Treatment Options

IVF at RAD

What is IVF?

In Vitro Fertilization is a fertility treatment process to bring an egg and sperm together when it’s believed to be that it isn’t happening naturally.  The IVF process involves taking a series of medications to stimulate egg production in the female partner.  This then allows us to remove a sample of eggs from the ovaries.   Once retrieved from the ovaries, the eggs are then fertilized in our IVF lab.  From that point early embryos develop and the healthiest embryos are selected for transfer to the uterus.  This treatment process allows us to detour the fallopian tubes.  IVF also provides an opportunity to performing testing on the embryos to ensure that they have the right number of chromosomes or are free of genetic diseases.

Do I need IVF?

Frequently patients believe that if they are having difficulty getting pregnant naturally, IVF is the only solution to their problem.  However IVF is not always the most efficient or cost effective treatment for achieving a successful pregnancy.  There are many potential barriers to natural conception, in which IVF can be the right answer for attaining a pregnancy.  However there are a variety of other treatment options and procedures to consider before proceeding with IVF.

At RAD, before undergoing IVF treatments we ensure that all other underlying problems are taken care of.  These issues may include endometriosis, and uterine polyps or fibroids that could interfere with an embryo implanting.  Many times patients that repair any underlying causes of infertility can get pregnant naturally after surgery without continuing to IVF.  However for patients who still experience infertility post surgery, IVF is often the best method of treatment.  Patients who have experienced the following also might consider IVF treatments:

• Damaged or diseased fallopian tubes
• Significant male factor infertility
• Severe pelvic adhesions or abnormalities
• Severe endometriosis
• Failure of other treatment options

Why IVF at RAD is unique:

Team Approach:

Each patient’s IVF cycle is discussed in great detail ahead of time with our fertility team to ensure the appropriate drug regimens and protocols are designed.  This approach allows us to make the most effective recommendations for their care.

Commitment to eSET (Elective Single Embryo Transfer):

At RAD we always recommend the most conservative treatment option, and are committed to single embryo transfer during our IVF cycles.  Unlike many other fertility practices that transfer multiple embryos to increase the chances of pregnancy, we believe that transferring one single embryo is the safest and most effective way to attain a healthy pregnancy.  SART statistics demonstrate that implantation rates for eSET IVF cycles are higher than traditional multiple embryo transfers.  Risks of multiple embryo transfer include a higher risk for twins, triplets or greater multiples.  These high-risk pregnancies can often result in:

• 50% rate of premature delivery
• Hospitalization on recurrent basis to prevent premature delivery
• Higher cost for hospitalization for twin and triplets in comparison to singleton pregnancies.

Defined IVF Cycles and Intensive Cycle Monitoring:

Unlike other fertility clinics who are constantly running IVF cycles, we start our IVF treatments at defined times.  By doing so, we believe this method provides patients with the best care because every department of our fertility care team is in sync.  These defined cycle times allow our fertility experts to closely monitor our patients as a team.  Further, patients can organize both their work and personal life around the structured treatment time commitments.

Innovative Lab Technologies:

Our IVF laboratory utilizes the most advanced techniques for egg development, fertilization, and embryo culture.  New IVF lab technologies commonly have a 70-80% chance of success often times just after one attempt.

PGD/PGS Testing:

Exciting new embryo genetic tests at RAD dramatically improves success, minimizes miscarriage, and eliminates the need for implanting multiple embryos.  Determining the genetic and chromosomal health of an embryo before transfer greatly enhances the outcomes of embryo selection for an IVF cycle and increases the chance of a healthy pregnancy.

Donor Services

There are times for some patients when utilizing their own biological eggs or sperm may not be an option. Reproductive Associates of Delaware understands the challenge this can bring. That is why we incorporate streamlined options for both egg and sperm recipients. Reproductive Associates of Delaware utilizes the top egg donor and sperm donor facilities in the US. We have built a strong, trusting, discrete, and ethical relationship with the following facilities.

Donor Egg Services:

We are proud to partner with My Egg Bank of North America (MEBNA). MEBNA is a multi-center network of egg banks which provide frozen donor egg services that are more economical, convenient and efficient than traditional fresh donor egg programs. RAD is one of the only centers in the region to offer this unique treatment option.

Program Benefits:

High Success Rates

Success rates of frozen eggs are equal to or greater than successful outcomes of traditional fresh egg donation.

Low Cost

Frozen donor egg costs one half to one third of the price of fresh egg donation. Unlike traditional fresh egg donation, patients are not responsible for covering the high costs of treatment, compensation, and medication for their donor.

Immediate Start of Treatment

With frozen donor egg there is no need to synchronize recipient and donor menstrual cycles. Patients also do not have to wait 6-9 months to find a donor match, allowing them to begin treatment immediately.

Increased Donor Choice

Patients have the ability to choose the donor they prefer through MEBNA’s donor egg database. The database provides detailed information on all potential donors currently available for adoption.

Eggs Guaranteed

With frozen donor egg, patients are guaranteed a set number of eggs. With fresh donation patients rely on mere predictions of how many eggs their chosen donor may produce.

MEB-NA History

Based on the success of its own egg bank, in 2010, Reproductive Biology Associates in Atlanta established My Egg Bank North America (MEB-NA). MEB-NA is a network of high quality infertility centers providing frozen donor egg bank services to patients across the United States and Canada. RBA partnered with Seattle Reproductive Medicine, Reproductive Science Center of New England in Boston, and Reproductive Medicine in Orlando to form the first multi center network of egg banks.

MEB-NA Donors

All MEB-NA donors undergo thorough medical, genetic and psychological testing. Donors are college educated and come from diverse ethnic and racial backgrounds. To view donors in the current database visit www.myeggbank.com.

Donor Sperm Services:

We have partnered with four sperm donor agencies, all of which do infectious disease screening and genetic screening on all sperm donors.

• Xytec – located in Atlanta, GA. They can be reached at 800-227-3210 or via their website @ xytec.com
• Cryogenic Laboratories – located in Roseville, MN. They can be reached at 800-466-2796 or via their website @ cryolab.com
• Fairfax Cryobank – located in Fairfax, Virginia. They can be reached at 800-338-8407 or via their website @ fairfaxcryobank.com
• California Cryobank – 3 locations in CA and one in NY. They can be reached at 866-927-9622, e-mail at askccb@cryobank.com or via their website @ cryobank.com

For additional information or to set up an appointment with our IVF/Egg Donor team, please call 302-623-4242.

Tubal Ligation Reversal

Many women who decide they are done building their families choose to have their tubes tied as a form of contraception.  However we all know, the only constant thing in today’s world is change. Often women who have had this procedure approach our office with new hopes and dreams because they experience a personal, social, health, or financial change.  Are you in the same situation and considering reversing that decision? For patients who have had their tubes tied but are now looking to move forward and build or expand their family, tubal ligation reversal can make these dreams a reality!

This outpatient procedure involves restoring the fallopian tubes back to their original state in order to naturally achieve pregnancy.  Like all surgeries performed at RAD, our experienced two-physician team utilizes laparoscopic surgical methods that are less costly and minimize incision sites, resulting in a shorter healing and recovery process.

A variety of factors play a role in determining if a tubal reversal is right for you:

• Age
• Overall health
• The type of tubal ligation the patient received
• Length of the tube

Common tests to assess whether or not a patient is a good tubal reversal candidate include:

• A dye test (HSG) to make sure that the fallopian tube(s) are still attached to the uterus, and to determine the length
• A review of the OP report from the prior tubal ligation
• General labs (i.e. blood work)
• A semen analysis to ensure that the partners semen are healthy (if applicable)

If we find that tubal reversal surgery may not be the right method to achieve pregnancy, IVF is another treatment option. 

What is IVF?

What Financing and Payment Options are available?

Our practice is committed to offering you several affordability options. Our expert financial counseling team will also guide you to personalized and affordable financing options as you plan your care at RAD.

A Guide to PGS/PGD at Reproductive Associates of Delaware

What is Pre-Implantation Genetic testing?

Traditionally, the embryo selection process for an IVF cycle is based solely on an embryo’s phenotype (the physical appearance). However a physically normal embryo is not necessarily an indication that the embryo is chromosomally or genetically normal. Pre-implantation genetic screening and testing can provide insight into the genetic and chromosomal health of the embryo. At RAD we offer both Pre-implantation Genetic Screening (PGS) and Pre-Implantation Genetic Diagnosis (PGD). These tests can greatly enhance the outcomes of embryo selection for an IVF cycle, increase the chances of a healthy pregnancy and lower the rate of miscarriage. Determining whether or not to pursue testing depends on a variety of factors, and is both a personal and medical decision.

Pre-Implantation Genetic Testing is performed on cell(s) that are safely removed from an embryo 5 or 6 days after fertilization to test for a particular inherited genetic disease or for chromosomal abnormalities. These tests provide our IVF experts with the unique and specific genetic make-up of each embryo, allowing our team to choose the embryo with the lowest risk of genetic mutations carried by the parents and greatest chance for a healthy pregnancy.

Why PGS and PGD at RAD is Unique

At RAD we utilize a unique and highly technical method of PGS and PGD testing. Traditionally, many fertility laboratories perform testing on day 3 of the embryo formation because it allows for an easier extraction of the cells. However this poses some risk, such as injury to surrounding cells, or the extraction of a cell that does not provide a complete picture of the genetic composition of the embryo. At RAD, we perform a more technically challenging test by extracting the cells on the 5th day of development. Not only does this allow us to analyze multiple cells, providing a more precise measurement of the genetic components of the embryo, but it also lowers the risk of embryo damage. This sensitive testing provides patients with a greater chance for a successful pregnancy and sets RAD apart as an advanced center in fertility technologies.

Success Rates Summary
Reproductive Associates of Delaware January 2010 – December 2012

PGS

Patient Benefits:

There are several important benefits for prospective patients who are considering PGS:

• High implantation and pregnancy rates (about 60%) and extremely low miscarriage rates (less than 10%).
• Enhanced confidence in single embryo transfer. With PGS testing, embryologists can identify embryos that are chromosomally normal and have the highest chance of implantation, therefore eliminating the need to transfer multiple embryos. This also decreases the chance of high-risk multiples pregnancies
• Safer IVF stimulation cycles, avoiding hyper stimulation syndrome almost 100% of the time.
• Enhanced fetal growth and pregnancy outcome with frozen embryo transfer.
• The ability to identify and freeze healthy embryos for fertility preservation for future pregnancy wishes.
• Provides credible information for patients considering donor egg or embryo adoption in situations where no embryos are chromosomally normal (typically in older patients).

When should I consider PGS?

We offer PGS to all IVF patients, although we recognize that PGS may provide more benefit to patients of advanced maternal age. All IVF patients will meet with our Genetic Counselor, Tracy Gardner to consider whether PGS makes sense for them. Common indications that are discussed for recommending IVF with PGS include:

• Maternal age over 34
• Paternal age over 40
• Unexplained infertility at any age
• Prior failed IVF without explanation(s)
• Prior pregnancy losses
• Diminished ovarian reserve (i.e. low AMH, high FSH)

PGD

When should I consider PGD?

Couples who are carriers of inherited genetic diseases can consider PGD testing to increase the chances of a healthy embryo selection. PGD tests for diseases such as

• Sickle cell anemia
• Tay-Sachs Disease
• Cystic Fibrosis

What if I don’t know if I am a carrier?

As part of RAD’s routine initial patient work up, you will be offered testing for certain genetic diseases, in order to develop an appropriate plan of care. If both partners are carriers for specific genetic mutations, PGD offers the most appropriate solutions to identify those embryos that lack the familial genetic disease mutations.

Expanded Success Rates Data