Click on of the following questions to jump to the Answer:
What is ICSI?
What is Conventional Insemination?
How many times does a semen sample have to be provided by male partner?
How is my transfer day detemined?
What are the benefits of a Day 3 transfer vs a Day 5 transfer?
What is Assisted Hatching?
What if I make more embryos than I need for transfer?
What is a Freeze All Cycle?
What are the advantages of a Freeze All Cycle?
What is Vitrification?
How many embryos are usually transferred?
What is embryo splitting?
Does Dr. Noble accept insurance?
Does Dr. Noble accept Tricare, Medicare, Medicaid or HMO insurance?
Are fertility treatments covered under insurance?
Do you offer payment plans?
IntraCytoplasmic Sperm Injection. This is a procedure used in the ART Laboratory for fertilizing oocytes. It is the Gold Standard for obtaining a good fertilization and good production to Blastocysts of fertilized embryos. It is a technical procedure that requires several steps, an inverted microscope and micromanipulators. Essentially a single sperm is picked up in a specially prepared viscous solution with a very minute needle and injected into the oocyte. It does take some technical expertise to perform and is used routinely on all cases in our program.
This is the older method of fertilization where the oocytes are mixed with the sperm in a tube or dish, thereby improving odds for a successful fertilization, but the sperm must still bind and penetrate the oocyte on its own. It has a lower fertilization rate. Sometimes it is prognostic of sperm's ability to fertilize on its own.
A minimum of 2 times: once for analysis and once on the day of oocyte retrieval. Freshly ejaculated sperm fertilizes the best. Sometimes a specimen may be frozen prior to an IVF cycle, if there is a very low count or the patient has a difficuly time collecting or is going to be out of town the day of the retrieval. Also if a severe male factor is present, the patient may be asked to collect twice on the retrieval day. On dual collections, the second specimen can be better than the first.
It is a multifactorial decision, primarily based on maternal age and number of oocytes fertilized. In general cases with 4 or less oocytes are transferred back on D3, which is 4th day post retrieval (retrieval day is day 0, as the embryo has not been created yet). If 5 or more oocytes fertilize, then the decision is maternal age dependant and also on embryo quality. This decision is usually made on day 2 after the quality is checked by an embryologist. If good, onto Day 5, if poor, a Day 3 transfer will be scheduled. Assisted Hatching is indicated in patients over 35 and that is done on a Day 3 transfer. Also Assisted Hatching is beneficial in cases of poor quality.
Both transfers have their benefits. Day 3 transfers are affected less by culture conditions as the embryos finish their development in the woman's body. Also Assisted Hatchingis performed, which aids implantation. With Day 5 transfers, the embryos have completed their development farther and it is easier to pick the best ones for transfer. The embryos also match the uterus's receptivity better. Assisted Hatching is not performed on Day 5 transfers as the zona should be thinned naturally.
Assisted Hatching is a technical micromanipulation procedure performed on Day 3 embryos and on all frozen blastocysts thaws. The embryo and oocyte are protected by a complex glycoprotein shell, and in order for the embryo to be able to implant in the uterus, it must come out of this shell called the Zona. It is analogous to a chicken and it's shell. Assisted Hatching uses the inverted microscope and micromanipulators to make a small breach in the Zona so the embryo can escape easier. It saves the embryo energy and sometimes is the only way an embryo can escape it's Zona. It is believed that the freezing process hardens the Zona, hence the use of hatching on all frozen blastocyst thaws.
Extranumary embryos are cryopreserved as a backup to the fresh transfer and if the fresh transfer is a success, they can be used for another child at a later date. Not all cycles will create extra embryos. Our program only freezes at the Blastocyst stage, so the patient must have enough embryos to create Blastocysts. On every cycle, if there are embryos left over after transfer, they will be held to Day 5 and 6 and evaluated for freezing. They must make a good quality Blastocyst for freezing. For patients who don't conceive on their fresh cycle, cryopreservation offers another chance with less expense and trouble. For those who do conceive, more children can be conceived with only a thaw and transfer.
A Freeze All cycle is when either for health reasons (Hyperstimulation Syndrome) or other reasons, the doctor will ask the embryologist to freeze all the Blastocysts made and there will be no fresh transfer on the stimulation cycle. All Blastocysts will be frozen that are made on both the 5th and 6th Day. The woman will wait for that cycle to end or her next period to restart a cycle to receive frozen embryos. The preparation is different than for a fresh cycle as there will be no oocyte retrieval.
The patient will not get sick or not as sick as they could get, the embryos will better match the luteal phase, and the Blastocysts will have been hatched. So all things add up to a better chance for good implantation and a viable pregnancy. Many programs are taking advantage of these benefits and doing more Freeze All cycles when the luteal phase is in question. Also there is some belief that those Blastocysts which survive freezing process are more hardy than unfrozen ones. This is not proven yet, but many programs are showing improved success in their freezing programs.
Vitrification is a novel new method of cryopreserving Blastocysts and oocytes. Previously oocytes were not able to be frozen by traditional methods and so pregnancy rates were very low for cycles using cryopreserved oocytes. With the use of vitrification, now oocytes can be frozen and used at a later date. Also the survival rates and pregnancy rates are very good compard to traditional slow freezing on both frozen oocyte cycles and vitrified Blastocysts cycles. In the future, if rates continue to rise, vitrification will probably replace traditional slow freezing. It is a fairly new technology so more data needs to be collected before programs switch. It still requires a lot of technology and technical skill to be successful at it and different storage methods.
That is a multifactorial decision based primarily on maternal age and embryo age and quality jointly made by patients, doctor and embryologist. The less embryos transferred, the less chance of multiple gestations and the direction all programs are going. One embryo per transfer is our goal.
Identical twins are formed naturally in the body when a single embryo splits into two. Twinning occurs at the Blastocyst stage. There appears to be higher incidence of splitting of an embryo into two in Blastocyst culture and transfer. Splitting can occur on fresh cycles as well as frozen. Non-Identical twins (fraternal) are formed when more than one embryo is transferred and two different embryos implant.
Dr. Noble is an in-network provider with many PPO plans and only one HMO Plan, (Athena). However, his participation does not guarantee payment of infertility related services. Please note that our office does not file secondary insurance claims.
Does Dr. Noble accept Tricare, Medicare, Medicaid or HMO insurance?
No, Dr. Noble does not participate in any of the above plans. Patients with this type of coverage are considered private pay. Our office does not file insurance claims with non-participating (out-of-network) plans.
Are fertility treatments covered under insurance?
Most insurance does not cover fertility treatments or services. We strongly recommend that you contact your insurance carrier prior to your visit or treatment and inquire about the fertility benefits and limitations under your plan. Our office will verify your benefits as well on the day of your visit or prior to any treatment. Payment will be collected in full at time of service for all non-covered services.
We at Southwest Center for Reproductive Health know all too well the high cost of infertility treatment and the fact that not all insurance covers this type of treatment. Keeping this in mind, we strive to keep our fees as low as possible in order to make our services more affordable to everyone. Another alternative to consider is available for qualifying applicants through Springstone Patient Financing*. Click on the link below to apply or for more information.
*Our office is not affiliated with, nor do we endorse this company.