Dr. Hosseinzadeh’s over 20 years experience along with her commitment to do what is best for the international fertility patients makes her uniquely qualified to take care of you.
Her many years of experience gives her the ability to tailor your treatment to suit your needs with respect to the amount of time you are able to spend in our wonderful city of San Diego.
We offer telephone consultations to facilitate the process in order to gather the information, order the necessary diagnostic tests and review the treatment options. Many of our international fertility patients are able to have their testing done locally, near their home as well as some of their monitoring. Prior to starting your treatment cycle, you will be given a calendar of when to anticipate your procedures and we will be with you at every step of the way, to hold your hand, give guidance and answer all your questions.
Once you travel to San Diego, Dr. Hosseinzadeh will conduct all of your appointments, unlike larger practices where you are treated by a variety of physicians and no one really knows your specific situation personally.
We offer quality care in a small, boutique setting. Some of the types of treatments we offer our international patients are listed below:In Vitro Fertilization
Depending on your situation, you may opt to travel to San Diego for the entire IVF cycle, including stimulation, egg retrieval and embryo transfer. For some patients, the first part of the stimulation regimen can be monitored by your OBGYN at home and the results are communicated to Dr. Hosseinzadeh who will be making all decisions regarding the dosage of your medications. Once the follicles are larger, you will travel to San Diego and have the egg retrieval performed. The embryo transfer will follow a few days later after which you may fly back home.
Read more about our In Vitro Fertilization Program here.
What is PGD?
Genetic testing of embryos is a state-of-the-art procedure, which enables us to screen embryos for genetic diseases before the embryos are transferred into the uterus. The purpose of this is to decrease the likelihood of finding chromosomal abnormalities, once the patient is pregnant, during prenatal diagnosis with tests such as chorionic villus sampling, amniocentesis or fetal blood cell testing. In order for PGD to be performed a patient must undergo IVF. There are 2 types of genetic testing:
Preimplantation Genetic Diagnosis (PGD):
In this procedure the embryos are tested for a specific disease such as:
- Chromosomal translocations (where parts of the chromosomes have been rearranged).
- Single-gene disorders where there is a mutation in a single gene. There are over 4,000 single-gene disorders. The most common diseases tested for are Cystic Fibrosis, Fragile X, Thalassemia, Sickle cell, and Huntington’s disease.
- Inheritable cancers such as BRCA1, which would increase the chance of passing the disease to your child.
- Sex selection for inherited diseases that are sex linked.
Preimplantation Genetic Screening (PGS):
PGS tests for the overall total number of chromosomes present in the embryo. In this procedure the embryos are screened for aneuploidy, which is testing for missing or additional chromosomes. An example of this would be Down’s syndrome which consists of an extra chromosome 21. As women age, the egg quality decreases and as a result the incidence of chromosomal abnormalities in the eggs increases. Embryos with missing or extra chromosomes generally result in either a miscarriage or a baby with chromosomal abnormalities. In the past, embryo selection for transfer was based on the “look” of the embryo. However we know that this can be misleading as even “good looking” embryos can be aneuploid or abnormal. PGS has revolutionized the field as we now have a powerful tool to select the normal embryos in order to increase implantation and pregnancy rates.
Who Would Benefit From PGD/PGS?
Some of the patients who would benefit from PGD include:
- Couples where one or both partners are carriers of an inherited genetic disorder.
- IVF patients over the age of 35.
- Patients with diminished ovarian reserve, regardless of their age.
- Patients who have had 2 or more failed IVF cycles.
- Patients with multiple miscarriages.
- Couples interested in gender or sex selection.
How is PGD Performed?
At Fertility Institute of San Diego, we use the latest cutting-edge modalities in an attempt to provide the best service for our patients. The PGD is comprised of 2 steps:
- The first step is the embryo biopsy. We usually perform the embryo biopsy at the blastocyst stage of development (day 5 embryo). A laser is used to make an opening in the shell of the embryo and a trophectoderm biopsy is performed in which a few placental cells are removed. This is a very delicate procedure that could damage the embryo.
- The second step is the genetic testing. The cells that are removed are sent to our reference cytogenetic lab. At the present time we use the services of Dr. Mark Hughes in Detroit, Michigan at Genesis Genetics. The tests typically performed on the biopsied cells are either
- Polymerase Chain Reaction (PCR) in cases where a single gene is being assessed, or
- Comparative Genomic Hybridization (CGH) in which the complete chromosomal composition of the embryo, all 46 chromosomes, are assessed. This is the most comprehensive way of assessing an embryo for aneuploidy.
As it normally takes up to 48 hours to receive these results, after the embryo biopsy is performed, the embryo is immediately frozen at the blastocyst stage. The normal embryos are transferred back in a subsequent frozen embryo transfer.
What are the Limitations of PGD?
Some of the important things to keep in mind are that:
- PGD cannot screen for all genetic diseases.
- Normal results do not completely eliminate the risk of genetic diseases.
- It is possible for all of your embryos to be abnormal in which case a transfer cannot be performed and the cycle is cancelled.
- There is a very small risk (0.1%) that the embryo may be damaged during the biopsy procedure.
- Misdiagnosis due to a phenomenon called mosaicism is possible. This is because not all of the cells in an embryo are the same. In the past the vast majority of patients had biopsies performed on day 3 embryos where only one cell was removed. If this cell was the only abnormal one in an otherwise normal embryo, then an otherwise normal embryo would have been discarded. Conversely, if the one cell biopsied was the only normal cell in an otherwise abnormal embryo, an abnormal embryo would have been inadvertently transferred. This is why at the Fertility Institute of San Diego, we primarily perform the embryo biopsy on day 5 as on this day the embryo has hundreds of cells and it is possible to remove 5-10 cells for testing thereby minimizing the problem of mosaicism.
- PGD is not considered a replacement for prenatal testing.
Read more about our Preimplantation Genetic Diagnosis Program here.
An egg donation cycle can be performed in one of two ways:
Fresh Embryo Transfer Cycle:
The cycle of the donor and intended recipient are coordinated so as to perform a fresh embryo transfer. This type of cycle is usually easier for the intended recipient than a traditional IVF cycle. The donor is monitored in our office and the recipient is only required to be in town for the embryo transfer. As a sperm sample is required on the day of the egg retrieval, most couples arrive at this time and are able to fly back after the embryo transfer. Alternatively, if your sperm parameters allow, a sperm sample that has been previously frozen can be used so that you can shorten your stay even further, and only the intended parent on whom the embryo transfer will be performed will be needed at the time of the embryo transfer.
Frozen Embryo Transfer Cycle:
In this scenario, the donor is monitored, the eggs are harvested, fertilized and the resulting embryos are grown in culture and usually cryopreserved or frozen at the blastocyst stage. A sperm sample will be required on the day of the egg retrieval, and depending on your circumstances either a fresh sperm sample or alternatively a frozen sperm sample that is stored in our institution can be used. Following this, the cycle of the intended parent is coordinated so that the approximate day of the embryo transfer is predetermined at a time that is convenient for you. You may begin the preparation for this cycle at home and arrive in San Diego closer to the time of the embryo transfer.
Read more about our Egg Donor Program here.
You are the one who chooses the surrogate. She may be a family member, friend or chosen from a Surrogacy agency. The surrogates undergo an extensive screening as well as psychological assessment. They must also give informed consent for the procedure. Surrogates are also required to execute a legal contract.The process will vary depending on whether the intended parent will be providing the eggs or using an egg donor. In the case where the intended parent is providing the eggs, your cycle will be similar to a long-distance IVF cycle. If you plan on using an egg donor, then your cycle would resemble that of a long-distance egg donation cycle.
Read more about our Gestational Carrier/Surrogacy Program here.
What is Egg Freezing?
The American Society for Reproductive Medicine no longer considers egg freezing or cryopreservation experimental. Egg freezing involves stimulating the ovaries with gonadotropins, undergoing an egg retrieval to extract the eggs, freezing and then storing these eggs. The eggs can be stored for several years and when one is ready to use them, the eggs are thawed, fertilized with sperm to create embryos and transferred into the uterus.
Advances in cryoprotectants and the new vitrification protocols have resulted in significant survival rates compared to the slow freezing protocols used in the past. This innovative procedure better protects the delicate cell structure of the unfertilized egg by preventing the formation of ice crystals in the egg and as a result they are less likely to fracture upon thawing.
This new technology has revolutionized the field of reproductive medicine in that for the very first time, women now have a means to stop their biological clock. To date, approximately 2,000 babies have been born from frozen eggs. There appears to be no increased risk of birth defects when compared to the general population.
Who Would Benefit From Egg Freezing?
Some of the patients who would benefit from egg freezing include:
- Women diagnosed with cancer prior to undergoing chemotherapy or radiation therapy.
- Women undergoing IVF for whom embryo freezing or cryopreservation is not an option for ethical, religious or moral reasons.
- Women who must undergo surgery to remove their ovaries due to diseases such as endometriosis.
- Women with a family history of premature menopause who may wish to freeze eggs before their eggs are depleted at an early age.
- Single women in their 20s and early to mid 30s who desire to delay becoming pregnant due to the pursuit of career or educational goals, not having met their life partner, or for other personal or medical reasons.
Is Egg Freezing For You?
If you are considering egg freezing, we ask that you contact us to set up an appointment, as your success rates will depend on several factors. The most important factors that come into play will be your age and your ovarian reserve testing. The younger you are and the more eggs that you have, the greater the likelihood for success.
In order to be able to counsel you with a greater degree of accuracy, we will first need to assess your ovarian reserve or egg quality. You will be asked to come in on the 3rd day of your menstrual cycle in order to measure the hormones FSH (follicle-stimulating hormone), estradiol (estrogen level) and anti-Müllerian hormone (AMH). You will also undergo a transvaginal pelvic ultrasound in order to measure your total antral follicle count (AFC). With this information in hand, Dr. Hosseinzadeh will be in a better position to counsel you regarding whether you are a candidate for this procedure.
How Many Eggs Should I Bank To Achieve a Pregnancy?
In good prognosis patients, thaw rates of 75% and fertilization rates of 75% are to be anticipated. In women under the age of 35, it is recommended to have at least 10 eggs to freeze and 20 eggs if you are 35 years or older. Unfortunately, women over the age of 35 usually require multiple stimulation cycles in order to be able to freeze this number of mature eggs.
Patients must be cautious and understand that there are no guarantees that they will have a baby even if they freeze this number of mature eggs. Also, not all pregnancies will result in a baby, as approximately 15% of patients will have a miscarriage.
There are many ways to help our patients achieve their goal of becoming parents depending on what your situation and diagnosis maybe. We tailor the treatments to your needs with the compassionate care that you deserve. Dr. Hosseinzadeh will review all of the options available to you so that you can make an informed decision of what best suits you.
Family Building Options for Women:
Some of the treatment options available are:
- Donor insemination by intrauterine insemination is an option for single women and lesbian couples. The sperm donor may be someone known to you or you may select a donor from a sperm bank. This approach will allow you to have a biological connection to your child.
- Same sex couples also have an option through IVF in which one partner undergoes the ovarian stimulation and egg retrieval and the resulting embryos are transferred into the uterus of the other partner to carry the pregnancy. This way both partners are contributing and sharing in the experience of making their dreams a reality.
Family Building Options for Men:
Some of the treatment options available are:
- Using a “traditional surrogate” for single men and gay couples. In this situation, the “surrogate mother” carries an embryo conceived with her own eggs and the sperm of the male wishing to have a child. This can be achieved via intrauterine insemination (IUI) or in vitro fertilization (IVF). The gestational surrogate is the biological mother of the child and makes this kind of surrogacy more legally risky as the surrogate may change her mind and decide that she is the mother of the child and would like to keep the baby.
- Using an egg donor and a “gestational surrogate”. In this scenario, IVF is used and the eggs from the egg donor are fertilized with the sperm from the intended father. Subsequently, one to two embryos are transferred into the uterus of the gestational carrier who in this case has no biological connection with the child. As this option is less legally risky, this is the option we recommend to most of our patients.
Out of State and International Fertility Patients
Dr. Hosseinzadeh’s over 20 years experience along with her commitment to do what is best for the patients makes her uniquely qualified to take care of you. Dr. Hosseinzadeh will conduct all of your appointments, unlike larger practices where you are treated by a variety of physicians and no one really knows your specific situation personally. We offer quality care in a small, boutique setting. Her years of experience gives her the ability to synchronize and coordinate the cycles of donors, surrogates and the intended parent in order to simplify the process for patients who are required to travel to our center. You will be given a calendar of what to expect and we will be with you at every step of the way, to hold your hand, give guidance and answer all your questions.
Happy Doctor’s Day to a fantastic Doctor !
We are so lucky to have met you and we will be forever grateful for your help!