Did you know that we all “hatched?” No, we didn’t hatch in the traditional sense of the term (i.e. break through a shell and into this world). We actually hatched as embryos through a protective coating. Hatching is a critical step in the sequence of events that leads to implantation. The failure of an embryo to hatch may be one of many factors that lead to implantation failure and, thus, infertility.

In order to reduce the possibility of implantation failure, an embryo can be assisted to hatch. According to a Practice Committee of the Society for Reproductive Technologies (SART) and the American Society for Reproductive Medicine (ASRM), “assisted hatching involves the artificial thinning or breaching of the zona pellucida (protective coating of the embryo) and has been proposed as one technique to improve implantation and pregnancy rates following IVF.”

Assisted hatching is generally performed on day 3 embryos. However, there are risks to the embryo that can occur when performing assisted hatching. According to the Practice Committee, “the assisted hatching procedure may be associated with specific complications independent of the IVF procedure itself, including lethal damage to the embryo and damage to individual blastomeres (cells that make up a day 3 embryo) with reduction of embryo viability.” In other words, the embryo can be damaged or destroyed during the process of assisted hatching. The skill level of the embryologist performing assisted hatching can determine the rate of embryo damage. The more experienced the embryologist, the less chance there will be damage to the embryo during the procedure.

The available data studying assisted hatching showed higher clinical pregnancy and implantation rates. However, the delivery rates did not improve significantly enough to justify the use of assisted hatching in every patient.

After reviewing the available studies on assisted hatching, the Practice Committee concluded that “the available published evidence does not support the routine or universal application of assisted hatching in all IVF cycles at this time.” The Committee further stated that “assisted hatching may be clinically useful in patients with a poor prognosis, including those with ≥ 2 failed IVF cycles, poor embryo quality, and older women (≥ 38 years of age).”

Assisted hatching is not the cure all for infertility, but it could help if you fall into one of the above categories. However, you must be mindful of the risks of assisted hatching. Ask your infertility doctor if assisted hatching may be helpful in your particular infertility situation.

Source: Fertility and Sterility, Volume 90, Issue 5, Page S196-7, November 2008, Authors: Practice Committee of the Society of Assited Reproductive Technologies and American Society for Reproductive Medicine.

Dr. Lowell T. Ku, M.D. is a leading Reproductive Endocrinology and Infertility specialist at Dallas IVF, one the nation’s premiere infertility centers.  Dr. Ku clarifies the many confusing terms used in the world of Infertility using straightforward explanations.

Photo by Stephanie Himel-Nelson

Today, I am going to go back to the basics and discuss the definitions of infertility and recurrent pregnancy loss.  Now, you may think you know how to define infertility and/or recurrent pregnancy loss. After all, if someone cannot get pregnant, they have infertility, right?  If someone loses four or five pregnancies, that’s considered recurrent pregnancy loss, right?  Well, you might be surprised to learn about the actual definitions of infertility and recurrent pregnancy loss.

In 2008, the American Society of Reproductive Medicine (ASRM) revised its definitions of infertility and recurrent pregnancy loss.  In a Practice Committee Report published in 2008 in the journal of Fertility Sterility, the ASRM states:

“Infertility is a disease, defined by failure to achieve successful pregnancy (clinical pregnancy) after 12 months or more of regular unprotected intercourse.”  So, infertility isn’t just the inability to get pregnant but the inability to conceive after actively trying for at least 1 year.

“Recurrent pregnancy loss is a disease distinct from infertility, defined by two or more failed pregnancies (clinical pregnancies).” Thus, the tragic loss of just 2 pregnancies can be considered recurrent pregnancy loss.

Did you realize that infertility and recurrent pregnancy loss are considered diseases?  The 31^st edition of Dorland’s Illustrated Medical Dictionary published in 2007 states that a disease is:

“Any deviation from or interruption of the normal structure of any part, organ, or system of the body as manifested by characteristic symptoms or signs; the etiology, pathology, or prognosis may be known or unknown.”

Source: Fertility and Sterility, Volume 90, Issue 5, Page S60, November 2008, Authors: Practice Committee of the American Society for Reproductive Medicine.

Dr. Lowell T. Ku, M.D. is a leading Reproductive Endocrinology and Infertility specialist at Dallas IVF, on the nation’s premiere infertility centers.  Dr. Ku clarifies the many confusing terms used in the world of Infertility using straightforward explanations.

Choosing an IVF center should be based on more than their success rates. Many patients assume that they should go to the IVF center with the best success rates. Although a reported high IVF success rate is important, an infertility center with a good track record with patients with similar fertility conditions as your own is even more important (to you).

I recommend that you choose an IVF center that is not only medically successful but also successful in supporting you emotionally through the process of infertility treatments. From the time you first step foot into the IVF center to the time that you are pregnant, the center’s staff, nurses, technicians, and physicians should be helpful, understanding, and supportive. I also recommend that you choose a physician that you trust and is willing to answer all of your questions in an honest manner.

I encourage patients to ask questions when assessing whether or not a fertility clinic is right for them. So, choosing an IVF center that is right for you is not just a matter of bottom line numbers, but whether or not an infertility center can support you during the difficult journey from infertility to parenthood.

Dr. Ku is an infertility specialist at Dallas IVF, one of the nations’ leading infertility centers that consistently has among the highest success rates in the United States.  (www.DallasIVF.com) Dr. Ku and his wife have suffered with infertility and Dr. Ku states that his experience with infertility has made him a better infertility doctor and makes him work harder for his patients. “I know how it feels to struggle with infertility. I am there for my patients every step of the way to parenthood!”

Dr. Ku is an infertility specialist at Dallas IVF, one of the nations’ leading infertility centers that consistently has among the highest success rates in the United States.  (www.DallasIVF.com)

Infertility specialists are not only clinicians but also surgeons.  Dallas IVF’s physicians are contemporarily trained in the latest techniques that are proven surgical procedures to correct anatomical abnormalities that can lead to infertility or pregnancy losses. Most infertility surgeries are outpatient procedures that do not require overnight stays in the hospital. Below are listed the most common types of surgical procedures performed by infertility specialists.

Hysteroscopy: When a diagnostic procedure such as a hysterosalpingogram, office hysteroscopy, or saline sonogram reveals an abnormality that can not be corrected in the office, an operative hysteroscopy will be recommended. During an operative hysteroscopy, a small hysteroscope (a fiber optic telescope) is inserted through the cervix and advanced into the uterine cavity with the patient asleep under general anesthesia. This procedure allows for direct views of the uterine cavity and permits the physician to surgically correct the abnormality. Patients go home the same day as the procedure and can often return to work the next day.

(To view video of an actual hysteroscopy revealing multiple polyps, please visit: http://www.dallasivf.com/infertility-treatment-dallas-tx/infertility-surgery.html)

Laparoscopy: If the infertility specialist suspects that you have an abnormality involving a pelvic structure that may be contributing to your infertility, surgery will be recommended. Laparoscopy, also known as minimally invasive surgery, often requires only a few 0.5 cm incisions through the abdominal wall. The surgeon inserts a laparoscope, a small fiber optic telescope, into the abdomen through these small incisions to view and make surgical corrections to the pelvic structures involved. Laparoscopy is a less-invasive procedure than open abdominal surgery and allows for a quicker recovery with a lower risk of adhesion (scar tissue) formation. Most patients go home the same day as the procedure and return to work 3-4 days later.

(To view video of an actual laparoscopy revealing a normal pelvis, please visit: http://www.dallasivf.com/infertility-treatment-dallas-tx/infertility-surgery.html)

Open Abdominal Procedures: Although most infertility surgeries are performed using the minimally invasive techniques, sometimes laparoscopy or hysteroscopy will not be sufficient to correct an abnormality of the pelvis. As such, the physician will recommend a larger abdominal incision. The most common type of abdominal procedure performed by infertility specialists is an abdominal myomectomy, the removal of large uterine fibroids. Most open abdominal procedures require at least 1 – 2 nights of hospitalization. Most patients return to work within 4 – 6 weeks.

Müllerian reconstructive surgery: A müllerian anomaly occurs when the uterus, tubes, or the upper portion of the vagina do not form correctly. Laparoscopic, hysteroscopic, or even open abdominal procedures may be necessary to correct these anomalies and restore fertility.

Dr. Ku is an infertility specialist at Dallas IVF, one of the nations’ leading infertility centers that consistently has among the highest success rates in the United States.  (www.DallasIVF.com)

Last week we discussed the evaluation your infertility doctor might perform to determine your ovarian reserve.  This week, we will discuss the anatomic evaluation your infertility doctor might perform in order to elucidate the etiology of your infertility.

Determining the health of the pelvis is essential.  Abnormal female anatomy may lead to infertility or recurrent miscarriages. Dallas IVF has a wide array of state of the art imaging and operative equipment to evaluate female anatomy, specifically the uterus, tubes, ovaries and pelvis.  At Dallas IVF, at least one, if not more, of the below described studies will be requested by one of our physicians:

Transvaginal Ultrasound: The principal diagnostic study employed by reproductive endocrinologists and gynecologists to determine the overall female anatomy is the transvaginal ultrasound. The ultrasound will help assess the condition of the uterus and ovaries. Ovarian masses and uterine fibroids can commonly be seen through this simple diagnostic study. Endometriosis, unless it involves the ovaries and is large, cannot be visualized on ultrasound.

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