Diagnostics and Laboratory Services
Stanford Medicine Fertility and Reproductive Health Services provides comprehensive diagnostic and treatment options and laboratory services for women and men.
Women’s Fertility Services
- Hormone Testing
- Endometriosis
- Amenorrhea
- Uterine fibroids
- Ovulatory disorders
- Recurrent miscarriage
- Tubal disease
Men’s Fertility Services
- Semen analysis
- Sperm preparation for intrauterine insemination
- Urology referrals and coordination
- Full service andrology testing
The REI Laboratory
Stanford’s REI Laboratory conducts a wide variety of reproductive hormone and andrology tests. Our endocrine laboratory uses state-of-the-art instrumentation taking advantage of the new non-radioactive automated assay systems. Our andrology laboratory uses CASA (Computer Assisted Semen Analyzer)—another example of cutting edge technology in the laboratory. Headed by leading medical technologists, our experienced laboratory staff are all highly specialized in REI.
Medical and Surgical Options
Many conditions that result in infertility respond to medical or surgical therapy. the Stanford REI Center offers the most advanced treatment options available.
Medical Therapy
Oral or injectible medications may be used for medical therapy for infertility. Your physician will provide detailed information about your particular treatment plan.
Reproductive Surgery
Stanford physicians offer the latest surgical therapies for infertility including video laser laparoscopy, video hysteroscopy, myomectomy and tubal ligation reversal. We offer the full range of diagnostic and operative laparoscopic procedures, including ablation of endometriosis, treatment of ectopic pregnancies, and surgeries on the fallopian tubes and ovaries.
Assisted Reproductive Technologies
Assisted Reproductive Technologies (ART) refers collectively to the various procedures and techniques involving the laboratory handling of human oocytes (eggs) and/or embryos. These options offer new hope to infertile couples who may have been considered untreatable, or for those who have not responded to traditional medical treatment.
Infertility treatment is rapidly evolving, nowhere more so than here in the Stanford REI Center. Although ART procedures generally follow the steps described below, no single approach is exactly the same for each person. Your health care team will discuss every option and every step with you in great detail. They will also discuss current success rates that may apply to your specific situation.
If the cause of infertility is suspected to be the inability of sperm to reach and fertilize the egg, or if the quality of cervical mucus is inappropriate, intrauterine insemination can be tried. Semen prepared in our lab is deposited directly into the uterus via a small catheter bypassing the cervical mucus and placed closer to the egg.
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) includes these steps:
Ovarian Stimulation
Women with normal ovarian function generally produce one egg per month. To increase the number of mature eggs available for fertilization, the ovaries are stimulated with carefully regulated hormone doses, administered by injection. Your physician will monitor your response to these hormonal preparations and track follicular development through ultrasound scans and blood tests.
Egg Retrieval
Ovulation is triggered with a hormone injection. Once the follicles mature, your physician will retrieve as many eggs as possible, using a technique called ultrasonically guided aspiration. With the patient under conscious sedation or light anesthesia, the physician uses vaginal ultrasound to direct a needle through the vaginal wall to aspirate mature oocytes (eggs) from the ovary.
Fertilization
The fertilization and transfer of embryos can be accomplished by in several ways.
In vitro fertilization (IVF) occurs the same day as the egg retrieval. A semen sample is collected and the retrieved eggs are placed in a laboratory dish with the motile sperm where fertilization takes place. (The fertilized eggs develop from 3 to 5 days in a special culture medium in a controlled environment, and are then transferred to the woman’s uterus for potential implantation and embryo development.)
Intracytoplasmic sperm injection (ICSI) is an effective treatment for male infertility. Following egg retrieval, a single sperm is injected into each egg. It is possible to aspirate sperm directly from the epididymis or testicles utilizing the technique percutaneous epididymal sperm aspiration and testiclular sperm estraction (PESA/TESE), ways of recovering sperm from men with obstructive and non-obstructive azoospermia (no sperm in ejaculate).
Preimplantation genetic diagnosis (PGD) brings the emerging technologies of genetics and IVF together for the first time allowing eggs or embryos to be tested for various chromosomal or genetic conditions before impolantation during the IVF process.
Embryo Transfer
Embryos are transferred into the uterus either day 3 or day 5 after retrieval. The transfer is done in an office setting under ultrasound guidance. A small catheter is passed through the cervix and the embryos are placed into the uterus.
Assisted hatching involves laboratory manipulation of the embryo to create an opening in its outer covering (zona pellucida). Allowing the embryo to emerge in this way can increase the chance of implantation, especially in reproductively older women.
Blastocyst transfer (BT) is a technique introduced here at Stanford University in 1998 by our embryologists and physicians.1 As with IVF, the eggs are retrieved from stimulated ovaries, fertilized, and allowed to develop for 3 days in a special culture medium. The embryos are then transferred to a new chemical-based culture medium for 2 additional days before being transferred to the woman’s uterus. During those crucial days, the embryos undergo key developmental changes that help to determine which are most likely to survive. The extra days also allow for further enrichment of the uterine lining, increasing the chances for successful implantation. Physicians transfer fewer embryos, called blastocysts at this stage, thereby reducing the chance for multiple births. In the last four years, we have performed several hundred blastocyst transfers with a success rate in the range of 50% per cycle. We believe that patients with more than three good quality embryos on the third day are most likely to benefit from going to a day 5 transfer.
Egg Transfer
During the time between transfer and the pregnancy test, medications are continued to support the pregnancy. Approximately two weeks after embryo transfer, pregnancy can be detected by blood testing. Early and close monitoring of pregnancy in our clinic is highly advisable. Ultrasounds are usually done two and four weeks after a positive pregnancy test to determine fetal heart beat.
Embryo Cryopreservation
This procedure allows storage of embryos through freezing for transfer at a later date. The extra eggs retrieved during a cycle can be fertilized and then stored for use in a later cycle. If the uterine lining is not suitable for implantation in a stimulated cycle, cryopreservation allows transfer during a different menstrual cycle. Women facing medical procedures affecting fertility can use cryopreservation to bank embryos for the future.
Most assisted reproductive technologies are no longer considered experimental. The American Society for Reproductive Medicine (ASRM*) considers the following procedures to be within mainstream medical care:
- IVF
- Donor oocytes
- Embryo cryo-preservation
- ICSI for male infertility
*Established in 1944, the ASRM comprises over 10,000 fertility specialists worldwide.
Third Party Reproduction
Third party reproduction (The donor oocyte (egg) program) offers hope for women who have failed other treatments or have poor or no egg production. With egg donation, the father contributes genetically and the recipient mother carries the baby. With the ability to retrieve eggs from one woman and implanting the embryos into another, this procedure offers a solution to a problem that was not previously solvable. Third party reproduction allows a genetic and biological link to the child, control of the prenatal environment, and no legal complications.
Fertility Preservation
Embryo freezing, egg freezing and ovarian tissue freezing are fertility options being offered the patients undergoing cancer therapy. In the face of a disease like cancer, it is easy to lose the will to fight, especially when realizing that the hope of having children might not be possible. Stanford University has been a pioneer in fertility preservation for these patients.
Genetic Evaluation and Counseling
As one of the country’s leading teaching and research institutions, we are working toward new discoveries in all areas of women’s health. Stanford University Medical Center remains at the forefront of medical and technological innovation in infertility treatment. The Stanford REI Center addresses all aspects of your care—including emotional support and genetic counseling.
We recognize that assisted reproduction represents an important crossroad in your long, stressful, and emotionally difficult struggle with infertility. To address the psychological aspects of infertility and hormone effects, the Stanford REI Center offers individual and group support through our professional and caring counseling staff.
Our ART Laboratory and faculty facilitates genetic evaluation for male and female factor infertility and preimplantation genetic diagnosis. In addition, genetic counseling is provided by an outstanding group of genetic counselors.