Department of  Obstetrics & Gynecology  

Joan C. Edwards School of Medicine

The Center for Advanced Reproductive Medicine, located in  Cabell Huntington Hospital,  opened  its doors in April, 2004 and provides fertility treatment to couples who want to have a child, yet have been unable to conceive on their own.   The purpose of the Center  is to provide sophisticated diagnostic testing first and in vitro  fertilization and embryo transfer when needed. The nature of fertility treatment often requires repeated visits to a physician’s office, as many as seven per month depending upon the level and type of treatment provided. Previously, patients   have traveled three or more hours to have procedures such as  artificial  insemination and In Vitro Fertilization (IVF).  Having a reproductive center in Huntington will lessen this burden. The treatments now available through the hospital will help many couples who might otherwise forego fertility therapy.

William Burns, M.D., Director Center for Advanced Reproductive Medicine Cabell Huntington Hospital      Associate Professor      Department of Obstetrics & Gynecology      Division of Reproductive  Endocrinology and  Infertility      Joan C. Edwards School of Medicine      Marshall University

William Burns, M.D.

Understanding Infertility

•  Infertility affects about 6.1 million Americans.

• A woman’s fertility peaks from her late teens through her late 20s.

• Infertility affects  both men and women .

• 85-90 percent of infertility cases are treatable.

The medical definition of infertility is failure to achieve pregnancy in one year of regular intercourse without contraceptives. Pregnancy is the result of a chain of events that  occurs in a woman’s body. She must release an egg from one of her ovaries, and the egg must travel through a fallopian tube toward her uterus or womb. A man's sperm must join with the egg along the way, and the resulting fertilized egg must attach to the inside of the uterus. Although this process typically occurs naturally, many things can happen to interfere with pregnancy.

Contrary to popular belief, infertility is not always the woman’s problem. About one-third of infertility cases are due to problems with the male, such as low sperm count, inability of the sperm to reach the egg or no sperm production at all (sterility). Female factors account for another third of all cases. One of the most common factors is ovarian dysfunction, which can result in infrequent or absent ovulation. Polycystic Ovary Disease (PCOD) is the most common female reproductive disease.  Fallopian tubal damage, whether caused by infection, complications from a tubal pregnancy, a previous tubal ligation, or scarring from gynecological surgery, is also a major factor in female infertility. Endometriosis is another very common cause of infertility. In other cases of infertility, a combination of male and female factors  may be the cause, and in some instances, a cause  cannot be identified. Research  shows  that a woman’s age plays a significant role in her ability to become pregnant. A woman in her 20s has an 80 to 90 percent chance of conceiving within a year. Once she turns 30, her chances begin to decline. After age 35, there is an accelerated  drop in a woman's fertility.

Dr. Burns  works  with an embryologist to  determine the best course of treatment in achieving pregnancy. 

Testing for Infertility
If a couple has been trying for a year to have a baby without success, consulting with a specialist could be very helpful.  Age is a critical factor in infertility, and  If the woman  is  36 or older, consultation should be considered after just six months of infertility. There are a number of tests that can be performed to determine the cause of a woman’s infertility.
The process typically begins with physical exams and obtaining the medical and sexual histories of both partners.  If it appears the couple is timing intercourse properly but no pregnancy has resulted, diagnostic testing is done. It is important   to determine whether or not   the woman is ovulating each month. There are several ways to test for ovulation. For a man, semen can be  examined to determine the number, shape, and movement of his sperm. In the laboratory, very sophisticated diagnostics  are available to assist in pinpointing the cause of  infertility. Depending upon the results, additional screenings may be performed

Treating Infertility
The Center for Advanced Reproductive Medicine offers several therapies to help infertile couples have children.  Treatment options for infertility are as varied as the sources of the problem itself.  Each couple is unique in their circumstances and reasons for seeking assistance in getting pregnant.
Dr. Burns offers  insight  to couples who have made the decision to seek medical help in conceiving. Patient history must be taken into account to determine eligibility for fertility therapy. For many women, in particular, getting pregnant is a central component of life. It is assumed that when she is ready to have a child, she will be able to do so. When consulting with a patient,  he gives them a realistic assessment of their chances for success, outlining not only the course of treatment itself, but also the physical and emotional stresses that come with it.

Eighty-five to 90 percent of infertility cases can be treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems.  Sometimes surgery can be done to repair damage to a woman's ovaries, fallopian tubes or uterus if  the damage is not severe. Likewise, male infertility may be corrected by surgery. Recent advancements in some fertility treatments, such as more  oral drugs and an increased understanding of the role obesity plays in ovarian dysfunction, have  helped  to make  treatment more accessible and effective.

The In Vitro Fertilization Cycle
In preparation for IVF, a woman follows a specific drug protocol. Typically she is put on birth control for 30 days to suppress her hormones.  After approximately 10 days, she then receives daily injections for 10-20 days. During this period of time, she makes 4-6 office visits for ultrasound examination and blood testing. When testing indicates that the eggs are optimally developed, the eggs are removed and subsequently returned to the uterus as described above. Based on the patient’s age and medical history, Dr. Burns and  Melissa  will consult with the patient to determine the number of fertilized eggs to be transferred to the woman’s uterus.    

In Vitro Fertilization  plus  Intracytoplasmic Sperm Injection (ICSI)
This relatively new and highly effective treatment  specifically addresses male infertility issues and is performed in a laboratory setting. Following a cycle of fertility drugs that are given to the woman to help produce multiple eggs, the eggs are  removed. In the laboratory, a cluster of cells surrounding each egg is removed, allowing for better viewing and assessment of the egg’s maturity.  ICSI involves the injection of a single sperm into an egg.

Treatment with  In Vitro Fertilization  is effective. However, there is always the chance that it may take more than one cycle to achieve pregnancy.

2005 IVF Success Rate
This graph does not include patients who received donor oocytes.

Since the opening of the  Center for Advanced Reproductive Medicine, a pregnancy rate that exceeds the National Average reported by the CDC, www.cdc.gov/ART/index.htm.  has been maintained. The most recent data provided by the CDC is for the reporting year 2003. In 2003 there were 399 IVF centers which reported pregnancy results.  The average ongoing pregnancy rate of these centers was 39.4% per egg retrieval and an ongoing pregnancy rate of 42.2% per embryo transfer. An ongoing pregnancy is defined as visualization of a gestational sac and fetal heart beat within the uterus. CARM is proud to report an ongoing pregnancy rate of 62% per egg retrieval and per embryo transfer for 2005. 

The IVF Laboratory
The IVF laboratory environment is complicated and must meet strict guidelines.  The lab is equipped with a special filtered air-handling system to eliminate particles and chemicals that could prove detrimental to embryo growth. There is a continuous controlled temperature of 78 degrees, with a constant humidity of 40 degrees. Eggs and embryos are extremely sensitive to outside particles. Therefore, anyone entering the lab must wear full hospital scrubs to protect the sterile environment. Periodic tests are performed on the lab to ensure it meets all national standards.

Cost of Infertility Treatments
It is a goal of the Center to provide a level of service to any woman who wants to get pregnant. Fertility treatments can be expensive, with IVF utilizing injections  as described above,  ranking at the top at  $9,000 to $10,000 per cycle. IVF can also be performed with the oral drug clomiphene at a lesser cost, approximately $4000, albeit with a lesser success rate. With fertility treatments becoming more common  and as the options and techniques are improved, insurance coverage has improved in some cases. Each patient should check with her insurance carrier to determine which costs are covered

Getting Started
If you are interested in learning more about fertility treatments, please contact the Center for Advanced Reproductive Medicine at Cabell Huntington Hospital at 304-691-1400.

For additional information, visit the following website:
American Society for Reproductive Medicine at www.asrm.org.