"Unfocused technology is not medical therapy. We must diagnosis a problem, discuss the options, listen to our patient's concerns then treat in the most knowledgeable, efficacious, cost effective, and ethical manner."

Treatments:

All aspects of Infertility Therapy

Ovulation Induction: Patients are treated with medications that cause the ovary to produce multiple mature eggs. It is used in conditions such as Polycystic ovaries (a hormonal imbalance resulting in lack of ovulation, irregular periods and infertility).

Intrauterine Insemination: Semen is processed in the laboratory to enhance the proportion of normal active sperm. It is then placed directly into the uterus using one of many various specialized catheters.

In Vitro Fertilization (IVF): Eggs are obtained from the ovaries by inserting an aspiration needle by way of the vagina. The eggs are then cleaned and processed sperm is then added to the droplet containing the egg. Fertilization then occurs. The now fertilzed egg is called zygote. Zygotes develop into embryos. After three to five days the embryos are placed into the uterus.

Intra Cytoplasmic Sperm Injection (ICSI): process of a single sperm being injected into an oocyte (egg or ovum that is produced inside the ovary) using micromanipulation equipment. Useful when there are very few sperm or in sperm that are unable to fertilize.

Gamete Intrafallopian Tube Transfer (GIFT): an alternative to IVF (In Vitro Fertilization) procedure requiring laparoscopy. After collection of the oocytes (eggs), they are mixed with processed sperm and using a catheter, they are then placed using laparoscopic guidance into the fallopian tube. Fertilization therefore occurs in the body (in vivo) as opposed to in a glass dish (in vitro).

Blastocyst Transfer: When the embryo reaches five days of development it is called a blastocyst. Transferring the blastocyst on day 5 enhances the pregnancy rates and reduces the risk of multiple pregnancies.

In Vitro Maturation of oocytes (eggs) IVM:

is when the eggs are removed (retrieval) from the women and then allowed to mature in the laboratory for two to five days

TESA, PESA, MESA (microsurgical sperm aspiration): When sperm are unable to move through the genital tract due to uncorrectable blockage, sperm can be extracted directly from the epididymis and/or the testicles. These sperm are then used to fertilize the egg using ICSI (see above).

Gynecologic Microsurgery: fine and delicate surgery requiring magnification often using a microscope. It is used to reconnect tied tubes after sterilization or repair blocked fallopian tubes or reverse previous tubal ligation.

Donor gametes (donor egg and donor sperm programs): eggs donated for patients who have lost their ovaries, have premature ovarian failure or advanced maternal age to help achieve pregnancy. Sperm that has been donated (known or anonymously) used in men with no sperm. Commercial sperm banks screen prospective sperm donors with a battery of genetic tests for sexually transmitted diseases including HIV before releasing sperm. Physical characteristics are provided to help match various traits as desired.

Third Party Program: women who have eggs but an inability to use or lack of a uterus require other screened women to gestate their embryos.
For more detailed information on the laboratory procedures please see the Laboratory section

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All Aspects of Endocrine Therapy

Can be Treated at RMFC

Endometriosis: Uterine lining tissue found outside the uterus, often inside the peritoneal cavity on the ovaries, fallopian tubes, uterus, bowels and bladder. It is a leading cause of infertility by affecting nearly all aspects of reproduction. Treatments include laser surgery, medical management, microsurgery.

>Figure1. Classis Endometriosis Lesion include chocolate cyst, power burns lesions and gunmetal lesions. Adhesions are formed by the endometriosis.

Menopause: the cessation of the menstrual cycle. Occurs when there are no more oocytes (eggs) in the ovaries. Includes all aspects of hormonal therapy

Androgen Excess: women who experience excess hair production on face, chest, abdomen, legs and back. Treatments include medical management.

Uterine Fibroids: overgrowth of muscle fibers in the uterine wall that may interfere with reproduction or normal sexual relations. Treatments are usually surgical.

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RMFC Fertility Laboratory Systems, Inc.
“Assisted Reproductive Technology Laboratories”

RMFC offers the following services:

• Comprehensive Endocrine Evaluation
• Genetic Evaluation
• Comprehensive Andrology Laboratory Testing and Services
• Semen Analysis
• Kruger Morphology
• Computer Assisted Sperm Analysis (CASA).
• Antisperm Antibody Testing
• Sperm Penetration Assays
• Sperm Freezing
• Sperm Washing for Inseminations
• Sperm Processing from Epididymal (MESA) and Testicular (TESE) specimens.
• Semen evaluation and sperm freezing pre and post vasectomy or vasectomy reversal

Comprehensive ART Laboratory Services

• In Vitro Fertilization (IVF)
• Intracytoplasmic Sperm Injection (ICSI)
• Assisted Hatching (AH)
• Blastocyst Transfer
• Embryo Cryopreservation
• Embryo Co-Culture

Future Research and Technology: RMFC is committed to providing "Cutting Edge" technology to our patients. RMFC will continue to research and develop new technologies to assist our patients in reaching their goal of parenthood.

An essential part of the process in helping the infertile couple achieve their goal of pregnancy involves the laboratory evaluation of both partners. RMFC consists of three laboratories; Endocrine (hormones), Andrology (sperm), and Embryology, and offers a comprehensive battery of tests and services for RMFC’s patients. RMFC also offers the latest innovations in “High Tech” Assisted Reproductive Technology (ART) procedures.

Semen Analysis: Most men produce Millions of sperm each day, however, many of these may be abnormal either in their shape, movement, or function. Many studies have shown that 50% of infertility is related to the sperm. RMFC’s Comprehensive Andrology Evaluation of the male will provide virtually all of the information necessary to assess an individual’s fertility potential. This comprehensive evaluation will utilize a battery of tests to assess the number, appearance, movement, and functional capacity of the sperm present in the man’s specimen.

Figure 1. Detailed drawing of a human sperm (spermatozoa)

Assisted Reproductive Technologies (ART): In the event that pregnancy is not achieved after the comprehensive male and female evaluation, the use of assisted reproductive technology procedures are an option. When the patient and physician decide that it is time to undergo these “High Tech” procedures, RMFC’s Laboratory Team and RMFC’s clinical staff collaborate to facilitate your ART experience.

In Vitro Fertilization (IVF): IVF is the most commonly performed form of ART. IVF is currently indicated to treat many fertility problems, including unexplained infertility, male factor infertility, and failure of conventional infertility treatments. IVF is a five step process:

Step 2: Egg (oocyte) Retrieval – Ultrasound guided aspiration of the contents of the mature follicles (follicular fluid and oocytes) by the physician. The eggs are then identified and placed in culture by RMFC’s Embryology Team. (Figure 3)

Figure 2 Ultrasound Image of Developing Follicles

Step 3: Semen Collection, Processing, and Insemination – Shortly before or after the oocyte retrieval, a semen sample will be collected. This sample will be processed to isolate the strongest, most active sperm. Thousands of these sperm will then be placed with each mature egg. For partners who are concerned about producing a specimen on demand or who may not be available at the time of oocyte retrieval a semen specimen is frozen several weeks before the oocyte retrieval.

Figure 3 Human Egg or Oocyte Surrounded by supporting Cumulus Cells, as seen at time of Oocyte Retrieval

Step 4: Fertilization Evaluation – Fourteen to Eighteen hours after the sperm and eggs have been placed together, the eggs will be evaluated to verify fertilization. If fertilization is achieved the zygotes (fertilized eggs) will be cultured in preparation for embryo transfer. “Extra” zygotes may be frozen at this time for subsequent use. (Figure 4)

Figure 4 Zygote or Fertilized Oocyte

Embryo Biopsy for PGD

How does PGD work?

Protocols

Preimplantation Genetic Screening (sometimes referred to as Preimplantation Genetic Diagnosis or PGD)

PGD

• Patients undergo In Vitro Fertilization to produce eggs
• These eggs are either fertilized by a procedure called Intracytoplasmic Sperm Injection (ICSI) using
• The embryo is biopsied on Day 3 of development and the "sex" and/or chromosomes of the embryo (up to 10) are determined by fluorescence in situ hybridization (FISH) which allows the number of X- and Y-bearing embryos to be sorted and the normal versus abnormal embryos to be segregated

Utility

• Help couples with chromosomally abnormal genotypes to produce normal offspring
• Help couples with only one sex represented in the offspring to "family balance" for the opposite sex in the offspring

Blastocyst Culture and Transfer: Until recent years most embryos produced in IVF were transferred on day 3 of development. Recently, with advances in our understanding of the needs of developing embryos, our ability to produce blastocysts in the laboratory has increased. Culturing and transferring blastocysts on day 5 of development allows us to maintain high pregnancy rates while transferring fewer embryos to reduce the risk of multiple gestations. Normally only 2 blastocyst stage embryos are transferred, effectively eliminating the risk of multiple gestations higher than twins. (Figure 6)

Zygote and Embryo Cryopreservation: Freezing of fertilized oocytes (zygotes) and embryos is utilized when the number of embryos produced during an ART cycle exceeds the number necessary for a day 3 or day 5 embryo transfer. Once frozen, these embryos may be thawed and transferred in a subsequent cycle.

FAQ's

Q. How do I choose a doctor to treat us? Why do I need to see a Reproductive Endocrinologist & Infertility specialist?

A. Understanding the training and preparation physicians undergo to become Reproductive

Endocrinologist & Infertility (RE&I) Specialists will help you be better prepared to choose. RE&I Specialists have: a) completed 4 years of medical school, b) completed 4 years of general Obstetrics & Gynecology specialty training, and c) completed 2-3 years of fellowship specialty training in Reproductive Endocrinology and Infertility.

Unlike general OB/GYN doctors, RE&I specialists are thoroughly trained in all aspects of reproductive health and they have apprenticed themselves in the art of infertility treatments. In addition to the high-tech assisted reproductive technologies, your RE&I physician can treat a) hormone imbalance as it relates to infertility; b) disorders of the anatomy which may affect fertility, c) disorders of sperm; d) disorders of eggs; and e) disorders of fertilization, implantation, and early pregnancies.

The additional specialty training beyond the OB/GYN specialty is invaluable. Choosing a physician that is board certified in OB/GYN and RE&I will significantly increase your chances to become biological parents.

Q. What are my chances of getting pregnant?

A. The chance of becoming pregnant is very good for most couples. In fact, in the first year of trying naturally, it is approximately 80% to 90%. This is why it is a good idea to seek medical help if you haven't become pregnant within 1 year of trying (or 6 months if your age is 35 or over).

Q. Should we be having intercourse every day to achieve pregnancy?

A. Normal healthy sperm remain active in the woman's reproductive system from 48 to 72 hours. Therefore, having intercourse at 48-hour intervals near the time of ovulation is usually more then adequate. Actually, once or twice a week is usually enough. If the man has a low sperm concentration that replenishes slowly, intercourse on a daily basis may actually be counterproductive.

• Society of Reproductive Endocrinology and Infertility (www.socrei.org)
• American Society for Reproductive Medicine (www.asrm.org)
• Resolve The National Infertility Association (www.resolve.org)

Q. Does a diagnosis of infertility mean I am sterile?

A. Infertility is not the same thing as sterility. About 90% of all diagnosed infertility cases can be traced to specific causes, and two of every three infertile couples that seek treatment are able to have children.

Q. Does treatment for all types of infertility involve 'high-tech" procedures?

A. Many couples are successful in their attempts to conceive utilizing relatively simple and "low-tech" procedures. Less than 2% of all couples seeking treatment will undergo assisted reproductive technologies (ART).

Q. Is ART considered experimental therapy?

A. ART is not considered "experimental" medicine. The American Society for Reproductive Medicine (ASRM) considers IVF, GIFT, ZIFT, donor oocytes, embryo cryopreservation and the use of ICSI for male infertility non-experimental. These procedures are considered acceptable medical practice and the standard of care in the United States and throughout the world.

Q. How successful are these procedures?

A. As in any statistic, success rates vary depending on many variables, such as, the age of the women and the presence of a sperm problem. A successful pregnancy occurs naturally for couples without fertility problems at approximately 20-25%. The success rate of low-tech procedures, such as IUI and ovulation induction, is 19-29%. High tech procedures (IVF) can be 30-50% per attempt. Click here to view our statistics.

Q. What actually is In Vitro fertilization (IVF)?

A. In infertile couples where women have blocked or absent fallopian tubes, or when men have low sperm counts, IVF offers a chance at parenthood to couples who would have no hope of having a "biologically related" child.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes.

Q. What is Intracytoplasmic Sperm Injection (ICSI)?

A. In the treatment of significant male infertility ICSI is a method that involves the injection of a spermatozoon (a single sperm) directly into the oocyte ("the egg"). This procedure is accomplished outside of the body in the laboratory.

Q. Does In Vitro Fertilization work?

A. Yes. Since 1981, when IVF was introduced in the USA, more than 30,000 American babies have been born from IVF and over 50,000 from all assisted reproductive technologies (ART).

Q. Does RMFC have a donor program?

A. Yes. We have a large number of multi-national donors available for our patients. All donors go through an extensive screening program, including genetic testing, psychological evaluation, and infectious disease screening.

Q. How expensive is ART?

A. The expense involved with creating a successful pregnancy usually depends on the nature of the disorder being treated and the age of the female partner. Understanding the problem first is the most cost effective approach to treating infertile couples. There is the generally held belief that any infertility problem will cost many thousands of dollars to treat and that the chances for success are small. Over two thirds of all infertile couples will achieve a child through infertility treatments. Some couples and healthcare providers believe that surgery is the least expensive option. Recent studies have shown that achieving pregnancy through surgery can cost approximately $70,000. The average cost to pregnancy after seeing an RE&I specialist is $2000. The average cost using oral fertility medicine and inseminations is $8000, using injectible medicine and inseminations is $9000, IVF $28,000 (based on three cycles for a women under age 40). As you can see, ART generally costs much less than surgery.

Q. Will ART be covered by my health insurance plan?

A. Most insurance companies cover the diagnostic testing and evaluation for infertile couples. Each policy is different, but most will cost share at least 50% of the diagnostics. Some companies now even cover a portion of IVF. It is a good idea to check with your insurance company or your employers' benefits person to determine what is covered by your policy.

Q. Does RMFC offer financing?

A. RMFC has agreements with local banks to assist patients with financing. Also, several of the drug companies offer financial assistance and discounts based on need. Our IVF Coordinator and Patient Services Manager will be able to assist you as necessary

Donor Program

Women Helping Women

If you are 21 to 32, healthy and a nonsmoker, you may be able to help a couple achieve their dream by becoming a egg donor.

Please call (719) 475-2229 and ask to speak to our Donor Coordinator if you are interested or have any questions.

Minimum Compensation of $4,000 provided.

3rd Party Reproduction

RFMC is proud to offer a multitude of 3rd party reproduction options to our patients:

• Egg Donor
• Shared Egg Donor
• Anonymous Egg Donor
• Known Egg Donor
• Gestational Carrier
• Known Gestational Carrier
• Anonymous Gestational Carrier
• Donor Embryos
• Donor Sperm

Since its inception (1999), RMFC has developed a world class Egg Donor Program. Most of our Donors are Colorado and New Mexico residents and we thoroughly evaluate their suitability.

Shared Egg Donor Program - Woman-2-Women™

We have recently introduced our Woman-2-Women™ shared egg donor program. In this program women will be able to donate eggs to more than one couple and couples will be able to reduce the costs for a donor egg.

Why choose the RFMC donor program?

• Easier access - Our RMFC donor program now has twice the number of donors.
• More choices - Two couples can now choose the same donor in the same cycle.
  More rapid treatments - One donor can help two families at the same time.
• Lower costs - RMFC has reduced the fees associated for each shared donor, so costs are > 25% lower.
• Quicker turn-around time - If a patient does not get pregnant they can quickly find another donor

Acupuncture Program

• Colorado Consortium (www.eastwindsacupuncture.com)
• New Mexico Consortium (www.engerymedicinedoctor.com)
• Research

Dr. Cridennda (left) and Polasky (right)

Our Acupuncture Consortium was developed with the assistance of Dr. Diane K. Cridennda. Dr. Diane received her Doctor of Oriental Medicine in New Mexico in 1987. She practices in Colorado Springs as a Licensed Acupuncturist and Chinese Herbologist.

Dr. Diane act as a liaison to RMFC and many other local and national IVF programs. She is our Acupuncture Consortium Leader for Colorado and oversees New Mexico.

Dr. Diane Polasky has recently joined RMFC’s family as the Acupuncture Consortium leader in New Mexico. She owns her own practice and has been involved in teaching and treatments for many years.

Both Dr. Diane’s are dedicated to blending Eastern and Western Medicine to help couples create the family they desire.

RMFC believe s that we all have the right to reproductive choices. These choices should not be reserved to the well-to-do , our goal is to make IVF affordable, cost effective, efficacious and within reach of the common laborer.

Financial

• Planning 4 Pregnancy™
• women 2 women ™
• Deposits
• Payment Plans

IVF as low as $ 4750

Planning-4-Pregnancy is a shared risk plan. The goal is a fetal heart beat which is an excellent indication of a normal pregnancy that should go to term. This plan allows for up to 4 fresh IVF treatments cycles and as many frozen embryo transfer cycles (FET) as possible for one inclusive price, as low as $ 4750/Fresh IVF cycle.

Women-2-Women is an new program to help many couples benefit the generosity of women helping other women as egg donors. Reproductive Medicine & Fertility Center has shared and exclusive egg donor options to help reduce the cost and allow couples to proceed in a timely manner.

Deposits and Payment Plans: Not everyone can go to their savings and have the cash necessary for infertility care. Reproductive Medicine & Fertility Center has made IVF available to almost everyone by allowing for a down payment followed by monthly payment plan. Payment plans over 2 to 3 years can start as low as $ 201.88 per month.

RMFC believes that we all have the right to reproductive choices. These choices should not be reserved to the well-to-do , our goal is to make IVF affordable, cost effective, efficacious and within reach of the common laborer.

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PO Box 50, Gladstone, NJ. 07934