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Your Trusted Fertility Clinic In New York, NY

Your Journey. Your Family.

At Sher Fertility Solutions, we understand that each patient is unique. Everything we do is customized to you and your specific needs.

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Your Trusted Fertility Clinic In New York, NY

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Your Trusted Fertility Clinic in New York, NY

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Dr. Drew V Tortoriello MD

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Infertility diagnosis/treatment

The causes of infertility are multiple and are often difficult to define but may include anatomical conditions involving tubal patency and/or function as well as diseases of the testicles and/or or sperm ducts, dysfunctional levels of certain hormones in both men and women, and ovulation difficulties in women.

Recurrent miscarriage diagnosis/treatment

The time has come to embrace the reality that the term “unexplained” is rarely applicable to 1) infertility of unknown cause, 2) repeated IVF failure, and 3) recurrent pregnancy loss (RPL). More often than not, rather than being “unexplained,” the condition is simply ignored and as such remains “undiagnosed.” All that is needed is to investigate and treat the issue appropriately in order to solve the problem.

Egg freezing for future fertility

There are many reasons why patients may need to preserve their fertility. For some, it may be a focus on education and career delays and for others it may be due to an illness. Although the decline in reproductive potential that occurs with age cannot be reversed, freezing your eggs at a younger age may allow the eggs to be preserved until you are ready to conceive. While there are no guarantees, using cryopreserved eggs may improve your chances for pregnancy in the future.

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Dear Patients,
I created this forum to welcome any questions you have on the topic of infertility, IVF, conception, testing, evaluation, or any related topics. I do my best to answer all questions in less than 24 hours. I know your question is important and, in many cases, I will answer within just a few hours. Thank you for taking the time to trust me with your concern.

– Geoffrey Sher, MD

I Have a Question

Mosaic transfer

Name: Xiomara R

Hi!!
I have a grade 422 low level mosaic.
Specifically, it says 46, XY, -Yp (x0, mos, ~40%), -14 (x1, mos, ~50%).
What are my real options to have a healthy/sick baby if I get it transferred?

Thank you so much,
Xiomara

Answer:

  • Human embryo development is a marvel of intricate processes, including reprogramming, sequential cleavage divisions, mitotic chromosome segregation, and embryonic genome activation. However, the journey towards a successful pregnancy is not without its challenges, as chromosomal abnormalities can occur during germ cell and preimplantation embryo development, leading to early implantation failures and pregnancy losses.

    Two decades ago, a groundbreaking technique emerged: full embryo karyotyping through preimplantation genetic sampling (PGS)/preimplantation genetic testing for aneuploidy (PGT-A). This method revolutionized the field by allowing us to identify and characterize an embryo’s karyotype, enabling the selective transfer of euploid embryos (those with a complete set of 46 chromosome! into the uterus. This innovation led to a remarkable increase in implantation and birth rates, coupled with a significant reduction in early pregnancy losses following in vitro fertilization (IVF). Today, PGS/PGT-A is a standard practice worldwide.

    However, this advancement presents a moral and ethical dilemma. Many IVF programs require patients to consent to the disposal of all aneuploid embryos—those with irregular chromosome quotas. Recent evidence has raised questions about whether some aneuploid embryos, when transferred, can “autocorrect” during development, potentially resulting in healthy babies. This dilemma forces us to reconsider our approach to discarding embryos.

    The crux of this embryo “autocorrection” lies in the fact that many embryos labeled as aneuploid through PGS/PGT-A also contain chromosomally normal (euploid) cells. This coexistence of aneuploid and euploid cells within the same embryo is known as “mosaicism.”

    In response to this complexity, more IVF practitioners are opting to cryobank certain PGS/PGT-A-identified aneuploid embryos, preserving the option for future transfer. To make informed decisions in such cases, it’s crucial to understand the two types of embryo aneuploidy:

    Meiotic aneuploidy: This results from chromosomal numerical abnormalities originating in the egg or sperm during preconceptual maturational division (meiosis). Meiotic aneuploidy is permanent, affecting all subsequent embryo cells and often leading to implantation failure, early pregnancy loss, or chromosomal birth defects.
    2.    Mitotic aneuploidy (Mosaicism): This occurs when some cells of a meiotically normal early embryo, in the process of cell replication (mitosis), mutate and become aneuploid after fertilization. The outcome depends on whether aneuploid or euploid cells predominate. Mosaic embryos with more euploid cells are likely to undergo autocorrection once arriving in the uterus, leading to the propagation of chromosomally normal and healthy pregnancies.

    Differentiating between these two types of aneuploidy is crucial, and next-generation gene sequencing (NGS) has significantly improved the accuracy of full embryo karyotyping, aiding in the diagnosis of mosaicism.

    Several factors influence the autocorrection potential of mosaic embryos, including the stage of embryo development at diagnosis, affected chromosomes, the complexity of aneuploidy, and the percentage of aneuploid cells. Embryos diagnosed as “mosaic” at earlier stages may autocorrect as they develop into blastocysts. Segmental mosaic aneuploidies and lower percentages of mitotically aneuploid cells in the blastocyst increase the chances of autocorrection.

    Transferring embryos with autosomal meiotic trisomy often results in implantation failure, miscarriage, or the birth of a defective child. In contrast, autosomal mitotic trisomies, which can autocorrect, require careful consideration. Patients are advised to undergo prenatal genetic testing and be prepared to make difficult decisions if necessary.

    When dealing with meiotic autosomal monosomy, the chances of a viable pregnancy are minimal, with those that do implant often ending in early spontaneous miscarriage. However, mosaic autosomal monosomic embryos can often autocorrect, making them a viable option for transfer. Nevertheless, full disclosure to patients and a commitment to prenatal genetic testing are essential in such cases.

    When we biopsy an embryo for PGS/PGT-A, we test only a few cells, typically around six. If at least one of these cells is healthy (euploid) while the others are not (aneuploid), it’s called a “mosaic” embryo, and is potentially capable of self-correcting in the womb and leading to a healthy baby. On the other hand, if all the tested cells are aneuploid, it’s highly likely that the rest of the untested cells in the embryo are also abnormal, making it an unsalvageable, meiotically aneuploid embryo. However, we can’t be certain because we haven’t tested all the cells. So, even if we diagnose an embryo as aneuploid, in a few cases, it might still be mosaic and have a chance to develop normally in the uterus.

    In summary, while we can confidently diagnose euploid embryos, diagnosing mosaic embryos is currently not perfect, and there’s a possibility that some may have the potential to develop into healthy babies. Embryo mosaicism adds complexity to the world of IVF, forcing us to navigate a delicate balance between minimizing risks and providing opportunities for patients to have healthy babies. The evolution of diagnostic techniques like NGS has brought us closer to understanding and harnessing the potential of mosaic embryos, but the journey remains intricate and ethically charged.

    PLEASE SHARE THIS WITH OTHERS AND HELP SPREAD THE WORD!!

     

    Herewith are  online links to 2  E-books recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)……. for your reading pleasure:

    1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

     

    1. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

     

    I invite you to visit my very recently launched “Podcast”,  “HAVE A BABY” on RUMBLE;   https://rumble.com/c/c-3304480

    If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\

     

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Causes of Infertility

Causes of Infertility

Infertility refers to the inability to conceive despite engaging in well-timed unprotected sex for...

Our Team

The emphasis we put on innovative, state-of-the-art technology began with our founder, Dr. Geoffrey Sher, one of the pioneers in the field of IVF, who has been influential in the births of more than 17,000 IVF babies. Dr. Sher plays an active role alongside our medical director, Dr. Drew Tortoriello. Together they have over 55 years of clinical and academic experience in the field of Reproductive Medicine.

Together, they were the first to introduce Preimplantation Genetic Testing which vastly increases the chances of IVF success and is now performed worldwide. They also pioneered the testing and treatment of Immunologic Implantation Dysfunction (IID) that frequently leads to “unexplained” infertility, repeated IVF failure, and recurrent miscarriage. We’re able to conduct a variety of other treatments and tests right on site. For example, we offer on-site sperm testing to ensure proper sperm selection techniques are used to create the healthiest possible embryos.

For those women seeking to preserve their fertility, we offer vitrification, a state-of-the-art technology that ensures their eggs will ultimately be thawed successfully.

From the moment you walk into our state-of-the-art New York fertility clinic, you’ll feel the warmth and compassion that will define your experience with us. Drew Tortoriello, MD serves as our Medical Director. He’s an outstanding fertility specialist that you’ll find to be caring, compassionate and personable.

When you receive fertility treatment with us, your doctor will participate with hands-on management of your case throughout your treatment. We’ve gained a reputation of being the place to turn to when all other treatment options have failed, and patients are searching for hope and fresh alternatives.

TL;DR:

  • Our doctors are among the best in the world, with over 55 years of combined experience
  • Together, they pioneered several tests and treatments that can help where other treatments have failed
  • We do many tests right here at the clinic, which means faster results and ensures proper techniques are used
  • Your doctor will be with you at every step of your treatment
  • Everyone here will get to know you during your treatment so you won’t just feel like a number
  • We’re known for being the clinic to go to when all other treatments have failed