In-Vitro Fertilization (IVF)
Eggs (oocytes) are removed from the ovary with ultrasound guidance just prior to ovulation.  The eggs are mixed with the partner's sperm to allow for fertilization.  The embryo(s) is then transferred into the uterus to achieve pregnancy. The  procedure may also be done using either donor eggs and/or donor sperm.
 

Intra Cytoplasmic Sperm Injection (ICSI)
A micromanipulation procedure whereby a single sperm is injected into the egg. It is particularly effective in men who have very low sperm counts, or when fertilization has not occurred with conventional IVF. 
 

Blastocyst Transfer
In the past, fertilization of embryos in the laboratory was limited to the 2-to8-cell stage with embryo transfer occurring 48 to 72 hours after retrieval.  The recent development of new culture mediums now allows the embryos to develop to a more mature state in the laboratory thus increasing implantation rates in the uterus.  Because of better implantation rates and depending on the patient's age, generally not more than 2 to 4 embryos are placed back into the uterus.  Blastocyst transfer is usually done 5 days after egg retrieval.
 

Artificial Insemination
Intrauterine insemination is a procedure in which the sperm are "washed" and placed into sterile medium.  The sample is then placed directly into the woman's uterus near the fallopian tubes where fertilization takes place.  The insemination is done around the time of ovulation.  New research indicates that the use of ovulation drugs with well timed intrauterine inseminations results in a 33% pregnancy rate.
 

Treatment of Endometriosis 
Endometriosis is a common disorder in which a woman's endometrial tissue, which lines the uterus, grows outside the uterine cavity.  This tissue responds to the woman's cyclic hormonal fluctuations and will swell and bleed, just as the endometrial tissue does during menstruation.  Endometrial implants can cause pelvic pain, increased pain with menses, and is a causative factor in infertility.  It can usually be treated by medication or surgery designed to preserve fertility.
 

Treatment of Uterine Fibroids
Uterine fibroids are tissue masses of smooth muscle tissue that are located in and around the uterus and sometimes the cervix.  It is estimated that uterine fibroids occur in one of every four to five American women.  Infertility may result from uterine fibroids by making it impossible for a fertilized egg to attach to the uterine wall.  Fibroids that are large enough to cause significant symptoms may require surgery.  Specialized surgery can be done to remove the uterine fibroids and preserve fertility.

Microsurgical Epididymal Sperm Aspiration (MESA)
In some cases, the male partner has no sperm in the ejaculate but his sperm production at the testicular level is still functional.  In these cases, it is still possible for these men to have their own babies, because the sperm can be retrieved from the epididymis through percutaneous aspiration, with resulting sperm used to fertilize the female oocytes.  Fertilization is accomplished utillizing ICSI.
 

Testicular Sperm Aspiration (TESA)
& Testicular Sperm Extraction (TESE)
These procedures are used when there are no sperm present in the ejaculate or in the epididymis.  In these cases, a last chance to recover some sperm to fertilize the woman eggs is made by searching directly in the testicles.  There are two options:

Testicular Sperm Aspiration (TESA) - a needle biopsy of the testicle used to obtain small amounts of sperm.  A small incision is made in the scrotal skin and a spring loaded needle is injected directly into the testicle.  Usually not enough sperm are recovered to freeze for later use.

Testicular Sperm Extraction (TESE) - removal of a small piece of testicular tissue through a skin incision.  The tissue is placed in culture media and separated into tiny pieces.  Sperm are released from within the seminiferous tubules where they are produced and are the extracted from the surrounding testicular tissue.  This procedure can be done using local anesthesic or IV sedation.  It is possible to get enough sperm to freeze for future use.

 

Preimplantation Genetic Diagnosis (PGD)
One of the most impacting recent discoveries is the high proportion of chromosomal abnormalities in eggs and sperm.  This is true even for people without reproductive problems.  This phenomenon could explain why many IVF cycles fail to produce a pregnancy or end with an early miscarriage.  In other cases, there is a genetic problem associated with one or both parents, which represents a high risk to be inherited by the baby.

Developed in the early 1990's, PGD basically entails the removal of a cell from the fertilized egg or embryo and then analyzed to determine the presence of chromosomal abnormalities or genetic disorders.  Only the normal embryos are transferred into the woman's uterus increasing the chance of pregnancy and assuring that a particular genetic disorder will not be passed on to the next generation.

Microscopic Tubal Reconstruction
Approximately 1% of women who undergo tubal ligation regret their decision and subsequently opt to have a microsurgical tubal anastomosis procedure (tubal reversal).  Due to the invention of the surgical microscope and very fine suturing materials, success rates after tubal reversal have improved dramatically.  Tubal ligation that results in the least amount of tissue destruction or removal (such as the Pomeroy procedure and clip and ring application through laparoscope) is most amenable to tubal reversal.  The type of sterilization procedure done and the length of the remaining viable tube will affect the outcome.  Isthmic anastomosis (mid-portion of the tube) yields the highest success rate, whereas, ampullary-cornual anastomosis (most distant portion of the tube from the uterus) is associated with the poorest outcome.  Patients with tubal lengths of more than 4 centimeters after tubal reversal generally have a favorable prognosis.  Additionally, tubal pregnancy occurs in 2 - 4% of patients after surgery to restore the tubes.