In Vitro Fertilization (IVF)

The In Vitro Fertilization Program of Women's Clinic, Ltd. was one of the first private practice IVF programs in the United States. This began as a concept in February 1984. We initiated our first patient stimulation in September 1986 and had our first pregnancy in April 1987. Baby #1 was delivered in January 1988. We have continued to be extremely successful ever since. Our pregnancy rates have always been quite good and indeed, at a top level for the state of Pennsylvania. In 2006, our standard IVF clinical pregnancy rate, proven by ultrasound, per embryo transfer has been 56.3% for all comers to the program. Over 300 babies have been delivered from our program. Vincent A. Pellegrini, M.D. is the Clinical Director of the IVF Program. Dr. Minassian and Dr. Fehnel are actively involved as well.

Our IVF program is a very well controlled, personal and individualized program. There are only a few people involved in the day to day care of the IVF patients and therefore, this has allowed us to develop very close relationships with our patients, while keeping their situation very finely tuned. This is part of the reason for our continued success. Attention to detail is another. Our IVF patients are very carefully screened to eliminate the presence of underlying conditions that might diminish their chances for pregnancy. Old records are extensively reviewed. Our patients are not placed into predetermined protocols, but are all studied and handled individually. A low drug dose stimulation is used for almost all patients, unless the clinical situation requires otherwise. It is our feeling that this produces better egg quality and enhances the potential of pregnancy.

From the beginning of our IVF program in 1986, we have had a very unique philosophy regarding embryos. All normally fertilized and developing embryos have always been transferred into each patient several days after the eggs were removed from her ovaries. In 2005 & 2006, the average number of embryos transferred was 3.1. In this scenario, the number of embryos transferred is limited by controlling the number of eggs inseminated. The number is determined by a mutual decision between the IVF team and the couple, taking into account the female's age and the clinical situation. Four eggs are most often inseminated, but the number varies between two and five. It is expected that 80% of the inseminated eggs will fertilize and become embryos. These embryos are all transferred. In this process, it is statistically unlikely for more than 50% of the transferred embryos to develop into fetuses. In the usual situation of inseminating four eggs, this would mean that three embryos will probably be available for transfer and one or two fetuses will result if pregnancy occurs. It would be rarely possible for all the inseminated eggs to fertilize and then all subsequently develop into multiple fetuses. Our multiple pregnancy rate has been 30% over all of our years, with most of these being twins. In this process, there are no “leftover” embryos to freeze, donate or discard. This thus avoids the moral questions raised by potentially discarding frozen embryos that are not needed in the future, as is reported to occur with up to 70% of all frozen embryos nationwide. The situation has been totally avoided by limiting the number of eggs that are inseminated to begin with. Because of the need to repeat the entire IVF cycle if another IVF attempt is desired when there is no embryo freezing, Women's Clinic, Ltd. offers a 50% discount of our fee for every other IVF cycle. This process of no embryo freezing will continue at Women's Clinic, Ltd. under the direction of Dr. Pellegrini.

The arrival of Dr. Minassian in September 2007 at Women's Clinic, Ltd. initiated an embryo freezing program. If embryos are hoped to be preserved by freezing, then most of the retrieved eggs will be inseminated. A few embryos of the highest quality will be transferred fresh. This would typically be two embryos. The rest of the embryos will be frozen for future use. For those couples who choose embryo freezing, the advantages include a decreased potential of multiple pregnancy, as fewer embryos are replaced, along with typically not having to subsequently repeat the entire IVF process since there will hopefully be frozen embryo embryos for their future use. The 50% discount for every other cycle does not apply if embryo freezing is planned. Dr. Pellegrini will not be involved in the egg retrievals of patients planning embryo freezing. Dr. Minassian and Dr. Fehnel will perform these procedures.

Over the last ten years, we have developed a successful intracytoplasmic sperm injection (ICSI) program as part of our vast array of available services. This procedure is used to treat severe male factor infertility. It opens the door to a large number of men who would otherwise be considered totally sterile. With this ICSI procedure, each egg is injected with a single sperm, one at a time. Therefore, only a few normal sperm are needed. In some effectively sterile men, the sperm need to be obtained surgically. This procedure is carried out under light anesthesia, with the help of several urologists. Aspirating the testicle itself or the surrounding tubules can obtain the sperm. Excess sperm can be frozen for future use. Since ICSI will help a very significant number of infertile couples, it is probably one of the most significant advances since the very beginning of IVF.

The IVF team is also made up of embryologist, Michele Haas, BS, and embryology assistant, Mindy Purcell, CMA. We have Barbara Zieckler, Cindy Cavalieri and Hanna Larese who do our sperm processing and blood testing. Additionally, Delphine Weitzel, Janice Cohen and Michele Nagle do our ultrasound studies. Debbie Kibler is involved in gynecologic nursing for the Program. The Program Coordinator is Debra Schott, C.R.N.P., assisted by Robin Rohrer, R.N.C. Debra and Robin organize all of the patients going through IVF, in addition to other infertility therapies. The IVF laboratory is overseen by its Laboratory Director, Dr. Sheldon Schlaff, a Medical Endocrinologist.

IVF egg retrievals are performed in our office under I.V. sedation administered by an M.D. anesthesiologist from the Reading Hospital. This type of procedure usually takes about 20 minutes and our patients are kept very comfortable by the anesthesia staff. Spouses are not permitted to be present in the egg retrieval room but are encouraged to be at the embryo transfer. We have a monitor arranged so that our couples can see exactly what we see on our ultrasound during the cycle monitoring. Additionally, following the standard IVF procedure (not ICSI), our couples are able to see their eggs while being studied by the embryologist. They will also see their embryos immediately before the embryo transfer procedure.

The embryo transfer process is usually carried out three days after retrieval with the aid of ultrasound visualization to assure the embryo transfer catheter is correctly located in the uterine cavity. Our patients are accommodated in the office for about two hours after the transfer, and then go home to bed rest for an additional twenty-four hours.

The Women's Clinic, Ltd. takes great pride in our IVF program. We feel we have maintained a very superior program, and bring to it a very personalized atmosphere.