Medical testing for intended parents
Uterine assessment of the recipient: It is important to evaluate the uterine cavity and endometrial lining in all embryo recipients. The presence of any surface lesion protruding into the uterine cavity, whether polyps, uterine synecheae, fibroids or congenital defects, are all capable of eliciting a macrophage response, similar to that produced by a uterine contraceptive device. Such a “foreign body response” might seriously prejudice implantation. Similarly, an inadequately estrogen-proliferated endometrium could likewise reduce the chances of a successful outcome. The performance of hysteroscopy or hydrosonography can readily identify all relevant uterine surface lesions while ultrasound measurement of endometrial pattern and thickness around the time of normal or induced ovulation, will assist in the assessment of implantation potential.
Medical evaluation: While advancing age, beyond 40 years, is indeed associated with an escalating incidence of pregnancy complications, such risks are largely predicable through careful medical assessment prior to pregnancy. The fundamental question namely: “Is the woman capable of safely engaging a pregnancy that would culminate in the safe birth of a healthy baby” must be answered in the affirmative, before any fertility treatment is initiated. For this reason, a thorough cardiovascular, hepato-renal, metabolic and anatomical reproductive evaluation must be done prior to initiating IVF in all cases. On a case by case basis, clearance from an internist is required, particularly in women older than 45 years of age, contemplating pregnancy.
Selective immunologic evaluation and immunotherapy: Certain female organopelvic conditions such as endometriosis as well as a personal and family history of primary autoimmune disorders are associated with a high incidence of immunologic implantation failure. This is related to an abnormal endometrial lymphocyte response involving Natural Killer (NK)-cell and T- cell activation, which can be evaluated through the measurement of specific phenotypic markers on the surface of such lymphocytes that spilled over into the peripheral blood. The detection of IgM and IgG-related antiphospholipid antibodies in the peripheral blood also point to an increased likelihood of subsequent immunologic implantation failure. It is for this reason that we selectively evaluate recipients so at risk, for lymphocyte induced TH-1cytokinopathies and thereupon selectively prescribe therapeutic immunomodulation with heparin, steroids and/or immunoglobulin.
Assessing sperm function: A comprehensive computerized semen analysis and semen cultures along with the performance of an indirect immunobead blood test for antisperm antibodies are necessary to establish a basis for selective enhancement of fertilization through micromanipulation procedures including intracytoplasmic sperm injection (ICSI).