Welcome to the Fertility and Genetic Department of Al Khalidi Medical Center. 

It was established in 1998 as a tertiary care facility. Now we are one of jordanian largest and most experienced infertility clinics. We offer couples who have been unable to achieve pregnancy the opportunity to get pregnant by utilizing a number of various techniques and treatment options . Our department is committed to providing state-of-the-art fertility treatment in a friendly, comfortable and supportive environment at a reasonable cost.  ( Virtual Tour )

Our Philosophy

 We promote informed decision-making, superior yet sensitive care with utmost confidentiality, and the principles of total quality management. We provide a safe, ethical, evidence based approach to assisted reproductive technologies. We value the unique needs and cultural diversity of the individuals and the contributions of a skilled, multi-disciplinary team.

 Dr. Suleiman Dabit is the Head of ART and Genetic Department, Al Khalidi Medical Center :  

Consultant Obstetrician & Gynecologist Infertility Consultant Austrian Board for Obstetrics & Gynecology Arabic Board for Obstetrics & Gynecology Member of the American Society of Reproductive Medicine Member of the European Society for Reproductive Medicine and Embryology Middle East Fertility Society Ambassador for Jordan Dr. Suleiman 's e-mail is ivf@kmc.jo         ( Virtual Tour )

  Procedures

• In Vitro Fertilization (IVF)
• Intracytoplasmic Sperm Injection (ICSI)
• Sperm Retrieval (MESA/PESA/TESA)
• Embryo Freezing (Cryopreservation)
• Assisted Embryo Hatching
• Blastocyst Transfer
• Ovulation Induction & Super ovulation
• Male Infertility Services
• Genetic Counseling & support
• Intrauterine Insemination (IUI)
• Hysteroscopy
• Laparoscopy

( Virtual Tour )

  Available Treatment and Technologies   

Treatment Comprehensive infertility evaluation Male infertility treatment Laparoscopic surgery Hysteroscopy surgery Intrauterine Insemination (IUI) Recurrent pregnancy loss evaluation and treatment Reproductive immunology

Gynecologic Endocrinology Menstrual irregularities Polycystic Ovarian Syndrome (PCOS) Endometriosis Pelvic Adhesions Uterine fibroids Premature ovarian failure Menopause

Ovulation induction and stimulation protocol

 Assisted reproduction technology relies on the production of multiple mature oocytes for fertilization in order to increase the likelihood of pregnancy. Controlled ovarian hyperstimulation (COH) may be achieved by clomiphene citrate or exogenously administerted gonadotropins. The best predictors of ovulation response to COH are the patients age , early follicular phase serum follicle stimulating hormones (FSH ) and Estradiol concentration which are reliable predictors of ovarian response to pharmacological stimulation.

 In general , one may safely assume, that the standard ovulation induction protocol ,with or without GnRH analog for pituitary desensitization ,will result in desired response in the young patient with normal ovarian physiology. It is in the low responder patient that provides the greatest challenge to the reproductive endocrinologist and for whom the choice of protocol becomes challenging in obtaining the best possible response.

 Ovulation induction and intrauterine insemination (OI/IUI)

 Although not strictly in the ART category, ovulation induction and intrauterine insemination (OI/IUI) comprises a major part of most infertility practices. Strict indications for intrauterine insemination which is the deposition of sperms in the uterine cavity – are male subertility and cervical mucous barrier to sperm.

 The ultimate goal of the procedure is to bypass the cervical mucous barrier and increase sperm density at the site of ovulation. A variety of techniques has been developed for the separation of higher quality sperm, the most popular of which are the wash and swim-up, the discontinuous percoll gradient. With OI/IUI, may expect pregnancy rates per cycle 13-18% in cases of male subfertility, and 20-26% in women with nontubal infertility.

 Gamete intrafallopian transfer (GIFT)

 Gamete intrafallopian transfer involves the transfer of the preovulatory oocyte and washed sperm into the ampullary portion of the fallopian tubes. Following controlled ovarian hyperstimulation and egg retrieval (via ultrasound guidance or laparoscopy), commonly 1-2 oocytes along with 100,000 washed sperm are transferred into each tube.

 In vitro fertilization and embryo transfer (IVF/ET )

 A new era in the field of human reproduction began in 1978 with the birth of the first baby conceived by in vitro fertilization.

 Intracytoplasmic sperm injection (ICSI)  

The successful fertilization of clinical pregnancies resulting from the injection of a single spermatozoon into the oocyte (ICSI) which started a new era in the field of assisted reproduction. This technique is performed in cases of severe male infertility and combination with MESA, PESA or TESA.  There is no evidence to date for any significant increase in the rate of major congenital malformations in children born after ICSI.

      Embryo culture and embryo morphology  

A reliable technique to identify the embryos with the greatest chance for implantation is fundamental in any IVF laboratory. Indiscriminate transfer of multiple embryos in order to improve outcome increases the likelihood of multiple gestations and leads to a higher rate of obstetrical complications. However, todate embryo morphology remains the most widely accepted and single best predictor of embryo implantation.

 Morphologic evaluation of embryos is based on a grading system that of embryos with the greatest probability for implantation. The determination of embryo morphology on the number and symmetry of blastomeres and the percentage of extracellular fragmentation. While human embryos are routinely transferred 2-3 days after fertilization at 4-8 cell stage, mammalian data suggest that IVF/ET may be more efficient if embryos are transferred at the blastocyst stage. Culture media is presumably a source for growth factors and proteins necessary for embryo in vitro.

Assisted hatching

 While many factors may contribute to implantation failure , one may be the inability of the embryo to hatch from the zona pellucida ,necessary step prior to implantation. Microscopic interruption of a small segment of the zona, termed assisted hatching ,has been demonstrated to improve implantation rates, especially in the subset of patients with prior history of poor IVF outcome.

Embryo cryopreservation  Since the first report of a successful pregnancy following the transfer of a cryopreserved human embryo , cryopreservation has become wide spread practice in most IVF laboratories. Simply stated, cryopreservation maximizes IVF cycle yield without the fear of embryo wastage.Cryopreservation decreases the risk of multiple implantation by allowing the transfer of fewer embryos, reduces the risk of ovarian hyperstimulation by allowing transfer in nonstimulated cycles, and permits delay in embryo replacement in cases of suboptimal or adverse maternal conditions.It appears that despite the inevitable loss of some embryos in the freeze-thaw process, high quality embryos after thawing have as much chance for implantation as similar quality fresh embryos and should be regarded equivalent to their fresh counterparts in decisions regarding the number of embryos to be transferred.

  Preimplantation genetic diagnosis

 The ability to exclude embryo obtained in vitro which have diagnosed genetic deficiencies prior to the initiation of pregnancy offers an attractive means to prevent inheritable genetic disease . The ability to remove a single cell from an early eight cell embryo and rapidly test for specific genetic disease prior to embryo transfer does not decrease embryo viability , nor affect the live born offspring that results.

 Preimplantation genetic analysis using FISH

 Fluorescent in situ hybridization allows direct visualization of specific chromosomes in blastomeres fixed on glass slides .Directly labeled probes bind to specific portion of specific chromosomes and can be visualized by fluorescence microscopy. The number of a particular chromosome or its presence or absence can be inferred. While this modality is useful for aneuploidy assessment, defining mosaicism, and gender determination for medical reasons.

 Genetics, age and implantation failure

 The new techniques for PGD have provided a mechanism for studying the genetics of the early human embryo. In addition, implantation failure, which increases with age, has been shown to be reflected in higher rates of aneuploidy in embryos from older women. The use of FISH for diagnosis in couples who are translocation carriers is also a possibility, such couples carry an increased risk for miscarriage and chromosomally abnormal fetuses. Polar body and blastomere biopsies can detect the fate of a maternally derived chromosomal translocation.

 Finally, PGD assessment of aneuploidy in chromosomes X, Y, 21, 18, 16 and 13 may be used to screen embryos from patients over 35 years of age. Presumably, this would allow discrimination of embryos that have a lower chance for implantation or a greater risk for miscarriage.

A special team at Al Khalidi Medical Center was established with a new laboratory , performing FISH technique :Dr. Suleiman Dabit, Head of ART and Genetic Department in collaboration with Dr. Faisal Abu Farsakh, Director of Al Khalidi Central Medical Laboratory , Senior Embryologist Mrs. Suzan Sousou and Senior Genetist Sinan Nassar.  Information on the availability of PGD should be provided to at least women of advanced reproductive age or poor prognosis IVF patients, so that they may have the opportunity of improving their chances of becoming pregnant and avoiding the establishment of a pregnancy destined to be lost due to aneuploidy.

 Preimplantation genetic diagnosis (PGD)  

Preimplantation Genetic diagnosis is becoming an established approach to detect and avoid transferring embryos with genetic abnormality as an alternative to the transfer of embryos based on morphological criteria.  PGD is performed by blastomere biopsy at the cleavage stage (6-8 cells embryo). The Biopsied material is tested for single gene disorders using polymerase chain reaction (PCR) analysis or for chromosomal abnormalities using Fluorescence in situ hybridizations (FISH) analysis

 In vitro maturation of human oocytes (IVM)

 ( Virtual Tour )

The basic of IVM is the maturing in vitro of oocytes from the G.V stage of development to the MII stage.  An attractive alteration to ovarian stimulation in these women who refuse to take normal treatment, that is to retrieve oocyte from unstimulated women and consequently mature and fertilize these oocytes in vitro avoiding hormonal stimulation and reducing the cost of hormonal injection.

 Women suffering from PCOS (Polycystic Ovarian syndrome) are extremely sensitive to stimulation with exogenous gonadotrophin in assisted reproduction, and they have an increased risk of developing OHSS (Ovarian Hyperstimulation syndrome). Severe OHSS is associated with occasional severe complications such as thromboembolism, adult respiratory distress (ARDS) and, rarely, death. The long-term side effects of gonadotropin stimulation are unknown. The recovery of immature oocytes followed by in vitro maturation (IVM) of these oocytes could be developed as a new method for the treatment of women with infertility. The benefits of IVM include avoiding the side effects of GnRHa and gonadotrophins, avoiding the required ultrasound and serum monitoring (therapy reducing direct and indirect costs), and avoiding the risks of ovarian stimulation – including OHSS).

 Concluding Remarks 

The goal in assisted reproduction has always been to achieve pregnancy with the safest most efficient protocols provided by science.  Despite the advances in ART, the persistently low pregnancy rates in women over the age of 40 has perhaps been the most frustrating issue to most reproductive endocrinologists. The oocyte is believed to be the major determinant of reproductive aging. Currently research is under way to determine factors that are responsible for cellular aging and programmed cell death or apoptosis. Furthermore, it is believed that the production of oxygen free radicals in the mitochondria of the senescent oocytes may play an important role in apoptosis in human embryos.