Embryology and Andrology

Our CLIA-certified andrology laboratory performs all types of sperm evaluation and sperm function testing to determine the optimal treatment choice for men with low sperm count or poor sperm function. Our laboratories are recognized for excellence and in fact, our laboratory director, Tom Turner, and Dr. Kaylen Silverberg actually write the chapter in the Textbook of Assisted Reproductive Technology on sperm evaluation. Our andrologists also prepare sperm specimens for intrauterine insemination (IUI), choosing from among several different preparation methods in order to maximize the total number of rapidly moving sperm for insemination. In cases of severe male factor infertility, our andrologists and embryologists work together to isolate and prepare even extremely low numbers of sperm for fertilization or injection directly into eggs. In the most extreme cases of male factor – those following previous vasectomy or for men with genetic obstructions or other abnormalities – our embryologists work with Central Texas’ finest urologists to produce babies from cases in which we have had even fewer than twenty total sperm to work with.

When couples need advanced treatment using the assisted reproductive technologies, such as in vitro fertilization (IVF), they can be comfortable knowing that Central Texas’ largest IVF program is again prepared to offer anything that they need. From frozen eggs – where we are the only program in Texas to have produced healthy children from both donor and non-donor vitrified eggs – to novel stimulation protocols, laser-assisted embryo hatching, and complete genetic embryo screening, TFC has proven time and again to be a worldwide leader.

Stay tuned for this weekly series on Why TFC? Or if you prefer to read the article in its entirety, please visit

http://www.txfertility.com/why-texas-fertility-center.php

 Who We Are

Although thousands of our patients have benefitted from these endeavors, we have never actually taken the time to tell the TFC story; how we strive every day to fulfill our mission of turning couples into families, and why patients should choose TFC.  In the hope of enlightening our existing patients, as well as trying to convince infertile couples who are not yet seeing us that perhaps they should, we would like to take this opportunity to tell you a little more about our practice.  Founded in 1981, by Dr. Thomas Vaughn, TFC has grown to become the largest and one of the most successful fertility practices from Atlanta to Los Angeles.  All of our physicians are doubly board certified – in Reproductive Endocrinology/Infertility as well as Obstetrics & Gynecology – and all patients therefore see a Board Certified Reproductive Endocrinologist at every visit; 7 days a week, 365 days a year, unless they elect to see our sonographer who is available for early morning appointments for patients who desire to be seen at the beginning of their day. We also offer multiple office locations – from Round Rock to South Austin – to make coming to our office as convenient as possible.

Our practice is limited to the comprehensive diagnosis of infertility and recurrent pregnancy loss, as well as complex endoscopic surgery.  The term comprehensive is important, as we offer our patients the very latest in testing and treatment from pre-conceptual genetic evaluation – testing future parents before they even attempt to conceive – to the genetic screening of embryos prior to their transfer during in vitro fertilization.  Our medical treatments run the gamut from clomid, femara, metformin, steroids, and bromocriptine to the injectable gonadotropins.  Likewise, we offer every type of fertility surgical procedure – from open to laparoscopic to robotic – to treat any type of disease process affecting fertility.

Stay tuned for this weekly series on Why TFC? Or if you prefer to read the article in its entirety, please visit

http://www.txfertility.com/why-texas-fertility-center.php

WHY TFC?

In an attempt to answer this question, we wrote an article that you can find on the home page of our website at www.txfertility.com. I have taken the liberty of breaking this article down into smaller blog entries so that patients can read it at their leisure. In this first blog, I will tell you a little about the goals that we had in mind when we established TFC, and some of the things that make us different from other doctors who practice infertility.

Our Goals

From the moment that we decided to dedicate our careers to the diagnosis and treatment of infertility, we each made many commitments. First and foremost, we wanted to develop a patient-centric practice that would provide best in class care in a nurturing, yet state of the art environment. In addition, however, we all made the conscious commitment to be more than fertility specialists. We wanted to perform cutting edge scientific research and be strong patient advocates, while helping train future leaders in our field. We also wanted to use our business and management expertise to help pharmaceutical and biotech companies develop the next generation of fertility treatments while working with managed care and Fortune 500 companies to expand insurance coverage to more couples suffering from infertility. Finally, we all wanted to develop a mechanism through which some of our fortunate patients and other philanthropic Texans could help us provide resources to raise awareness of infertility as a curable disease, fund worthy scientific research, and help others who lack the means or insurance coverage to pursue fertility treatment.

Stay tuned for this weekly series on Why TFC? Or if you prefer to read the article in its entirety, please visit

http://www.txfertility.com/why-texas-fertility-center.php

Where does estradiol come from?

In a normal ovulatory cycle, the hypothalamus in the brain produces a hormone called GnRH. An increase in GnRH causes the anterior pituitary, a small gland located behind the nose, to release FSH, a hormone which stimulates the ovaries to begin developing follicles for ovulation. As the follicles grow and mature, estradiol is produced.

Why do we measure estradiol levels?

During your stimulation cycle, you will come into the office approximately every 2 to 3 days for sonogram monitoring. The sonogram allows your physician to monitor the size and number of developing follicles. On the days of your sonogram appointments, you will also be asked to have blood drawn in the morning. The sonogram results as well as the results of the blood work help the doctor to determine if the dosage of medication that you are taking is correct.

What does an estradiol level mean?

As previously mentioned, growing and maturing follicles will produce estradiol that is measurable in the blood stream. So, a small number or smaller follicles will produce less estradiol. A large number of follicles or larger follicles will produce more estradiol. Because each woman is different, there is no magic number that should be attained for estradiol results. Ultimately, we don’t want to see estradiol results too low or too high. Levels that are too low may indicate that you are not responding to the medication and require a higher dose. Levels that are too high may indicate an increased risk for multiples, due to a high number of follicles, or an increased risk of the development of ovarian hyperstimulation syndrome (OHSS).

For more information, please visit our website at http://www.txfertility.com or call us at (512) 451-0149.

Over the past 30 years, Texas Fertility Center has walked alongside men, women and couples who struggle with infertility. In addition to support programs and wellness resources, the TFC team encourages parents-to-be with testimonies from those who have faced infertility, too.

Life after infertility

• Nancy got pregnant after multiple IUI and IVF cycles and says she realizes that her babies (who are now 13 and 10) were meant to be. “All of those failed cycles paved the broken road that led me straight to my precious children.”

• Junior High sweethearts persevered through secondary infertility and will soon welcome baby Brody into the world. Mom-to-be Shelby says she loves to share her story of the miracle of conception and, through faith, how her family grew.

• Janis, the mother of adorable twin girls, says: “I know that we had a difficult time getting pregnant, but I really feel that going through everything we did allowed us to love our kids more than ‘normal’ parents. We got to fight early for our kids, which made our hearts grow that much bigger for when they actually came into our lives.”

• Angel and Dan struggled with infertility for 6 1/2 years, undergoing multiple cycles of treatment with Dr. Silverberg. With their very last attempt, they opted to use an egg donor and FINALLY had their dreams fulfilled. Their babies turned three recently and Texas Fertility Center celebrates these milestones.

Check out these and other inspiring stories on the Texas Fertility Center Facebook page.

Infertility by the numbers

You are not alone. In the US, 7.3 million will face infertility. Texas Fertility Center encourages you to get involved with a support group, whether an informal gathering of other couples trying to get pregnant or an organization like RESOLVE. Talking about your struggles with others who “get it” can help you deal with the stress and isolation of living with infertility in a fertile world.

A licensed professional counselor, Valerie Granoff, says: “It is important to remember that your fertility journey is a temporary one.” The months that end in disappointment usually result in a child eventually. You may conceive through simple ovulation induction, IVF, donor egg or donor sperm, or receive the gift of adoption. Each journey leads to the same destination.

If you would like to find out more about resolving infertility or connecting with others who share your story, contact the caring team at Texas Fertility Center.

The day after the egg retrieval, our embryologists will call you to review your fertilization report. They will let you know how many eggs have fertilized normally and they are available to answer any questions you may have. Your IVF nurse will also call to see how you are feeling and review the medications that you are going to begin the following day. You will also get a tentative time for your day three embryo transfer.

The morning of day three, your IVF nurse will call you to let you know if you will have your transfer or will wait to do the transfer until day five.

A day three transfer is not necessarility better than a day five transfer.

Which day you have your transfer is dependent on how much information your physician has the morning of day three. If we know which embryos are the best to transfer, the best place for embryos is the uterus and we will do your transfer on day three. If your embryos all look very similar and we are having difficulty deciding which embryos are the best to transfer, we will continue to let the embryos develop. This enables us to choose the best embryos to transfer on day five.

The embryo transfer is always done during the lunch hour and will happen at St. David’s Fertility Surgery Center, the same place as the egg retrieval. You will be given a Valium not because the transfer hurts, but it is a good smooth muscle relaxer and helps relax you and your uterus.
The transfer itself takes about ten minutes and afterwards you will relax for about thirty minutes or so and then you will go home.

We do ask the day of your transfer that you are on pelvic rest, not bed rest.

If you get up after the transfer, your embryos are not going to fall out.

If you get up to eat or drink and go to the bathroom the day of transfer, your embryos are safe. They are not going to fall out, we just ask you to take it easy that day since and you have had a valium and are unable to drive and go back to work.

After the transfer you will continue your medication regimen and await your pregnancy test. If you have any questions during this time, your IVF nurse is always available to answer any questions.

You will call your nurse after lunch on the day of your pregnancy test to receive the results. We ask you to call us, so that we know you are in a good place to receive the results.

The waiting period can be very difficult and your nurse is available to help you with any support you may need at this time. Visit http://www.txfertility.com for answers to any questions you may have. Check out the frequently asked question section too!

Once you arrive you will be taken to a private room and an anesthesiologist will give you an IV medication to keep you comfortable. You will not be put to sleep nor will you have a breathing tube placed in your throat. You will be taken to an OR where your eggs will be aspirated transvaginally under ultrasound guidance, by your physician, and placed in a media that mimics the natural environment of the female reproductive tract. The process last about 20 minutes, you will then be taken back to your private room where your day surgery nurse will monitor you in recovery for about an hour before you go home. Be sure you have someone to drive you home. Your partner will be directed to Austin IVF to collect a sperm specimen the morning of your retrieval. The specimen is prepared by an embryologist and added to the eggs to attempt fertilization. You can expect to be drowsy and feel some discomfort from the procedure; pain medication will be prescribed to relieve any moderate discomfort. You can also expect to spend the remainder of the day relaxing at home.

An embryologist will keep you updated on sperm and egg quality as well as fertilization and embryo quality. Your IVF nurse will call to let you know when to be seen back for your embryo transfer. This will take place three to five days later.

To learn more about embryo transfers and to see videos on Invitro Fertilization technology visit our website at http://www.txfertility.com/07ivf-lab.php

In the early 70s, couples who had a normal fertility evaluation were offered a laparoscopy to simply look inside the pelvis to see if any additional information could be learned. 40% of the women who underwent the laparoscopy were found to have an abnormality. Two thirds of the women who were found to have abnormalities at laparoscopy had endometriosis and one third of them had pelvic adhesions. These abnormalities were present without any symptoms other than having difficulty conceiving. Many women will assume that they cannot have endometriosis because they do not have pain. Pain is not required for endometriosis to be present. Women struggling to become pregnant, even without pain, do have a symptom of endometriosis – infertility. Therefore, in some situations of “unexplained infertility”, it may be very appropriate for the woman consider a laparoscopy prior to proceeding with fertility treatments.

Options for treatment of unexplained infertility include clomiphene citrate or Femara combined with intrauterine insemination, injectable gonadotropins combined with IUI and in vitro fertilization. These treatments have been demonstrated to increase the chance of conceiving even when the cause of the infertility is not known. However, some couples feel like they want to be sure that all diagnostic tests have been completed and known causes of infertility have been corrected prior to beginning treatments. These patients are good candidates for laparoscopy. Certainly if there are other symptoms of endometriosis and/or scar tissue in addition to infertility, then laparoscopy may be more indicated. For instance, if the patient does have severe dysmenorrhea (painful menstrual periods) or pelvic pain and/or if she has had a history of pelvic infections in the past, then laparoscopy would be even more likely to reveal an abnormality.

When undergoing a laparoscopy, it is very important that the physician be able to not only perform the laparoscopy to diagnose these abnormalities, but also be prepared to treat the disease. Usually the best surgical tool for treatment of endometriosis and pelvic adhesions is a CO2 laser. This instrument can be used to destroy, resect and/or correct the abnormalities. The laser is a better tool than an instrument that coagulates or burns the disease. Coagulation of endometriosis can destroy normal tissue next to the disease. The laser is much more pinpoint and accurate and is associated with less injury to the surrounding tissues.

It is certainly possible that a laparoscopy may be recommended to couples who have had trouble conceiving without any other symptoms to suggest endometriosis and/or pelvic adhesions. Abnormalities found at laparoscopy can commonly be treated with a CO2 laser. It is always worthwhile to discuss this procedure with your physician.

For more information, please visit www.txfertility.com to see how TFC can help!

Infertility affects approximately 6.1 million women in the United States so you are not alone.

The even better news is that over 80% of women that seek treatment consistently are successful at becoming a parent.

It is time to make the phone call to schedule an appointment to see a fertility specialist if you are under 35 and have been trying for one year without success or if you are over 35 and have been trying for 6 months and have not become pregnant.

Scheduling an appointment can be a difficult decision.

You want to make that the doctor you plan to see is a Board Certified Reproductive Endocrinologist. Many offices advertise that they provide fertility services, but they do not have Board Certified Reproductive Endocrinologists on their staff. All Texas Fertility Center physicians are Board Certified Reproductive Endocrinologists.
When you call Texas Fertility Center, you will speak to our New Patient Coordinators who will help you schedule an appointment with a doctor of your choice. Visit our website to find out more about our Board Certified physicians.

Once you have your consultation, your physician will personalize a treatment plan for you. You will have an assigned nurse who will be your point of contact while you are a patient at our office. The entire Texas Fertility Center team will work together to help achieve your dream of having a baby.

To learn more about what TFC has to offer, please join us at our upcoming Fertility 101 Patient Seminar ~ Please visit www.TexasFertilityCenter.com/Awareness to register!

However, if you plan to have a baby someday, reproductive endocrinologists urge you: “Don’t ignore your fertility.”

Why you shouldn’t ignore fertility

Age impacts fertility. Pregnancy rates decline slowly after the mid-twenties – more quickly after the age of 35.  Women over 40 have just a 5 percent chance of getting pregnant each month.  It’s critical to know the statistics before deciding to delay starting a family.

Many lifestyle and environmental factors contribute to infertility.  Knowing the risks can help you avoid problems conceiving. Common contributors to infertility include:

• Weight (over or under)
• Sexually transmitted diseases
• Chronic diseases
• Cigarette smoking
• Illegal drug use
• Alcohol
• Exposure to environmental toxins

You may also be surprised to learn that male infertility plays a role in half of all cases of infertility.  Thus it’s important to consider ‘his’ side, especially if ‘he’ has had any problems with sexual function, testicular pain or swelling, or chronic medical issues.

Am I infertile?

If you are under 35 and have tried for one year to get pregnant with no results, it’s time to see a fertility specialist.  Even if it has not been a full year, it’s not unreasonable to do some basic testing earlier, especially with any history of gynecologic issues.

Women over 35 should seek help after six months of unprotected sex – even more quickly if they are over 40.

The key to resolving infertility is to partner with a fertility specialist as soon as you suspect a problem to maximize your options and overall success.

If you’ve attended one of our monthly infertility educational seminars or followed us on social media (Facebook, Twitter, and blogs like this one), you know that Texas Fertility Center believes in education and advocacy.  That’s why we partner with RESOLVE in supporting National Infertility Awareness Week.

Infertility is a disease, but it is treatable. If you have experienced trouble getting pregnant, contact the compassionate team at Texas Fertility Center.  We will work with you to achieve your goals of having a family!