Intrauterine inseminations are prescribed for a variety of indications including mild or moderate abnormalities on semen analyses, unexplained infertility, or for the use of donor sperm. IUI requires that at least one fallopian tube be open for conception to occur.

IUI is a simple procedure performed on the day of ovulation. The male partner provides a sample (or in the case of donor sperm, a sample is thawed), which is then washed, analyzed, concentrated and prepared. The preparation takes about an hour. A small catheter is then placed into the uterus and the sperm are injected. After the IUI, the woman may resume her normal daily activities.

A pregnancy test is recommended two weeks after IUI. Expected pregnancy rates are 5-18 percent per cycle depending on the specific diagnosis. Several attempts of IUI may be needed before a pregnancy results.

Clomiphene Citrate (Clomid) is an oral medication taken for five days at the beginning of the cycle and used to induce ovulation in patients who don’t ovulate. This may also be used for treatment of unexplained infertility or luteal phase deficiency.

After the five days of medication, your infertility specialist may monitor your response to the medication with an ultrasound or urine LH kit testing.

Clomid is generally well-tolerated. Reported side effects include nausea, hot flushes, blurred or double vision and ovarian hyperstimulation. The multiple pregnancy risk with Clomid is 5-8 percent. There is no substantial evidence that Clomid treatment increases the overall risk of birth defects or the risk of any one particular anomaly. Miscarriage rates are not affected by Clomid treatment.

Ovulation may also be induced using a secondary class of medications called aromatase inhibitors. Medications such as Letrozole (Femara) are taken for five days at the beginning of the cycle, similar to Clomid. After the five days of medication, your infertility specialist may monitor your response to the medication with an ultrasound or urine LH kit testing.

Clomid failure is defined as the failure to ovulate after Clomid treatment, not the failure to conceive despite ovulatory success with several rounds of Clomid. Treatment options for patients who fail to ovulate with Clomid include adding secondary medications like glucocortiods or metformin or trying a different class of medications called aromatase inhibitors (Letrozole).

Injectable Human Menopausal Gonadotropins or recombinant gonadotropins are used to stimulate ovarian follicle growth. These daily injections are given to stimulate more than one follicle to develop, therefore increasing the chances of pregnancy. Pregnancy success rates using injectable medications are 15-20 percent per cycle. The risks of injectable medications include multiple pregnancies and hyperstimulation (enlargement of the ovaries during the second half of the cycle).

There are six steps when using injectable medications.

1. Injection Teaching
   a. After a visit with your infertility specialist, you will meet with a nurse to review injection teaching. You will learn how to administer the correct dose of medication daily.
2. Day 3 Baseline Ultrasound and Starting Medications
   a. On Day 3 of your cycle, an ultrasound will be completed to verify you are ready to start the medications.
   b. You will start and continue the daily injectable medications for approximately 8-10 days.
3. Ultrasound Monitoring
   a. Ultrasound monitoring is performed to examine the development of ovarian follicles.
4. Stimulation of Ovulation
   a. A Human Chorionic Gonadotropin (hCG) injection is given to stimulate the release of the eggs when the follicles appear mature by ultrasound and estradiol blood levels.
5. Intrauterine Insemination
   a. An intrauterine insemination is performed with partner or donor sperm.
6. Luteal Phase Support
   a. Your infertility specialist may recommend luteal phase support after your insemination. Instructions will be given on the type, dosage and directions.

For couples suffering from male factor infertility, the use of donor sperm is a means by which a pregnancy may be achieved. Pregnancy rates using donor sperm is dependent on the woman’s age but is on average 8-10 percent per monthly cycle. It is recommended that patients undergo three to six cycles of donor inseminations to give the treatment an adequate opportunity to work. RMI is not a sperm bank and sperm must be purchased from one of the FDA compliant sperm banks in the United States.

Donor Sperm Banks

• California Cyrobank
• Xytex
• Fairfax Cyrobank

IVF
In vitro fertilization (IVF) is a highly successful assisted reproductive technology. There are four basic steps in an IVF treatment cycle:

1. Ovulation Induction - A woman begins taking fertility medications to develop multiple mature eggs within the ovaries.

2. Egg Retrieval - Egg retrieval is a minor surgical procedure in which the mature eggs are removed from the female patient. Egg retrieval is performed on an outpatient basis at Shawnee Mission Medical Center. It typically takes about 10-15 minutes and requires anesthesia.

3. Fertilization and Embryo Development - The retrieved eggs are placed in the IVF laboratory and the semen sample is washed, incubated and placed with the eggs or injected by means of Intracytoplasmic Sperm Injection. After 18 hours, the eggs are examined and if fertilization occurs, then one to four of the resulting embryos are selected for transfer back to the female.

4. Embryo Transfer - Embryo transfer is a simple procedure without anesthesia. The selected embryos are inserted into a thin tube and guided toward the female’s uterus by ultrasound. Transfer typically takes place three to five days after egg retrieval. Rest and recovery are recommended for 24 to 48 hours after the embryo transfer.

Tubal Reversal (Tubal Renastamosis)

Introduction

RMI offers comprehensive counseling for women requesting a tubal reversal and our physicians have more than 20 years of experience with performing the procedure.

Initial Consultation

Patients desiring a tubal reversal are encouraged to meet with one of our specialists. In order to facilitate the appointment, the operative report from the tubal ligation procedure needs to be faxed or mailed to our office prior to the appointment. In your consultation, our physicians will take an initial medical history and then review the tubal reversal procedure, its costs and success rates.

Operation

The tubal reversal operation is done as a same-day procedure where patients do not typically require a hospital stay for recovery. The procedure is performed under general anesthesia. A small horizontal incision is made very low on the abdomen and the uterus and tubes are identified. The damaged portions of the tubes or the devices occluding the tubes (clips and rings) are removed. The remaining healthy tubal segments are re-approximated using microsurgical techniques. Very fine sutures and delicate instruments are used to handle the tubes to reduce the formation of scar tissue. The procedure takes about two to three hours.

Initial recovery takes two to three weeks for patients to get back to their normal activities. Some patients may need an extra two or three weeks for varying degrees of fatigue.

Success Rates

Factors that may influence the success rate of a tubal reversal include the age of the patient, the sterilization technique, the length of the remaining healthy tube and other factors that may reduce fertility (low sperm count and menstrual cycle abnormalities). Generally, two-thirds of patients with tubal reversals become pregnant. However, this number may vary by age.

Price

The total cost of the procedure (including facility, surgeon and anesthesiologist fees as well as a 23-hour hospital stay, if needed) is approximately $7,500.

Third party reproduction is a complex process in which a third party’s eggs, sperm or uterus is used as a part of the infertility treatment. This increasingly popular option has legal, medical and emotional considerations that must be addressed in a highly coordinated and individualized manner. Our team is here to support you through the entire process.

1. Gestational Surrogacy

In gestational surrogacy, embryos are made from the egg and sperm (of the donor) and then placed inside the uterus of the surrogate. The surrogate then is pregnant with a child that is not biologically her own and becomes a carrier. If you are interested in gestational surrogacy, we will help you evaluate the benefits of this treatment and provide information about cost, legal considerations, FDA guidelines and treatment.

2. Donor Sperm

Therapeutic Donor Insemination

For some couples suffering from male factor infertility, the use of donor sperm is a mean to achieve pregnancy. Pregnancy rates using donor sperm is dependent on the woman’s age but is on average 8-10 percent per monthly cycle. It is recommended that patients undergo three to six cycles of donor inseminations to give the treatment an adequate opportunity to work. RMI is not a sperm bank and sperm must be purchased from one of the sperm banks in the United States that is FDA compliant.

Donor Sperm Banks

• California Cyrobank
• Xytex
• Fairfax Cyrobank

3. Donor Egg

Some women are faced with reduced ovarian reserve or ovarian failure leading to infertility. Egg quality declines as part of the aging process, culminating in menopause. However, many women experience declines in fertility at much younger ages. The donor egg procedure brings new hope to women who cannot use their own eggs to become pregnant.

Candidates for the donor egg program include those who have undergone cancer chemotherapy or high dose radiation, have premature ovarian failure, natural menopause, decreased ovarian reserve, decreased egg or embryo quality, multiple failed IVF cycles, prior removal of the ovaries, unexplained infertility or for the prevention of genetic disease transmission.

Literature suggests that only half of men and women receive information about their reproductive health care options after cancer from their health care providers. A 2007 article in the American Journal of Surgery stated that only 15 percent of women undergoing colorectal surgery for malignancy received counseling on their reproductive health care options.

RMI recognizes that we have tremendous opportunity to provide integrated reproductive medicine care to all cancer patients of reproductive or pre-reproductive age. We provide education and counseling about the impact of cancer therapy on reproductive health and offer options in fertility preservation.

RMI is continually building a program that reassures cancer survivors the best opportunities available in the evolving field of fertility preservation.