Services Offered

In-Vitro Fertilization (IVF)
IVF is a six step process. After controlled ovarian hyperstimulation, eggs are obtained from the ovaries by inserting an aspiration needle through the back of the vagina while under light anesthesia. The eggs are cleaned and husband or donor washed sperm is then added to the droplet containing the egg for fertilization. Micromanipulation of the egg and sperm, such as ICSI would be preformed at this stage, if indicated. The fertilized egg is called a zygote, zygotes develop into embryos. The embryos are incubated in the lab for three to five days. Prior to the embryo transfer the assisted hatching procedure is preformed to encourage implantation.

Step 1: Ovarian Stimulation – Injectable hormone medications such Gonal F are given with a thin, small needle just underneath the skin for several days to stimulate the ovaries to produce multiple follicles. The development of these follicles is monitored by frequent vaginal ultrasounds and blood tests. Once the follicles have matured to the appropriate size, an injection of another hormone medication such as Ovidrel is given, which works like luteinizing hormone (LH) to release the egg. It is usually given the day after the last dose of Follistim and given at a specific time as instructed by the nurse. It is extremely important to adhere to the time the nurse states. The in-vitro fertilization (IVF) scheduled time is dependent to the proper dosing time of the Ovidrel.

Step 2: Semen Collection/Processing – Shortly before the egg retrieval, a semen sample will be collected and processed to isolate the strongest most active sperm. These sperm will be placed with each aspirated egg. We strongly encourage patients to consider freezing a semen specimen several weeks in advance of the egg retrieval date for several reasons. Coordinating work and surgery schedules can prove difficult and illness can occur unexpectedly. Also, the expectation of producing a sample on demand the day of the egg retrieval can be stressful.

Step 3: Egg Retrieval – Under light sedation given by a licensed Anesthesiologist, in a special air filtration egg retrieval suite, the doctor aspirates each mature follicle with a needle guided by ultrasound. This is usually done through the back of the vaginal wall but on rare occasions can be done through the abdomen. The aspirated eggs are then passed on to the Embryologist to identify and fertilize.

This is the stage where additional micromanipulation can occur if needed such as ICSI.

ICSI involves an embryologist injecting a single sperm directly into a mature egg under a microscope. This procedure is done to increase probability of fertilization when there is a male factor problem such as low sperm count, poor motility/morphology, or when the sperm aspiration techniques TESA/MESA are used to obtain a sperm specimen. ICSI is also recommended if fertilization did not occur in previous IVF attempts.

Step 4: Fertilization Evaluation – 14 to 18 hours after the sperm and egg are placed together; they are evaluated by the Embryologist to confirm fertilization. If fertilization occurs, the zygotes (fertilized eggs) are cultured in preparation for embryo transfer. Continued observation will occur over the next few days by the Embryologist, who will determine the quality of the embryo. The quality of the embryo will determine when the embryo transfer will take place and the number of embryos to transfer. Depending on the number of fertilized eggs, some may be frozen for use in a later cycle.

Step 5: Assisted Hatching (AH) – This technique is used to improve the probability of the embryo’s implantation. Assisted Hatching involves the Embryologist opening a small hole in the outer membrane known as the zona pellucida of the embryo. This opening improves the ability of the embryo to leave its “shell” and implant into the uterine lining. Patients that may benefit from Assisted Hatching (AH) include those with previous In vitro Fertilization (IVF) failure, poor embryo growth rate, moderate to excessive cytoplasmic fragmentation and women with advanced maternal age.

Step 6: Embryo Transfer – This brief, painless procedure involves the doctor placing a catheter that has been loaded with a selected number of embryos by the Embryologist, through the cervix and into the uterus to deposit the embryos. When possible Blastocyst transfers are done, which occur around day five of embryonic growth. Blastocyst transfers allow a more mature embryo to be transferred, allowing the Embryologist to select fewer embryos for transfer, achieving a high pregnancy rate with a lower risk of multiple gestations above twins. Occasionally, cleavage stage, day three of embryonic growth transfer are done at they recommendation of the Embryologist based on the quality of the embryo.

ICSI (Intracytoplasmic Sperm Injection)
ICSI has been one of the greatest advances in the treatment of male factor infertility. ICSI involves injecting a single sperm into a mature egg. This procedure involves an embryologist manipulating under a microscope a mature retrieved egg while injecting a micro needle loaded with a single sperm directly into the mature egg. This advancement in the hands of an experienced embryologist can increase the probability of fertilization to as much as eighty five percent. Indications for the ICSI procedure include couples with:

• Severely abnormal semen analysis, including low sperm counts below 20,000,000, poor motility, and abnormal morphology.
• Men requiring microsurgical epididymal sperm aspiration (MESA) or testicular sperm aspiration (TESA).
• Failed fertilization of embryos on prior IVF attempts.

The American Board of Obstetrics and Gynecology recommend that patients under age thirty five try to conceive for one year before pursuing infertility treatment. Patients between the ages of thirty five and thirty nine should try to conceive for six months and women age forty and over should wait no more than three months.

There are a few exceptions to these recommendations. Patients who have irregular menstrual periods (cycles that are thirty five days or longer between periods) or have had previous pelvic infections such as PID should seek advice from their Gynecologist for an earlier referral.

Board certified Reproductive Endocrinologist Infertility (REI) specialists have completed: 1) Fours years of medical school, 2) Four year residency training in the OB/GYN specialty, 3) Two to three years of fellowship training in the Reproductive Endocrinology Infertility specialty, and 4) Passed the national Reproductive Endocrinologist Infertility written and oral test along with the OB/GYN specialty written and oral given by the American Board of Obstetrics and Gynecology.

The additional two to three years of training beyond the OB/GYN specialty focuses on assisted reproductive techniques, advanced microsurgery of the pelvic organs, disorders of the anatomy which may affect fertility, and disorders of the sperm. This additional training beyond the OB/GYN specialty is invaluable and will increase your probability of conception.

Some insurance plans will only reimburse fees for infertility services if the doctor is a Reproductive Endocrinologist and Infertility specialist. The American Board of Obstetrics and Gynecology recommends patients seeking advanced infertility treatments see a board certified REI.

The cost involved with creating a successful pregnancy depends upon the nature of the disorder causing the infertility, the age of the female partner, and if a male factor is involved. Costs can range from a small co-pay for those who have insurance coverage for treatment. For patients who do not have insurance coverage for IVF treatment, we offer discounted package prices. Our practice has been able to greatly reduce the total cost for those patients needing the most advanced treatments such as IVF by having our own egg retrieval suite on site thus eliminating a separate facility fee to a hospital. Our egg retrieval suite is equipped with state-of-the-art equipment and all anesthesia is given by licensed Anesthesiologists who practice within the Memorial Hermann Hospital system.

* Fees are subject to change without notice but not during a treatment cycle.

Most insurance plans cover the initial consult with a Reproductive Endocrinologist Infertility (REI) specialist and the diagnostic portion (the testing) of finding out why you are not able to get pregnant. The infertility treatment itself may be covered in part or completely. Although the trend is toward more insurance plans covering infertility, there are still plans that offer no coverage.

Our staff is highly trained in handling insurance coverage verification and claim filing. We will make every effort to obtain payment from your insurance plan when possible.

Improvements in medication, microsurgery, and in assisted reproductive technologies (ART) make pregnancy possible for the majority of the couples pursuing treatment. Over two thirds of infertile couples will be able to make their dreams of having a child come true. In particular, success rates have dramatically improved for couples who require ART. The pregnancy rate for an ART cycle approaches the monthly fertility rate for most couples. After an initial consultation and a review of diagnostic tests we can better determine your probability as success rates vary from patient to patient and from situation to situation.

Most cases of successful treatments with either ovulation induction with IUI or IVF will result in a single birth. The national averages are approximately 25% twin rate and 5% triplets or more. Currently our twin rate is less than 10% and our triplet rate is less than 1% and currently no higher order of multiples (quadruplets, quintuplets).

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Many women well into their 40’s will have healthy children. The risk for birth defects such as Down Syndrome do increase as you age, as do the risks of developing complications during pregnancy such as Gestational Diabetes (Diabetes during pregnancy) or Hypertension (high blood pressure). Early genetic screening can be used to detect certain defects like Down syndrome. Maintaining a healthy diet and exercise pattern will help reduce the possible health complications. Your physician can help you evaluate your individual risks based on your age and overall health.

The majority of patients who respond to Clomiphene Citrate do so during the first month of therapy. Three ovulatory courses constitute an adequate therapeutic trial. If pregnancy has not been achieved after three ovulatory responses, further treatment is not recommended. Other treatment options should be considered.