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The rate of conception for a couple is approximately 20% per cycle. However, due to many factors which may impair fertility, one out of every six couples attempting to achieve a pregnancy will experience difficulty. Our objective is to provide the best medical evaluation and therapy available in order to achieve a pregnancy in a minimal amount of time. Ovulation
Disorders Another type of ovulatory problem is a luteal phase defect. There are two kinds of luteal phase defects, the first, referred to as a pure luteal phase defect, in which there is insufficient production of the hormone progesterone, but the follicle (the sac containing the egg) is mature. Progesterone is needed to build up the uterine lining, to enable the embryo to implant. To determine a progesterone deficiency an endometrial biopsy is performed, a simple procedure done in the office where a small sample of endometrial (uterine) tissue is obtained with a plastic pipette. Supplementation of progesterone during the luteal phase of the menstrual cycle (after ovulation) may be given. Information regarding the benefits of progesterone and the options for treatment will be provided to patients in order that they may select the treatment option that best suits their physical comfort and financial affordability. Another type of luteal phase defect is known as immature follicles. This is determined by inadequate serum estradiol levels, less than 200 pg/mL, and or follicles size less than 18mm on ultrasound, both studies being performed at mid-cycle when follicular maturation occurs. Ovulation inducing drugs, as previously described, are used to correct these defects. The medication used is chosen after careful monitoring with blood levels and ultrasound. Each drug has its advantages and disadvantages. Clomiphene citrate is a less expensive ovulation inducing drug, but may sometimes interfere with the production of cervical mucus (causing what is known as cervical factor-for a more detailed description see cervical factor below). Although more costly, hMG in some cases is more effective in promoting follicular maturation. The decision of which drug to employ is made after careful evaluation and consultation with your physician. Another ovulation disorder is known as premature luteinization, when the production of progesterone occurs prematurely, that is before ovulation has taken place. Referred to medically as the follicle undergoing "atresia", it causes the egg to die and destroys the cervical mucus needed to aid in transporting the sperm through the cervix. Once again, an ovulation inducing drug may be used to insure ovulation has taken place before the rise in progesterone. Frequently, this may be corrected by first blocking the woman's LH through the use of high-dose estrogen or a drug known as a gonadotropin releasing hormone agents (GnRHa) which suppresses LH and FSH. Examples include leuprolide acetate (Lupron) or nafarelin (Synarel). These drugs would be followed by either Pergonal, Humegon or Metrodin. Cervical
Factor Another therapy to overcome inadequate or "hostile" cervical mucus would be intrauterine insemination (IUI), a procedure which involves placing the sperm (after it has undergone a critical "cleansing" procedure known as sperm washing), directly into the uterus, thus bypassing the cervix altogether. Also, in vitro fertilization (IVF) is another option (see IVF below for details). Male
Factor Other tests performed include the sperm penetration assay (SPA)-percent of sperm that can penetrate a zona free hamster egg and acrosome reaction-measurement of the ability of the sperm to undergo changes necessary for binding and fertilization of an egg. We also provide services to increase the likelihood of a male or female offspring by selecting out a higher concentration of X and Y sperm and then inseminating. This process does not damage the sperm in any way. Mechanical
Factor This procedure may also determine the presence of any uterine anomaly. The HSG is a relatively easy procedure, the only real drawback is that some women may experience cramping, but that can be decreased considerably by taking ibuprofen prior to administering the test. There are times when the test itself seems to help a woman achieve a pregnancy. A second, more definitive diagnostic procedure is the laparoscopy. This is a surgical procedure performed in the hospital with the use of anesthesia. By inserting a "scope" through the navel, thus gaining full visualization of the pelvis, it allows the physician to see the presence of endometriosis and or adhesions, as well as tubal patency. An advantage of this procedure is that endometriosis and adhesions can be treated through the laparoscope. If tubal occlusion is determined, in vitro fertilization-embryo transfer (IVF-ET) is usually performed because of its high success rate. (see Assisted Reproductive Techniques below for complete description of this procedure). Though a surgical procedure known as tubal reanastomosis by microsurgery can also be performed, it is usually best reserved for certain cases of previous tubal ligation; blockage due to infection has a low success rate following surgery and a high risk of tubal pregnancy. Endometriosis Treatments for endometriosis include laparoscopic vaporization or burning of endometriotic implants, or, the use of one of several drugs now available which may help the pain often associated with endometriosis. These drugs include Norlutin, Danazol, Depo-Provera, Ovral or low Ovral, Provera Oral, or estrogen suppression by GNRHa-Depo-leuprolide acetate (1x/month), or Nafarelin nasal spray (1x/day), although there is no evidence that they improve fertility. Unexplained
Infertility Assisted
Reproductive Techniques We are members of The Society for Assisted Reproductive Technology (known as SART), a national registry for IVF centers. SART's function is to set guidelines and monitor procedures and pregnancy rates of its members in this rapidly growing arm in the field of Reproductive Medicine. We perform approximately 1000 oocyte retrievals and 800 embryo transfers annually and thus are the largest IVF center in the Delaware Valley and one of the five largest in the country. Our staff of physicians, nurses, embryologists and andrologists, are all trained in state of the art procedures in IVF. In addition to transvaginal oocyte retrieval and embryo transfer, we offer other procedures which include GIFT (gamete intrafollopian transfer), TET (tubal embryo transfer), ZIFT (zygote intrafallopian transfer, (zygote refers to the fertilized egg before cell division begins). we also use micromanipulation techniques such as ICSI (intracytoplasmic sperm injection ) and assisted embryo hatching. This involves measuring the thickness of the zona pellucida of the embryo, and if greater than 13 microns, the embryologist skillfully creates a small hole in the zona to assist the embryo to hatch and thus implant. Each case is carefully monitored and evaluated to determine the best therapy for each patient, each cycle. In the event that more embryos are available than can be transferred back into the uterus in one given cycle (for fear of multiple births), we have a cryopreservation program for freezing of both sperm and embryos. Cryopreserved embryos can be placed back into the uterus during a "transfer" cycle. A transfer cycle is a much less complicated process in terms of medications and procedure, and also much less in terms of cost. Our pregnancy rate resulting from frozen embryo transfer does not differ much from the rate of success using fresh embryos. In fact we have the most successful cryopreservation program in the Delaware Valley and quite possibly in the country. It is our intent to make the IVF process available to as many people as possible, therefore we make a concerted effort to maintain reasonable and affordable prices for the retrieval, embryo development, and embryo transfer. By having a successful cryopreservation program, frequently from one retrieval of eggs, you can get one to four more cycles of embryo transfer without being stimulated to make multiple eggs and without undergoing the retrieval process. For those patients with significantly limited funds, we have a Donor Oocyte Program, whereby the patient is willing to share oocytes with another couple. The cost of the IVF cycle for the donor is covered by the recipient and the medication is provided. Additional information for IVF patients, including current costs, is provided in our IVF booklet. Insurance There are differences in coverage, within the same insurance company, depending on the plan offered to you by your employer. For this reason you should contact your Employee Benefits Department of call Member Services at the insurance company. You would need to know what is covered and whether there are any time or cost limitations, and any or all exclusions. Our experienced and knowledgeable staff stands ready to assist you with your questions and claims. Our practice is committed to your clinical, emotional, and financial well being. Our fees compare most favorably to others who provide the same services. Research The research team, headed by Dr. Check, reports its scientific findings throughout the world via slide and poster presentations at international meetings and symposia, as well as publications in scientific books and journals. Most importantly, our findings are applied right here in our own practice so that we can offer the most effective approach and treatments for the various factors that play a role in establishing and maintaining a healthy pregnancy. In fact, our group has published over 500 manuscripts in peer review journals, mostly dealing with new methods of diagnosing and treating infertility; thus, in addition to the teaching of medical students and OB/GYN residents at Robert Wood Johnson Medical School and Camden, our publications help physicians around the world to improve treatment of their patients. The department is comprised of a full-time staff of clinical and administrative personnel. Some of our physicians, nurses and technologists also contribute to the time consuming task of collecting and evaluating data. Our research is part of what makes us a unique center and contributes greatly to our ability to offer state of the art medicine. Because we like to provide our patients with as much information as possible, we do make available pamphlets and booklets from outside sources. However, we do not necessarily always endorse all the treatments and therapies described therein. |
