The Diamond Institute for Infertility and Menopause is one of the most widely respected centres in the world for treating infertility.

Two Israeli pioneers in the field, Dr. Matan Yemini and Dr. Arie Birkenfeld, direct the institute. The graduates of Jerusalem's Hadassah Hebrew University School both have extensive research backgrounds and have made significant advancements to treating infertility.

Among Dr. Birkenfeld's many achievements is the study of normal and abnormal uterine lining (endometrium) which led to better understanding of embryo implantation. This work led to new approaches that have seen higher success rates in fertility treatment. His years of research on the effects of commonly used fertility drugs on implantation pioneered current concepts of advanced assisted reproductive technologies.

Dr. Yemini's research on ovulation, fertilisation and early embryonic growth have contributed to the development of many current techniques that see higher success rates in some of the implantation methods used at the Institute.

And the institute has a long list of methods it uses to combat infertility. Its website lists 12, 11 of which are currently available. They are:

1) Controlled ovarian stimulation: A treatment where fertility drugs in different combinations are used to control the ovaries. Controlled ovarian stimulation is done to ensure ovulation with patients with an ovulation or ovulatory dysfunction or during cycle treatment of assisted reproductive technology in order to rescue more eggs from the ovaries. Increasing the numbers of eggs increases the chance for conception either through insemination cycles or through IVF. Different drugs are used in controlled ovarian stimulation. Some are in pill form and others must be injected daily. A specific regimen for each patient is created based on the patient's history and her hormonal status.

2) In vitro Fertilization (IVF): The Diamond Institute's laboratory virtually becomes the patient's fallopian tubes. The sperm and egg mature, chemically change (capacitation), join (fertilisation), and form life (the embryo) all within a culture that exactly duplicates the fluid in human fallopian tubes. The process starts with hormone stimulation of the female partner to induce egg maturation and release. After laboratory fertilisation of the retrieved eggs, the embryo is transferred to the uterus.

The culture fluid is key in this process, turning laboratory scientists into miracle workers. IVF is suitable in cases of damaged fallopian tubes, low sperm count, endometriosis, or unexplained infertility.

3) Gamete Intrafallopian Transfer (GIFT): The female eggs and the male sperm are placed separately into a catheter and injected directly into the woman's fallopian tubes. Fertilisation occurs in the woman's body, not outside (as during in vitro fertilisation). GIFT mimics the way a normally fertilised egg would begin its journey into the uterus for implantation.

GIFT requires that a patient have at least one good fallopian tube. The GIFT technique is a one-step procedure lasting 40 to 60 minutes. The procedure is performed on an outpatient basis at the institute.

4) Zygote Intrafallopian Transfer (ZIFT): As in vitro fertilization, the eggs are fertilized in a dish. The next morning, when the eggs have fertilised, they are called zygotes. At this stage, the zygote can be transferred back to the uterus through laparoscopy in the manner as the GIFT procedure. Chances for success rate are equal for GIFT, tubal embryo transfer, and in vitro fertilisation.

5) Tubal Stage Embryo Transfer (TSET) Following retrieval of eggs in the same manner as in vitro fertilisation, the eggs are fertilised in a dish and two days later, when they become embryos, the embryos are transferred to the tubes via laparoscopy. The treatment success rate is equal to GIFT, ZIFT, and IVF.

6) Intra Uterine Insemination (IUI): The usefulness of IUI for infertile couples is well established. IUI involves selection of the best sperm and inseminating it into the top of the uterine cavity so it can progress and meet the egg in the fallopian tube. Correct timing of insemination; precise control and monitoring of follicular development and ovulation are critical factors in achieving pregnancy.

7) Intra Peritoneal insemination (IPI): Beneficial in couples where sperm are slow, this method sees the sperm is brought closer to the egg. Prepared sperm are placed through the vaginal wall into the peritoneal cavity in an area called the cul-de-sac, which is adjacent to the ovary. Precise timing IPI enables the sperm to meet the egg in the cul-de-sac, and start the fertilisation process.

8) Egg Donation: Egg recipients may be women who are otherwise healthy but have lost their ovarian function prematurely. Ovarian function may be lost spontaneously, or following surgical removal of the ovaries. At the Diamond Institute, carefully screened egg donors, either known and chosen by the couple or anonymous donors, undergo egg retrieval. The husband's sperm will then fertilise the eggs and the embryo will be transferred to the recipient uterus.

9) Sperm Cryo-Accumulation: While not a new process, until recently, sperm cryo-accumulation for treatment of low sperm count has been relatively unsuccessful because freezing and thawing is damaging even to normal sperm. However, the new method used at the Diamond Institute employs a new technique that is particularly effective.

Cryo-accumulation is a two-step process for the selection and preservation of sperm. Initially, high gravity centrifugation, coupled with special sperm selection techniques, is used to obtain concentrated samples. The samples are combined and frozen using a cryo-protectant medium that shields the sperm and increases the energy potential of each individual sperm. The concentrated sample will be used later- for timed Insemination. With the use of cryo-accumulation, pregnancies and deliveries have been achieved for couples when the male had severely reduced sperm count (as low as one million sperm per ml).

10) Sperm Preparation Male Antisperm Antibody: Insemination and IVF/ICSI are both acceptable treatments for male antisperm antibody. In both situations, the sperm has to be prepared and washed in order to reduce the amount of antibody attached to the sperm. Using a three-stage preparation, the sperm is first produced in medium that dilutes and attaches to the antibodies. In the second stage, the sperm that carries antibodies on the surface is separated from the ones that are clean of antibodies. In the third stage of preparation sperm are concentrated and prepared for other insemination or in vitro fertilization/ICSI.

11) Treatment of Immunological Infertility: (not produced yet)

12) Artificial Insemination with Donor (AID): Sperm stored in a bank is used for insemination. This is used for males that have no sperm at all or any other sperm problem when the couple does not wish to do in vitro fertilisation/ICSI. As in vitro fertilisation/ICSI resolves most sperm problems today, the need for artificial insemination is less. When AID is done in the proper manner with the right controls and right timing, it gives usually gives a high chance for conception, which is usually a higher than normal chance in nature, for a cycle attempt.