Counseling & Support
Grief and loss
Decisions about disclosure
Financial stress related to undergoing infertility treatments
Considering options for fertility treatments
Considering options if fertility treatment does not result in a pregnancy
Feelings of guilt and helplessness over one’s fertility
Tendency to lay blame on self or partner
Relationship distress
Intrauterine Insemination (IUI)

While a number of ovarian follicles begin to develop during each normal menstrual cycle, the co-ordinated actions of Follicle-Stimulating Factor (FSH) and/or luteinizing hormone(LH) usually give rise to the production of only one mature follicle capable of ovulating an egg. Clomiphene or gonadotropins are usually given to increase the number of mature eggs.Intrauterine insemination (IUI; also known as sperm wash) usually involves a two-step treatment for infertility.

First, hormone therapy is used to improve the ovulatory response. Second, an optimally prepared semen sample is deposited directly into the uterine cavity. This treatment is designed to increase both the number of eggs and the number of motile sperm, which reach the fallopian tube (site of fertilization). Intrauterine insemination compensates for mild male factor and has provided success with cases of unexplained infertility. By passing the vagina and cervix can increase the number of motile sperm reaching the uterus and fallopian tubes.

Donor Insemination
TDI involves the deposit of frozen-thawed donor semen into the uterus during the most fertile period of a woman’s cycle. This process provides a relatively easy and inexpensive way to achieve pregnancy in a fertile woman.
In Vitro Fertilization (IVF)

During IVF you are given medications, which manipulate your ovaries and the eggs being produced. The idea is to try and get several eggs to mature, not just one or two. The follicles where the eggs are developing can be monitored by ultrasound and by measuring your estrogen levels. When the eggs are mature, they are taken from the ovaries (using a fine needle which is passed through the vagina under ultrasound guidance) and handed to the embryologist. The eggs are then fertilized with your partner’s sperm (or, in some instances, donor sperm).

The fertilized eggs (embryos) are then cultured undervery strict conditions and examined each day by the embryologist to assess their progress. On the fifth day the embryologist assesses the embryos and then we decide how many to replace inside the uterus (embryo transfer).

Intracytoplasmic Sperm Injection (ICSI)

ICSI is part of the whole IVF (In Vitro Fertilization) process. During a normal menstrual cycle, only 1 egg is usually recruited to mature in a capsule of fluid called a follicle. The maturation time of the egg inside the follicle, is usually 10-14 days. Most follicles measure about 16 – 20 mm when the egg is mature. At this time during natural ovulation, the follicle ruptures and the egg is released.

During IVF, fertility drugs are used to stimulate the ovaries and recruit a bunch of eggs. So instead of just one follicle maturing, a whole number of follicles are stimulated to grow. These follicles are monitored by ultrasound, and when they reach maturity the eggs are surgically retrieved. For retrieval, a fine needle is passed through the vagina and into the ovaries, where eggs are aspirated from the follicles.

Concurrently the sperm is prepared. Sperm may be collected from an ejaculated specimen of semen, or prepared from a previously frozen surgically retrieved specimen. The eggs are then stripped of the cumulus cells (which are the sunburst array of cells around the egg) The cells are removed to assess the maturity of the egg, to better visualize the egg during the ICSI process, and to prevent the inadvertent injection of DNA from the cumulus cells into the egg. The stripping is done with an enzyme called hyaluronidase, which is normally found in the sperm heads. In normal fertilization it is this enzyme that allows the sperm to digest their way through the cumulus cells to the egg.

A tiny collection of sperm is placed in a viscous solution called “sperm crash” – and this slows down the motility of the sperm making them more easily assessed and caught. A healthy sperm is identified and then immobilized by striking the tail with a tiny glass needle called the injection pipette. The sperm is then aspirated tail-first into the same glass pipette. Using a high-powered microscope with sophisticated manipulation equipment, the egg is located and held in position by a holding pipette. The injection pipette is inserted into the egg thereby tenting the membrane – and gentle suction applied until the elastic membrane is broken. Once the membrane is broken the sperm can be deposited into the egg and then the injection pipette is removed. Once the pipette is removed the egg will resume its normal shape and is then put into a specialized culture medium in an incubator. It is then assessed for fertilization 18 to 20 hours after the injection.

Assisted Hatching
Assisted hatching (AH) involves microdissection of the zona pellucida (shell), prior to embryo transfer, in order to facilitate the hatching of the embryo from its protective envelope and thereby improve the odds of uterine implantation. A new tool that was developed for microdissecting the zona pellucida, the diode laser, is now available to thin or fully open the zona pellucida (ZP). Further research is needed to provide absolute proof that AH significantly increases the chance of pregnancy. Many multi-centre studies are currently running and tend to show that AH is beneficial for selected patients. The mechanical methods previously used required great technical expertise, acid solution and were not as safe to perform as drilling the ZP using a laser system. Lasers represent ideal tools for microprocedures due to the fact that they allow reproducible generation of holes of controlled size, induce no deleterious mechanical, thermal or mutagenic side effects. Safe, simple and rapid is a good description of the new diode laser for assisted hatching.
Blactosyct Transfer
Recent advances in IVF laboratory methods have allowed for the successful culture of embryos to the blastocyst stage. Blastocysts may have a better potential to implant into the uterine wall than earlier stage embryos. Many embryos stop growing at the four- to eight-cell stage, probably because of some inherent problem. Therefore, fewer embryos will have the ability to grow to the blastocyst stage. Those that successfully reach the blastocyst stage are probably more developmentally competent than earlier stage embryos. As well, their stage of development when replaced into the uterus is very similar to what it would be in a natural conception cycle.
Embryo
Cryopreservation is a procedure for freezing and storing embryos at a low temperature. Water in the embryos is replaced with a chemical solution (cryoprotectant) that prevents ice crystals from forming inside the embryos, as this would destroy them. Embryos are placed in liquid nitrogen and stored at -196°C. They may be stored this way for prolonged periods of time. When embryos are thawed, the cryoprotectant is removed and replaced with water. About 90% of good quality embryos will survive the freeze-thaw process. Cryopreserved embryos are usually returned to the uterus during a menstrual cycle in which only supplemental estrogen and progesterone are taken. These hormones enhance the body’s natural cycle and ensure that the endometrium (lining of the uterus) is well developed. About 80-90% of the embryos will survive the freeze-thaw process, so we may need to thaw 3 or more depending on your age in order to obtain an adequate number of good quality embryos for transfer. You may be advised to delay use of your frozen-thawed embryos until after you have completed a 2nd IVF cycle in order to accumulate enough embryos before we begin thawing them. It is recommended that you wait at least two months following an IVF cycle before transferring frozen-thawed embryos. This allows your body a period of rest before attempting to achieve pregnancy again.
Sperm Retrieval (PESA/TESE)
Percutaneous epididymal sperm aspiration (PESA) are available for men with obstructed or absent ejaculatory ducts (i.e. unsuccessful vasectomy reversal, congenital absence of the vas deferens). Sperm are aspirated directly from the epididymis (the tiny collecting tubules next to the testes) for use in the ICSI procedure. The few drops of fluid may contain sufficient sperm to be frozen for several ICSI procedures. Testicular sperm extraction (TESE) is available for men with obstructions or ejaculatory problems that cannot be treated by any other method. Small samples of testicular tissue are obtained by needle biopsy and a few sperm are painstakingly dissected out of the tissue for use in the ICSI procedure.
Egg Bank
What is Egg Storage?

Research in the area of egg storage or egg freezing has been active in the past 20 years, and recently, the connection and comparison between pregnancy rates and the transfer of fresh embryos has already been established. In this method, mature eggs are retrieved from the ovaries and are cryo-preserved or frozen without being fertilized with sperms.

The standard and most successful way to promote egg development for Egg Freezing is through the stimulation of the ovaries with hormones given by injections.

Our staff will work with the clinical team during the procedure of egg extraction. Mature eggs are retrieved by needle aspiration through ultrasound guidance. The process of stimulation of the ovaries and until retrieval of the eggs, takes approximately 12-14 days per cycle. Frozen eggs are then stored in long-term and short term storage facilities in our Centre until they are ready to be used.

What are the benefits of the Egg storage procedure?

Egg freezing offers hope to women seeking to preserve fertility. It simply freezes your clock. In other words, preserve your fertility potential at the age group when your eggs were frozen. Egg freezing may be indicated in the following circumstances:
Before undergoing chemotherapy or radiation therapy
Preservation of fertility potential in women who wish to delay pregnancy.
If your work requires you to do activities which could affect the quality of your egg, such as in some professional sports, if you work in certain factories, or if you are in the Military.
For women who do not want to marry early but still plan to conceive in the future.
Healthy women who nevertheless want to be sure they have healthy eggs in case of any unexpected problem in the future.
Women who will be over 35 years old.
Women who heavily smoke or drink
For women who do not want to create extra embryos for freezing in their IVF cycles.

How to have your Egg stored?

Egg storage is only performed in specialized cryobank centers. Our centre has the latest technology for this kind of procedure, thus providing patients with the best care available. If you are interested, please contact Nahal Fertility Program. We have two different packages of egg storage: short-term storage period for a maximum of 1 year, and long-term storage period for the duration of 1 year and above.

Sperm Bank

Storage or sperm freezing is a procedure that involves the freezing of semen sample in temperatures of about -180 centigrade. In this procedure, we assess and analyze the sample, then wash the semen sample with special culture media. The sample is then mixed with a cryoprotectant solution and stored in -180 centigrade temperature which will keep the sperm in good condition for years and could be thawed when ready for use.

What are the benefits of the Sperm storage procedure?

By having your sperm stored, you can be prepared against declining sperm availability, production or function which could happen in certain situations:
If you are going to receive radiotherapy or chemotherapy or take any medication that will affect the quality of your sperm.
If you are going to undergo testicular biopsy or epididymal aspiration.
If your work requires you to do activities which could carry risk to sperm production or function such as in sports, if you work in certain factories, and the military.
If you already have a very low sperm count or have poor sperm motility or abnormal sperm morphology.
If you are going to have a vasectomy.
If you will be away while your partner is undergoing fertility treatment.
If you are going to be over 40 years old.
If you are heavy smoker or drinker.

How to have your sperm stored?

Sperm storage is only performed in specialized cryobank centers. Nahal fertility program has the latest technology for this kind of procedure, thus providing patients with the best care available. If you are interested, please contact Nahal Fertility Program. We have two different packages of sperm storage: short-term storage period for a maximum of 6 months, and long-term storage period for the duration of 1 year and above.