start your fertility journey with personalized care & support. Call us today to set up your consultation!

Parenting for same sex female couples:

When same-sex female couples begin their fertility journey, one of the first decisions you must make is who will carry the pregnancy. The partner carrying the pregnancy will proceed with an infertility work-up. If all tests come back normal, you will then select a sperm donor or use sperm from someone known to you that you may use to achieve the pregnancy. If you select an unknown donor, the cryobank sends the frozen sperm sample directly to the Fertility Center, where our andrologists will thaw and analyze it in our andrology lab. The next step you will undergo an intrauterine insemination or in vitro fertilization cycle.

Another LGBT family building option for lesbian couples is choosing to have one partner provide the egg and the other partner will carry the pregnancy. This is a more complex treatment protocol where we will test both partners and both will take medication to boost their fertility.

This is an excellent way for both you and your partner to feel connected to the pregnancy and the child.

Common FAQ

  1. What is the simplest way to conceive for lesbian couples? The simplest way to conception is to use a donor of your choice or from a high quality sperm bank that we have pre-reviewed, and time insemination through monitoring of a natural cycle, which we will do for you here at Punta Mita Hospital Fertility Center.
  2. What is the fastest and the least expensive way to conceive for lesbian couples?

Utilization of Intra Uterine Insemination (IUI) with donor sperm under the guidance of Dr. Rivas, preferably with Clomid enhancement of ovulation. Although seemingly more intense, careful monitoring and good timing will increase the success from single digits (4-9% in large studies of natural cycles) to 15-25% with Clomid combined with two donor sperm inseminations in an ovulation induction cycle. The chance of twins with Clomid is about 7-10% compared to 1.2% in a natural cycle.

3. Can we use fresh sperm of a friend or relative, instead of frozen sperm, which is less fertile?

Yes, the donor has to go through a full STD test prior to fertilization. Federal regulations strictly forbid the use of fresh sperm for insemination, because of the risk of transmitting infectious diseases through the sperm. All sperm used for insemination, with the exception of intimate partners, has to be frozen and quarantined for at least six months. The ‘donor’ has to go through STD testing, both before freezing and before thawing the sperm, and must be negative for HIV I and II, syphilis, gonorrhea, Chlamydia, CMV, Hepatitis B and C as well as HTLV on both occasions.

Parenting for same sex male couples:

If you are a same-sex male couple planning to build a family through fertility treatments, you will meet with Dr. José Luis Rivas to discuss the details of using an egg donor and gestational carrier. The partner wishing to use his sperm will undergo a semen analysis to test motility (movement), volume, concentration, and morphology (shape) of the sperm.

Punta Mita Hospital Fertility Center does not recruit gestational carriers/surrogate, but we will refer you to reputable agencies and attorneys who specialize in identifying gestational carriers. Once you have identified a gestational carrier/surrogate and she has undergone medical and psychological screening and legal contracts are in place, you may then select an egg donor. After the donor has gone through the egg retrieval process, you and/or your partner will provide frozen sperm samples that our in house embryologist will use in the insemination of the donated eggs. With close observation once the eggs are developed, Dr. Rivas will transfer the embryo to the gestational carrier/surrogate.

Common FAQ

  1. My partner and I are in a stable relationship and both of us would like to have children and if possible to continue our genetic lineage. What are our options?

There are several scenarios, which maximize the preservation of your and your partner’s genetic contribution to offspring. The option is to use an egg donor and inseminate the eggs during in vitro fertilization (IVF) with each of your sperm. For example, if there are 8 mature eggs, 4 could be inseminated by your and 4 by your partner’s sperm. In turn, embryos created by either your or your partner’s sperm would be implanted in the uterus of a gestational carrier.

Alternately your sister or a relative could donate the eggs or be your surrogate, which would be inseminated by your partner’s sperm or vice versa, circumstances permitting.

        2. What effect does the gestational carrier/surrogate have on the genetic composition of a baby?

If the embryos implanted in the gestational carrier/surrogate originate from an egg donor and the sperm of one of the intended parents, the gestational carrier/surrogate has zero contribution to the genetic make up of the baby. Thus, she is solely providing a nourishing environment for the baby.

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Fertility Preservation

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Egg & Embryo Freezing Q & A

by Sam Najmabadi, MD

What is Cryopreservation?

Cryopreservation is a technologically advanced method to preserve and save harvested eggs or embryos for future use. This process is often used in conjunction with IVF or if a woman wants to preserve her eggs to improve her chances of having children later in life. IVF can result in more viable embryos than can be injected at one time. When this happens the remaining embryos are frozen and stored for future use. The aim of this procedure and service is to store the embryo cryogenically and to maintain its viability for the future. For example, some IVF children could have younger siblings which were technically conceived at exactly the same time, but not implanted until years later due to the increased success of embryo cryopreservation.

What happens during the procedure?

When a large number of eggs are harvested the patient can either have the eggs frozen, or fertilized. If she chooses fertilization, some of the embryos will be implanted to her uterus as part of the IVF procedure. Any additional embryos are preserved for future attempts to have children. One of the processes available to freeze the embryos is called vitrification, which is essentially flash freezing the embryos in a matter of seconds. This technique can increase the chances of implantation in the future by eliminating opportunities for damage to occur to the embryo.

What kinds of technologies are available for freezing eggs or embryos?

There are now two types of freezing technologies that are used in IVF laboratories. The difference is the speed at which the embryos are frozen. The older technology is called slow freezing and the second, newer technology is called vitrification.

When the slow freezing method is used to preserve eggs and embryos, the freezing requires the removal of water from the individual cells of the embryo. If water remains, it forms crystals which can disrupt the inside of the cells or cut through the outer layer of the cells. A cryoprotectant is added to the cells which replaces most of the water inside the embryo. Under the correct conditions, the cryoprotectant does not form crystals and the embryo can safely withstand cryogenic storage.

Vitrification flash freezes the embryos or eggs. The embryos are submerged into liquid nitrogen at roughly minus 200 degrees. This process does not allow time for crystals to form and assume a glass-like state. Embryo survival after vitrification has significantly improved to 98% from approximately 70% after slow freezing.<

How successful is this procedure?

The success rates for an egg or embryo surviving the freezing and thawing process are higher using the newer vitrification technology and are closer to the success rates of using fresh embryos for implementation. The embryology team at the Center for Reproductive Health and Gynecology has extensive experience with the technique of fertilizing previously vitrified eggs. They have achieved egg survival rates of approximately 80%, fertilization rates of over 80%, and pregnancy rates above 50%.

Egg freezing financing available

At Citerra Finance, we can offer tailored medical loans.

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In Vitro Fertilization

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In vitro fertilization

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In Vitro Fertilization Q & A

by Sam Najmabadi, MD

What is in vitro fertilization?

In vitro fertilization, or more commonly known as IVF, is a technologically advanced procedure used to help infertile couples conceive a child. The procedure takes place outside of the womb and is usually implemented when other treatments have not been successful. There are five steps involved in IVF. First, the female patient takes injections to stimulate the ovary to produce multiple mature eggs at the same time. Second, the eggs are harvested and either mixed with sperm in a petri dish, or in some cases, a single sperm is injected into the egg to achieve fertilization.  Then, once fertilization takes place and the embryos are formed, they are transferred to the woman’s uterus via a catheter. If there are additional embryos, they are usually frozen for future use if the treatment is not successful or if additional children are planned.

What actually happens during hyperstimulation of the ovaries?

The patient will take injectable FSH (follicle stimulating hormone) for eight to eleven days, depending on how long the follicles take to mature. This hormone is produced naturally in a woman’s body causing one egg to develop per cycle. Taking the injectable FSH causes several follicles to develop at once, at approximately the same rate. The development is monitored with vaginal ultrasounds and following the patient’s levels of estradiol and progesterone. FSH brand names include Repronex, Follistim, Menopur, Gonal-F and Bravelle. The patient injects herself daily.

What happens during egg retrieval?

When the follicles have developed enough to be harvested, the patient attends an appointment  where she is anesthetized and prepared for the procedure. Next, the doctor uses an ultrasound probe to guide a needle through the vaginal wall and into the follicle of the ovary. The thin needle draws the follicle fluid, which is then examined by an embryologist to find the eggs. The whole process takes about 20 minutes.

What happens to the eggs?

In the next step, the harvested eggs are then fertilized. If the sperm from the potential father, or in some cases, anonymous donor, has normal functionality, the eggs and sperm are placed together in a dish with a nutrient fluid, then incubated overnight to fertilize normally. If the sperm functionality is suboptimal, an embryologist uses Intracytoplasmic Sperm Injection to inject a single sperm into a single egg with an extremely precise glass needle.  Once fertilization is complete, the embryos are assessed and prepared to be transferred to the patient’s uterus.

How are the embryos transferred back to the uterus?

The doctor and the patient will discuss the number of embryos to be transferred. The number of successfully fertilized eggs usually determines the number of eggs to be placed in the uterus.  Embryos are transferred to the uterus with transabdominal ultrasound guidance. This process does not require anesthesia, but it can cause minor cervical or uterine discomfort. Following transfer, the patient is advised to take at least one days bed rest and two or three additional days of rest, then 10 to 12 days later, two pregnancy tests are scheduled to confirm success. Once two positive tests are completed, an obstetrical ultrasound is ordered to show the sac, fetal pole, yolk sac and fetal heart rate.

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