Infertility Diagnosis
Infertility diagnosis mandates a comprehensive approach involving both partners. Initial meetings with Diamond physicians and assessment of previous treatments elsewhere lead to individualized plans combining the most current evaluative methods. All testing is performed at Diamond Institute, where a sensitive, supportive team has built on almost four decades of expertise. The workup for factors contributing to couple infertility includes the following.

General preconception workup: To ensure optimum parental health prior to conception, Diamond Institute conducts physical examinations and tests for STDs and performs the spectrum of prenatal tests – including cervical (Pap) smears, genital cultures, urine cultures, and additional screening (blood group antibodies, CBC, blood chemistry, and screening for carriers of genetic diseases such as cystic fibrosis, sickle cell anemia, fragile X syndrome, and Tay-Sachs).

Male Testing: Physical examination can reveal anatomical issues and sophisticated, computerized sperm analysis evaluates sperm concentration, motility (movement), and morphology (shape). If indicated Diamond can conduct additional endocrine testing as well as testing for antibodies (female against sperm, male against sperm).

Day 3 Hormone Profile: Hormonal imbalance on one or several fronts can affect fertility. Blood is collected from the patient on the third day of her menstrual cycle to obtain a complete hormonal profile including pituitary, thyroid, adrenal, and ovarian levels. Along with FSH (follicle stimulating hormone) testing, these results can indicate issues related to ovarian reserve, egg quality, implantation capability, and other, often-treatable factors related to successful pregnancy.

Pelvic Ultrasound: An ultrasound study of the uterus and ovaries will detect uterine fibroids, ovarian cysts and other abnormalities.

Hysterosonogram: This ultrasound conducted during injection of fluid into the uterus assesses that cavity – its shape, the presence of polyps or fibroids that can interfere with implantation – and can reveal whether the fallopian tubes are patent (open).

Hysterosalpingogram (HSG): Using injected contrast material, this is a radiological study of the uterine cavity and fallopian tubes.

Endometrial Biopsy: Aspiration of a small sample of uterine lining to detect infection or inflammation that can interfere with conception.

Hysteroscopy: During this same day surgical procedure, a scope is introduced transvaginally into the cervix and uterus for direct visualization of the uterine cavity to further rule out scar tissue, polyps, fibroids, or other malformations related to infertility. Treatment can be performed via this procedure.

Laparoscopy: This same-day surgical procedure introduces a scope through the umbilicus to visualize the pelvic cavity and detect possible tubal issues, adhesions, and endometriosis. If these conditions exist, treatment can be delivered at the same time.

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Controlled Ovarian Stimulation (COS): The ovary is stimulated using hormonal formations for ovulation timing and the production of multiple eggs. Bloodwork (estrogen, progesterone, lutenizing hormone – LH) as well as uterine and ovarian ultrasound monitor COS cycles. Several procedures can be combined with COS:
• Intra Cervical Insemination (ICI): Sperm is placed in the cervix just prior to ovulation.

• Intra Uterine Insemination (IUI): Sperm is washed, processed, and placed directly into the uterine cavity at the time of ovulation.

• Intra Peritoneal Insemination (IPI): Under local anesthesia, sperm is directed into the pelvic cavity through the vaginal wall.

• Artificial Insemination with Donor Sperm (AID): Using one of the above methods, this procedure utilizes donor sperm.

In Vitro Fertilization – When indicated by conditions including tubal blockage, endometriosis, ovarian dysfunction, and male factor infertility, the patient is sedated and through ultrasound, eggs are retrieved vaginally and fertilized by obtained or donated sperm in the Diamond Institute laboratory. Embryo transfer (ET) follows. IVF can involve one of several methods as well as embryo testing, and embryo reserve.
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• Fertilization Embryo Transfer: Embryos are transferred into the uterus three to five days after fertilization.

• Intacytoplasmatic Sperm Injection (ICSI): A single sperm is micro-injected into each egg to create embryos for ET. Click here to see video

• Testicular Sperm Aspiration (TESA): If the ejaculate contains no sperm for IVF or ICSI, direct aspiration from testicular tissue can produce viable sperm.

• Assisted Hatching (AH): When indicated by factors including maternal age, elevated FSH, or zona factor (thick outer embryo capsule), AH penetrates the shell to alleviate constriction and allow the embryo to develop and increase implantation potential.

• Pre-implantation Genetic Diagnosis (PGD): Diamond Institute can perform chromosomal/genetic testing on one embryo cell to detect abnormalities such as Down’s syndrome or cystic fibrosis. Click here to see video

• Embryo Freezing – Diamond Institute freezes couples’ embryos not used in implantation for future fertilization cycles.
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Gamete Intrafallopian Transfer (GIFT): Using laparoscopy, a mix of sperm and egg is placed directly into the fallopian tube.

Zygote Intrafallopian Transfer (ZIFT): With laparoscopy, this places fertilized eggs directly into the fallopian tube.

Oocyte Freezing: When pregnancy is delayed by choice or for medical issues that would affect later egg production (e.g., chemotherapy, radiation) Diamond Institute can freeze eggs for future pregnancy via IVF.

Tubal Embryo Transfer (TET): Using laparoscopy, a more advanced embryo is placed in the fallopian tube.

Hysteroscopy: Diamond Institute offers patients with intrauterine conditions including polyps, submucosal fibroids, or uterine septum scar tissue the option of correction at the facility.

Laparoscopy: This on-premise procedure can correct pelvic scar tissue, ovarian cysts, endometriosis, and other conditions related to infertility.

Microsurgery: Usually performed through laparotomy in a hospital surgical setting, microsurgery can repair blocked fallopian tubes and other pelvic abnormalities often involving the release and resection of scar tissue.

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Egg Donation
A woman who is unable to use her own eggs to conceive a baby may opt for egg donation. This is a very rewarding option because of high success rates as well of the reduction of risk for miscarriage and/or genetic malformation. Most of the time donors remain anonymous; however, donors known to recipients can participate. Diamond Institute prepares each donor and recipient for all clinical processes involved. Diamond complies with all current FDA Donor Guidelines and regulations.
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Gestational Surrogacy
An extension of in vitro fertilization, gestational surrogacy refers to the arrangement where a surrogate carries a pregnancy created by a transferred embryo produced by the intended parents. Diamond Institute evaluates carriers as well as intended parents -- medically and emotionally – before initiating any procedures. A legal agreement is established as well.

Preimplantation Genetic Diagnosis (PGD)
To give each couple a better potential outcome of producing a healthy baby, Diamond Institute employs preimplantation genetic diagnosis (PGD) along with in vitro fertilization. PGD screens early stage embryos for specific genetic diseases and/or chromosomal abnormalities. The process involves extracting and analyzing single cells from embryos, testing them for these issues, and then implanting embryos in the uterus when the results are clear.



Evaluation and Treatment of Recurrent Pregnancy Loss
Approximately 20 percent of patients come to Diamond Institute because they have encountered several consecutive pregnancy losses. Most experts begin evaluation and treatment following two first-trimester miscarriages or one second-trimester loss. Diamond’s comprehensive approach to diagnosis and treatment has yielded promising results for the majority of our patients. Together with couples that remain dedicated to achieving their dreams of full-term pregnancies, we have seen many healthy babies born.

Evaluative Services and Solutions
Chromosomal Studies (Karyotype) – Bloodwork can determine if either partner harbors a specific chromosomal rearrangement carrying miscarriage probability. Chromosomal rearrangements account for a small number of all recurrent pregnancy losses.
Advanced in vitro fertilization (IVF) techniques and preimplantation genetic diagnosis (PGD) through embryo biopsy can reduce miscarriage potential from chromosomal and genetic problems.

Female Blood Clotting Studies – Specific thrombophilic disorders – some immunologic, others from genetic mutation or blood and tissue factors – can lead to excessive clotting during pregnancy.
Thinning the blood with baby aspirin or other anti-coagulants often allows women to carry pregnancies to term.

Additional Blood Studies – Our workup includes thyroid function testing, hormonal assessment of ovarian reserve, glucose tolerance testing to detect diabetes or glucose intolerance, and determination of prolactin (lactation hormone) levels to see if there is an overabundance of the hormone, a possible miscarriage cause.
Correction of abnormalities can help women maintain pregnancies.

Uterine Anatomy Imaging – At our facility, Diamond physicians can detect anatomical problems using non-invasive radiological studies, including pelvic ultrasound, sonohysterography, and hysterosalpingogram (HSG).
At Diamond, minimally invasive treatment of anatomical disorders – including intrauterine polyps, myomas (fibroids) and congenital developmental abnormalities – can correct the majority of these factors. Using hysteroscopy, considered the gold standard for uterine and endometrial cavity evaluation, we can perform corrective surgery here on the same day as diagnosis.

Hopeful Outcomes – Losing a pregnancy carries the same disappointment and grief as losing a child at any age. Thanks to twenty-first century technology and a strong foundation of clinical experience, we can guide couples to the happy results of term pregnancies with healthy babies. For some the solution is relatively easy while others encounter extended treatment. We urge our patients to maintain hope and encourage them to seek individual counseling or to join support groups – whatever provides a comfort level, and to work with Diamond to help them reach their family goals.

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