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IVF & Lab

IVF is a precise, multi-step process, and the laboratory is where a significant part of it happens. How eggs are handled after retrieval, how fertilization is carried out, how embryos are cultured and evaluated, and how the transfer environment is prepared all contribute to the outcome. At Kofinas, IVF is not separated from the diagnostic work that precedes it or the clinical follow-up that follows it. It is one part of a continuum.

IVF can feel like a leap into the unknown, especially after prior attempts that did not go as hoped. Understanding the process, what is happening in the lab, and what each stage means for your specific situation makes it possible to move forward with more clarity and less dread. We explain what we are doing and why, at every step.

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IVF & Lab Providers

These board-certified specialists practice at Upper West Side and coordinate your care across all our locations when needed.

George D. Kofinas, MD, FACOG

Reproductive Endocrinologist

As the compassionate leader of Kofinas Fertility Group and a distinguished authority on fertility medicine, Dr. Kofinas has used his depth of knowledge and sharp intuition to help thousands of couples start families of their own. Dr. Kofinas has written and spoken about the full spectrum of assisted reproductive technologies, such as reproductive surgery and in vitro fertilization (IVF), and he has personally trained every doctor on his staff.

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Jason Kofinas, MD, MSc, FACOG

Reproductive Endocrinologist

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Peter Brzechffa, MD, FACOG

Reproductive Endocrinologist

Peter Brzechffa (BRESH – fuh), MD, FACOG is an active family man and the associate director of Kofinas Fertility Group in New York. Interpersonal connection is a big deal for Dr. Brzechffa, and even after over 20 years in fertility care, he still cherishes every minute that he spends with the people he treats.

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Melissa Montes, MD, MSc, FACOG

OB/GYN Specialist & Minimally Invasive Gynecologic Surgeon

Melissa Montes, MD, MSc, FACOG has over 10 years of experience helping New Yorkers and beyond start families. With numerous peer-reviewed publications and thousands of success stories under her belt, she continues to help Kofinas Fertility Group advance the boundaries of fertility medicine.

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Levica Narine, MD, FACOG

OB/GYN Specialist & Minimally Invasive Gynecologic Surgeon

Levica Narine, MD, FACOG places high value on face-to-face time with those she treats at Kofinas Fertility Group in New York. As an experienced OBGYN, Dr. Narine has solved a wide range of fertility and reproductive problems with many different types of people. Each challenge motivates her to do better, and every experience she has inspires greater passion for her work.

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Heather Toskos, MD

Why did you go into this profession?

Societies have long recognized the importance of family building. As reproductive medicine progressed, so did our understanding of its generational impact on women, their relationships, and their legacies. Today, we can reshape the fertility narrative and help patients take back control of their own biology.

Our therapies and technologies are rapidly changing, and I am proud to contribute to this ongoing evolution. As our understanding of physiology and genetics grows, innovations continue to flourish and take us farther than we were yesterday. From endometriosis treatment to preimplantation genetic testing, the scope of our practice is far reaching with great implications for the future of modern family building.

What did you find compelling about it? What do you most enjoy about it now?

I am proud to advocate for women’s health, and support patients in improving their quality of life and reaching their family goals. At our practice, we are pushing the boundaries of what is possible, and I am excited to see what new therapies we will offer our patients in the coming years.

How would you characterize your style of patient interaction?

Every patient has a story of their journey, and that story can be rewritten. Many journeys are paved with ambiguity, loss and the unknown. My role is to help patients retell their story in a space that is safe, respectful and rooted in trust. I strive for every woman to feel informed about her options and confident that she is receiving a comprehensive plan delivered with skill and compassion.

What do you hope to be able to give or do for patients?

The path to pregnancy can be overwhelming, but I am dedicated to navigating patients every step of the way. My goal is for patients to feel heard, understood, supported, and encouraged. Every woman deserves clear insight into her reproductive health and the opportunity to shape her family vision.

What is your best quality as a member of this practice’s team? How does that help you in your role?

My greatest quality as a member of this team is my commitment to evidence-based care and attention to detail. I stay current with the latest research and continually seek the next based strategies for my patients. Every clinical situation requires meticulous, individualized care, and I make sure to take all aspects into consideration when creating a treatment plan.

My background in minimally invasive surgery allows me to explain how internal disease processes can go unnoticed unless carefully evaluated. Conditions such as endometriosis and fibroids are two of the most common examples that can be surgically treated with significant effects on fertility and chance of live birth. My previous training in obstetrics also helps me to anticipate high risk pregnancy states and work to prevent complications through careful evaluation and optimization of the first trimester.

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Charalampos (Harry) Chatzicharalampous, MD, PhD, FACOG, FACMG

Reproductive Endocrinologist & Clinical Geneticist

Now try saying it 3 times as fast as you can. Just kidding, we call him Dr. C for short.

Dr. C is the newest member of the Kofinas Fertility team and we are thrilled to have his incomparable experience in both Reproductive Endocrinology & Infertility and Medical Genetics (AND delightful personality) at our center. His 14 years of training and expertise were enough to add so much value to our patients, but it is his vibrant and detailed approach to his patient care that sets him apart.

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Frequently Asked Questions

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Get quick answers to frequently asked questions

In IUI, sperm are placed inside the uterus, and fertilization takes place naturally inside the body. In IVF, eggs are retrieved from the ovaries and fertilized with sperm in a laboratory outside the body. The resulting embryo is then transferred to the uterus. IVF is a more involved process but may be more appropriate depending on the underlying fertility diagnosis.

There is no single number that applies to all patients. The number of eggs retrieved, how many fertilize, how many embryos develop to the blastocyst stage, and how many are chromosomally normal (if PGT is used) all affect the outlook for a cycle. Your clinician will discuss what is realistic based on your age and ovarian reserve before stimulation begins.

ICSI stands for intracytoplasmic sperm injection. It involves injecting a single sperm directly into each retrieved egg rather than placing many sperm around an egg in a dish. ICSI is recommended for male-factor infertility, prior failed fertilization, or when sperm has been surgically retrieved. Whether ICSI is appropriate for your cycle depends on your specific clinical situation.

PGT is a laboratory technique that involves removing a small number of cells from a developing embryo and analyzing the chromosomes or genes before transfer. PGT-A screens for chromosomal number abnormalities, which are associated with failed implantation and miscarriage. PGT-M tests for a specific inherited condition. PGT is not recommended for all patients, and your clinician will explain whether it may be beneficial in your case.

Embryos that develop to an appropriate stage and are not transferred in the current cycle can be cryopreserved (frozen) for future use. Frozen embryo transfers are a routine part of IVF care. Embryos can be stored for extended periods according to clinic policies and patient preferences. Decisions about unused embryos are discussed with patients as part of the consent process.

Frozen embryo transfer has become the standard approach in many IVF programs. Evidence suggests that frozen transfers can have comparable or in some situations favorable outcomes relative to fresh transfer, in part because the uterine environment may be more receptive when the body is not recovering from ovarian stimulation. Your clinician will discuss what is appropriate for your situation.

A full IVF stimulation cycle from the start of medication to the pregnancy test takes approximately 4 to 6 weeks, depending on the protocol and transfer timing. If a frozen embryo transfer is planned for a separate cycle, additional time is involved. Your care team will provide a calendar specific to your protocol.

Cycle cancellations can occur if the ovaries do not respond as expected or if other clinical concerns arise. Not all retrieved eggs will fertilize, and not all embryos will develop sufficiently for transfer or freezing. When a cycle does not produce the hoped-for outcome, your clinician will review what happened and discuss options, which may include a modified protocol, additional evaluation, or a conversation about alternative pathways.

Success rates are most meaningfully understood when broken down by age and diagnosis. National data from the CDC and SART provide context for how IVF outcomes vary across age groups and clinical situations. Rates reported as "success" may refer to clinical pregnancy, live birth, or other endpoints, and it is worth asking which measure is being cited. Your clinician can help you interpret what published data mean for your individual situation.