Preimplantation Genetic Screening & In Vitro Fertilization for Recurrent Miscarriage
Some women who have no trouble getting pregnant but experience recurrent miscarriages may be good candidates for in vitro fertilization (IVF) with preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD), which enable our fertility specialists to test an embryo for genetic and chromosomal problems that can lead to miscarriage. These procedures allow the doctor to transfer only healthy, chromosomally normal embryos to the uterus, dramatically reducing the chance for miscarriage.
Women over age 35 are more likely to have miscarriages caused by problems with chromosomes, but younger women can also be affected.
Specialists at NYU Langone’s Fertility Center are experts in determining the viability of embryos tested using PGS and PGD, which is done in conjunction with IVF. Our doctors have performed thousands of successful IVF procedures, and they have pioneered IVF techniques that have led to more efficient and safer treatments.
Doctors use sophisticated tests to check embryos for aneuploidy, a condition in which a developing baby has one or more extra or missing chromosomes. They can also test for a wide range of genetic conditions, such as cystic fibrosis, muscular dystrophy, Tay–Sachs syndrome, Marfan syndrome, and other single-gene disorders—birth defects that result from just one gene mutation.
NYU Langone doctors provide counseling to help you determine if IVF is right for you. Women who choose to have IVF treatments must attend an onsite orientation, during which our nurses provide information about the IVF process at NYU Langone. When applicable, partners are encouraged to attend this session.
Doctors and staff at NYU Langone’s Fertility Center provide support to individuals and couples throughout the IVF process.
On day 2 of your menstrual cycle, your doctor prescribes fertility hormones, such as gonadotropins and other medications, to stimulate the ovaries to develop multiple mature eggs, increasing the odds of fertilization and pregnancy. These medications are injected under the skin of your abdomen or thigh daily for 8 to 15 days. Our experts teach you and your partner how to give the injections at home.
In a small percentage of women, fertility medications that stimulate the ovaries to release eggs can lead to ovarian hyperstimulation syndrome, or OHSS, causing a buildup of fluids in the chest and abdomen. OHSS generally goes away with menstruation, but symptoms can continue with pregnancy. If this happens, your obstetrician monitors your symptoms. Severe OHSS requires hospitalization to drain the excess fluid.
During an IVF cycle, the doctor typically prescribes antibiotics for women and their partners to protect against infection in embryos. Your doctor may also prescribe Medrol® (methylprednisolone), a steroid that prevents the body from rejecting the embryos after they are transferred to the uterus, and progesterone, a hormone that helps the lining of the uterus sustain an implanted embryo.
Just prior to ovulation, your NYU Langone fertility specialist places a hollow needle through the vaginal wall and retrieves mature eggs from the ovaries. This procedure, which is guided by ultrasound images on a computer monitor, is performed with light sedation and takes 30 minutes to one hour to complete.
The eggs are delivered to our on-site embryology lab, where a specialist evaluates them for maturity. Then they are placed in an incubator.
Side effects include cramping, which can be treated with over-the-counter pain medication. You can go home the day of the retrieval.
Using a microscope, our andrologists, male reproduction specialists, and embryologists select good-quality sperm from a sample supplied by your partner or a donor and then add them to the incubated eggs. When necessary, they use a procedure called intracytoplasmic sperm injection, or ICSI, to inject the sperm into the eggs with a microscopic glass tube. Any resulting embryos are observed in the laboratory for several days.
Preimplantation Genetic Diagnosis and Screening
After five to seven days of incubation, a specialist removes a few cells from each viable embryo and screens them for aneuploidy, meaning chromosomal problems, or specific conditions, or both. Healthy embryos are biopsied and frozen, and a single embryo is transferred in the following IVF cycle.
Over the past 20 years, specialists at NYU Langone’s Fertility Center have pioneered improvements in genetic screening technology. This has led to more efficient and safer IVF procedures for women and their partners.
If needed, extra eggs, sperm, and embryos are frozen and stored for future transfer at the NYU Langone Fertility Center lab, which is equipped with the latest technology for cryopreservation (freezing) and storage.
Before the embryos are transferred and implanted in the uterus, your doctor discusses with you various factors, including the number and quality of the embryos, which can affect successful implantation and pregnancy. One or two embryos are typically transferred five days after fertilization, when they have reached the blastocyst stage.
These embryos have a higher rate of implantation in the uterus and a lower risk of pregnancy with multiples than embryos transferred earlier, because embryos that survive past day three typically have a lower rate of chromosomal abnormalities. This allows doctors to choose fewer and healthier embryos to implant.
Your doctor passes a long, thin catheter, or a hollow tube, into the uterus and releases the selected embryo or embryos. This 15-minute procedure is performed in the Fertility Center and usually requires no sedation.
IVF Post-Transfer Monitoring
After IVF, your doctor monitors your hormone levels with blood tests, including a pregnancy test nine days after the embryo transfer.