Inside This Issue: The Official Publication of Georgia Reproductive Specialists. Coping With Infertility: Advice to Friends and Loved Ones

Transcription

1 The Conception Connection The Official Publication of Georgia Reproductive Specialists Inside This Issue: Coping With Infertility: Advice to Friends and Loved Ones Fast Facts on Infertility Tubal Reversal Versus IVF: Which Is the Best Choice? Infertility Myth Busters Infertility Does Not Always Mean IVF Getting Started at GRS

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3 Georgia Reproductive Specialists has four metro Atlanta locations for convenient infertility treatment: Atlanta (Main Office) 5445 Meridian Mark Road, Suite 270 Atlanta, GA Alpharetta 3400-C Old Milton Parkway, Suite 475 Alpharetta, GA Decatur 2685 Milscott Drive Decatur, GA Stockbridge 175 Country Club Drive Suite 100A Stockbridge, GA Phone: Fax: Inside This Issue: Coping With Infertility: 4 Advice to Friends and Loved Ones 5 Fast Facts on Infertility Tubal Reversal Versus IVF: Which Is the Best Choice? Infertility Myth Busters Meet Our Team Infertility Does Not Always Mean IVF Getting Started at GRS The Conception Connection magazine is designed and published by Custom Medical Design Group, Inc. To Medical advertise in an upcoming issue please contact us at: or visit us online at This publication may not be reproduced in part or whole without the express written consent of Custom Medical Design Group, Inc. WELCOME Welcome to The Conception Connection, the official publication of Georgia Reproductive Specialists. Inside you will find educational articles covering many aspects of infertility and treatment along with general health and living articles. Our hope is that the articles in this magazine will provide you with additional tools to become more informed about your health and to make sound healthcare decisions. At GRS, we understand that infertility treatment can be overwhelming and our goal is to provide the most effective care possible in a trusting, compassionate environment. Most importantly, our physicians are dedicated to forming relationships with each patient and to treating each person as an individual no Doc of the Day, no technicians performing ultrasounds and no cookie-cutter treatment plans. If you are faced with infertility and ready to explore treatment options, we look forward to the opportunity to get to know you and work with you to build the family of your dreams.

4 Coping With Infertility: Advice to Friends and Loved Ones Dear Friend, I realize that sometimes it s difficult for you to know what to say to a couple who has a fertility problem. Sometimes it seems like no matter what you do, it s the wrong thing. I d like to give you a few suggestions that may help you be the friend I know you want to be: Be ready to listen. Infertile couples have a lot on their minds and need someone to talk to. Sometimes a good ear helps people get things off their chests. A good listener can help people express their anxiety, anger, and guilt; or help people work out solutions to problems. Without offering any suggestions your attentiveness and interest may provide the comfort and reassurance these couples need most. Don t offer advice unless you are really well informed. Infertile couples read everything they can get their hands on. Sometimes it seems as though they know more about fertility treatment than their own doctors. So talking off the cuff about something you don t really know about will only make them angry and defensive. Be sensitive and don t joke about infertility; attempts at levity will only anger them. Joking about infertility is as inappropriate as joking about death at a funeral. Remember, infertile couples are hypersensitive about many things. Try to put yourself in their shoes whenever you insist they come to a baby shower, when you brag about your children s achievements, or when you tell them about your friend s daughter who got pregnant at fourteen. Be patient. This couple may experience mood swings with every treatment or monthly cycle. One week they may be high because a new treatment promises hope; the next week they may be in mourning for the child they lost (didn t make) this month. They may be riding an exhausting emotional roller coaster which makes their actions and moods unpredictable. Try to understand and flow with their changes. And remember that when they want to be alone, they are not rejecting you. Don t get your feelings hurt by the preoccupation they have with their problems; keep in touch. Show that you understand their difficulty. Say things like, I know this is difficult for you, I don t envy what you re going through, or, If there is anything I can do to help, don t hesitate to ask. If you aren t sure about what they are experiencing, read some articles and books that discuss the emotional aspects of fertility problems. Be realistic and supportive of their decisions for or against fertility treatment. Once they ve reached a difficult decision, don t say, Shouldn t you see another doctor?, Are you sure that you really want to adopt? or, I d never consider doing that! These couples usually weigh each issue as though it were a life-or-death decision. Don t take their decisions lightly unless you have good reason. Don t put down their doctor or choices for treatment. Refrain from making comments like, I never heard of a doctor doing that. Does he know what he s doing? or, You don t need surgery. What you need is a vacation. Unless, from your reading or experience, you are certain that their physician is not using accepted methods, keep quiet about these topics. Be truthful. Don t, for example, try to hide a pregnancy in the family. The truth does not hurt, provided you are not brutally frank. Let them know when you don t know what to say. The couple will appreciate your honesty and will probably suggest how you can help them in that particular situation, even if it means remaining quiet. Admitting your problem will help establish honest communication. Be an advocate for infertile couples. Educate others and speak up for the couple s decisions. Promote your local RESOLVE chapter. If you do not have a support group in your community, help form one. Understand that individuals and couples respond to fertility problems differently. Learn to recognize the normal emotional stages they are experiencing denial, anger, depression, mourning, acceptance, and so forth. And realize that they may cycle through these stages with each new round of treatment and with each lost opportunity. Accept them when they are angry accept them when they are depressed, and accept them when they feel guilty. Unless they remain in a single stage for a prolonged period of time, don t become overly concerned. Above all, be there when they need you and show them that you care. Sincerely, Mark Perloe, MD This is a stressful time for everyone. Don t underestimate how important you and your relationship are to this couple. 4 Georgia Reproductive Specialists

5 Fast Facts on Infertility Infertility is the inability to conceive after one year of trying with unprotected intercourse for couples under 35 and six months of trying for couples over 35, or the inability to carry a pregnancy to term Approximately 15% of couples, or one in six, are faced with infertility In approximately one-third of cases, the cause of infertility is traced back to the female. A male factor is attributed in about one-third of infertility cases. In one-third of couples faced with infertility, the cause is attributed to both female and male factors In 15% of infertility cases, the cause remains unexplained after extensive testing 85-90% of infertility cases are treatable with medical therapies such as drug treatment or surgical repair of reproductive organs Treatments commonly recommended for infertility include ovulation induction, intrauterine insemination (IUI), surgery and in vitro fertilization (IVF) 7.5 million people in the United States are affected by infertility Worldwide, over 3.5 million babies have been born as a result of IVF. In the US today, close to 1% of all babies are born through IVF. Each year, about 200,000 IVF babies are born worldwide Of the live births resulting from IVF, 66% have been singletons, 30% twins and 2-3% triplets 91% of women surveyed wished they would have seen a fertility specialist sooner A Reproductive Endocrinologist (RE) is an Obstetrician-Gynecologist with advanced education (two-three year fellowship) who has undertaken specialized training in Reproductive Endocrinology and infertility 5

6 Tubal Reversal Versus IVF: Which Is the Best Choice? By Susan Conway, MD Georgia Reproductive Specialists Sterilization is the most common contraceptive method utilized by couples in the United States. The procedures are meant to be permanent and most women enter into the decision with a sincere intention to prevent additional pregnancies. Despite having consented to permanent sterilization, up to 14.3% of sterilized women request information regarding fertility options within 14 years of the procedure. What are the options for couples who desire pregnancy following tubal sterilization? Generally speaking, the categorical options are either surgery to reverse the sterilization (tubal reversal) or in vitro fertilization (IVF). Tubal Reversal Not all types of tubal sterilizations are reversible. Therefore, it is extremely important to know what sort of sterilization procedure was performed when considering surgery. Patients should obtain a copy of their sterilization operative note and pathology report (if tubal segments were removed) for review with their surgeon. A semen analysis for the male partner should always be done prior to surgery; if the findings are significantly abnormal, tubal reversal is extremely unlikely to result in a successful conception. Keep in mind that the tubes will always be somewhat damaged following any type of surgery and the risk of ectopic (tubal) pregnancy is ever present. If a reversal is successful there is also the need to again consider post-partum contraception options. IVF In vitro fertilization has become the dominant technique for achieving pregnancy in women with abnormal or blocked fallopian tubes. In essence, the technique involves intentionally hyper-stimulating the ovaries, obtaining the oocytes via needle-aspiration, combining them with the sperm in the laboratory and selection among resultant embryos for transfer back to the uterus. The events which ordinarily occur in the fallopian tubes thus occur in the laboratory, providing a sort of tubal bypass. IVF is less invasive than surgery and associated post-procedure down-time is minimal. Its greatest risks are ovarian hyperstimulation syndrome (occurring in 1-5% of patients) and multiple gestations. Success Rates Pregnancy rates are most strongly influenced by the age of the patient at the time of tubal reversal. Among women younger than 35 years of age with no other significant cause of infertility, a cumulative pregnancy rate of approximately 70% within 18 months of tubal reversal surgery was reported in one literature review. From a cost-per-cycle perspective, tubal reversal is relatively efficient. When viewed from a success-per-cycle perspective, however, the rates following tubal reversal are rather low: less than 5% in most series. As many couples considering pregnancy following tubal reversal are doing so in the context of a new marriage or relationship, the woman is often at an age where fertility is naturally and significantly diminishing. As age continues to advance, the likelihood of success-per-cycle diminishes to ever lower levels. If pregnancy does not occur in a timely manner following tubal reversal the only other option is to then consider IVF. A dilemma arises if tubal reversal fails as the woman has aged even further, diminishing her chances of success with IVF, and the costs of the procedures are thus combined if the couple must resort to both. IVF success rates are also profoundly affected by the age of the female. In the United States, overall live births rates generally 6 Georgia Reproductive Specialists

7 range widely between 20 and 35% per cycle. Most IVF centers report success-per-cycle rates for women under 35 up to 50%. Rates for women over age 35 are somewhat less and drop precipitously by age and beyond. Most IVF pregnancies are singletons but the rates of multiple gestations are much higher than those seen in spontaneous conceptions: approximately 30% of all pregnancies occurring via IVF are multiples, the majority being twins. If viewed from a cost-per-cycle perspective, IVF may be relatively expensive. When viewed from a success-per-cycle perspective, however, the IVF success rates are much higher than those for tubal reversal. Which Is the Best Choice: IVF or Tubal Reversal? In addition to costs and success rates, one should also consider long range plans. How many more children are desired? If multiple children are desired and the woman is young, tubal reversal is perhaps a better choice. If only one more child is desired and the woman is older than 35 years of age, perhaps IVF is the best choice. Beyond age 42-43, the likelihood of success with either tubal reversal or IVF is extremely low and approximately equal: less than 1-3% in most reports. In this case, tubal reversal often becomes the more cost-effective option. In a retrospective Belgian study published in 2007, the difference in pregnancy rates between IVF and tubal reversal were statistically insignificant until they were examined by age of the woman. It became clear that cumulative pregnancy rates for women under 37 were significantly better for tubal reversal; for women over age 37 the rates were better for IVF. However, for all age groups in all published reports the success-per-cycle rates in IVF are better than those for tubal reversal. The decision between IVF and tubal reversal is highly complex and profoundly affected by the factors of age, cost and time as well as the presence of other potential infertility problems. Each couple facing this decision must be assessed and counseled individually to ensure selection of the treatment option best suited to them. Your Trusted Strategic Partner As a full-service surety and insurance brokerage firm, Sterling Risk Advisors is dedicated to becoming trusted strategic advisors, offering a personalized touch to our commercial, professional and personal clients. Our services include: Commercial Business Insurance Medical Malpractice Insurance Personal Insurance Home-Auto-Boat/Yacht-Umbrella-Valuable Articles Unwavering Principles. Trusted Strategic Advice Georgia Reproductive Specialists would like to thank the following advertisers who, with their support, have made The Conception Connection possible. Buckhead Acupuncture &...14 Herbal Center Claiborne & Surmay, P.C...16 Gates Moore & Company...14 George Ausman Fertility Technology Resources, Inc Shallowford Road, Suite D5 Marietta, GA Phone (outside the US ) Georgia Urology...15 Freedom Fertility...15 RMS Associates...15 Sterling Risk Advisors

8 Infertility Myth Busters Georgia Reproductive Specialists The physicians at GRS hear myths from their patients every day regarding infertility. Because there are too many myths within the field of reproductive health to include, each doctor was asked to write about one myth they had busted within a particular week. Susan C. Conway, MD Myth: Infertility is the woman s problem. Truth: Infertility is just as likely to affect males as females. Approximately 35-40% of infertility may be attributed to a male factor, another 35-40% to a female factor, and the remaining 20-30% to a combination of the two. In many cases, perhaps 30%, this may include factors that are so subtle that no clear explanation can be determined. The most common causes of male factor infertility are low sperm counts, slow sperm motility (movement) and abnormal morphology (shape and size of sperm). Other causes include functional disturbances of ejaculation or other medical problems which may affect testicular function. Even though an explanation may be discovered via semen analysis, the underlying causes for the observed abnormalities are often difficult to identify. Possible underlying issues include genetic, physiologic and lifestyle factors. Fortunately, many male factor problems may be improved with simple interventions such as lifestyle changes. Simple fertility treatments, such as intrauterine inseminations for the couple with mild male factor, are often successful at reasonably low cost and risk. For men with severe male factor, donor sperm insemination was once the only treatment available. The truly good news is that current methods of assisted reproductive technology now make it possible for these men to become fathers. Carolyn Kaplan, MD Myth: If you are young, you don t need to see an infertility doctor until you have tried to get pregnant for at least a year. Truth: Many patients have medical problems that can easily be treated and can lead to early success! Some patients wonder whether you have to wait a year to see a fertility specialist. I have a patient with very irregular menstrual cycles, and her husband was giving her a hard time about coming in since they d only been trying for 4 months. We found that she had insulin resistance, and once we treated that, she was able to get pregnant on her own. Many patients don t actually need fertility treatment if they can address their underlying health problems. We really want to help patients get healthy before they get pregnant. This leads to safer and healthier pregnancies, and healthier babies! There are a number of simple tests that can be done that can be reassuring, and can identify women who just need to keep trying for a few more months. Then, there are some tests that will show that pregnancy will never happen without treatment, so trying to conceive the old fashioned way will just lead to frustration and stress. Once patients have basic knowledge about their options, they can be proactive and know when it s time to chill, and when it s time to see the fertility specialist. Desireé McCarthy-Keith, MD Myth: My fertility is okay as long as I m having regular cycles. Truth: Fertility can be impaired even when cycles are regular. Menstrual cycle changes are often a later sign of decreasing ovarian function. Women are born with a limited supply of eggs in the ovaries. With aging, eggs are gradually and permanently lost from the ovaries 8 Georgia Reproductive Specialists

9 and this process becomes accelerated over the age of 35. When the pool of developing eggs decreases, menstrual cycles become irregular and then ultimately stop at menopause. As the number and quality of the remaining eggs declines, levels of the ovarian hormone AMH tend to fall and the pituitary hormone FSH rises. These hormone changes are more likely to develop as a woman gets older and usually occur before any detectable change in the menstrual cycles. Simple blood tests can check your FSH and AMH levels and indicate if changes in ovarian activity are already occurring. For women, the decision to seek treatment should be based on the length of time you have been trying to conceive and age. When treatment is sought early, therapies are often effective in improving the chance of pregnancy. If you wait until menstrual cycle changes develop, the chance of pregnancy and likelihood of response to treatment can be less. Of course, you should see a fertility specialist even sooner if known causes of infertility such as blocked fallopian tubes, endometriosis or male factors exist. Mark Perloe, MD Myth: Testosterone replacement therapy will help with infertility Truth: Testosterone replacement therapy actually decreases the sperm count in men. One in five males over age 50 suffers from testosterone deficiency. Low testosterone can increase the risk of heart disease, diabetes, mood changes, decreased libido and greater risk of impotence. If you are not trying to conceive, then testosterone replace works fine for most men, but if you wish to father a pregnancy, please see a reproductive endocrinologist before beginning testosterone replacement therapy. While low testosterone does inhibit the growth of sperm, testosterone therapy inhibits it even further. Your reproductive endocrinologist will recommend medication that can restore normal testosterone levels while enhancing sperm production. Stephanie D. Singleton, MD Myth: Infertility therapy always results in multiples. Truth: In most cases, infertility therapy results in a single conception of one child. induction. With this form of treatment, careful monitoring and management is necessary to reduce the risk of multiple pregnancy. In most cases it is recommended that medication be used to produce no more than three potential eggs for fertilization, producing a multiple pregnancy rate of 10-20% in women less than 38 years of age (most commonly twins). If more than three follicles are produced then your physician may recommend options to reduce high order multiples include follicular reduction, conversion to IVF, or cancellation of the cycle. On the other hand, IVF can allow for greater control regarding the issue of multiple pregnancy. Although greater numbers of eggs are often produced with IVF, the number of embryos to transfer into the uterus is determined by you, your physician and the embryologist based upon factors to include the status of embryos, maternal age, history, etc. In most cases one or two embryos are transferred resulting in a 20-30% risk of twins and a 2-3% risk of triplets. Transferring one has a 1% risk of multiples. If strongly opposed to even the risk of twins, it may be advised that some younger couples, those using donor eggs or women with a uterine abnormality, consider a single embryo transfer. Your fertility physician realizes the risks that are associated with multiple pregnancy and we will make every effort to control for this while enhancing your chances for conception. Most pregnancies conceived through fertility therapy remain one baby at a time! Multiple pregnancies can, however, result from either ovulation induction (OI) or in vitro fertilization (IVF) therapy. Most high order multiple pregnancies (greater than twins) result from ovulation 9

10 Me e t Ou r Te a m Susan C. Conway, MD, MPH, MMSc, FACOG Dr. Conway came to Georgia Reproductive Specialists from the Center for Fertility and Reproductive Endocrinology at Virginia Mason Medical Center in Seattle. She also previously practiced at the Center for Reproductive Medicine of New Mexico. Dr. Conway earned her medical degree from Emory University School of Medicine. She also holds a Masters of Public Health in epidemiology and a Masters of Medical Science in clinical microbiology from Emory. Her OB/Gyn residency training was completed at the University of New Mexico Health Sciences Center and she completed a fellowship in Reproductive Endocrinology and Infertility at the Fletcher Allen Health Center at the University of Vermont College of Medicine. During her fellowship, Dr. Conway s research interests included the immunology of endometriosis, early pregnancy loss and ectopic pregnancies. She is an associate member of the Society for Reproductive Endocrinology and Infertility, a member of the American Society for Reproductive Medicine, a diplomate of the National Board of Medical Examiners and a fellow of the American College of Obstetrics and Gynecology. She now focuses primarily in fertility and assisted reproduction. Dr. Conway enjoys literature, gardening, hiking, skiing and gourmet cooking. Carolyn R. Kaplan, MD - Director of In Vitro Fertilization Dr. Kaplan, board certified in reproductive endocrinology, is the director of in vitro fertilization for GRS. She is the former director of the IVF program at the Emory Clinic and is an assistant clinical professor at Emory University School of Medicine. Previously, Dr. Kaplan was a member of the IVF committees at UCLA and Century City Hospitals in Los Angeles, CA. A graduate of the University of Texas Southwestern Medical School at Dallas, Dr. Kaplan completed a residency in obstetrics and gynecology and a fellowship in reproductive endocrinology at the University of Texas Health Science Center in San Antonio. She remains up to date on the latest advances in the field and maintains both obstetric and gynecology and reproductive endocrinology board certification through annual recertification exams. Dr. Kaplan specializes in the initial diagnosis of infertility, in vitro fertilization, egg donation cases, alternative approaches to family building and the patient-centered approach to infertility treatment. She was a principal investigator for several studies of hormonal efficacy and has authored numerous articles in medical journals and textbook chapters. Dr. Kaplan speaks frequently at community and professional seminars about reproductive health issues focusing on infertility treatments and their side effects, IVF, ovulation induction, hormone therapies and their uses and menopause. In Atlanta, she has served on the advisory board of the Georgia chapter of RESOLVE. Dr. Kaplan has two children and enjoys cooking, gardening, walking with her dog and camping. Dr. Desireé McCarthy-Keith, MD, MPH, FACOG Georgia Reproductive Specialists is pleased to welcome Dr. Desiree McCarthy-Keith, our newest physician to offer specialized, individual patient care. She earned her medical degree from the University of North Carolina at Chapel Hill and also a Master of Public Health in maternal and child health from the University of North Carolina. She completed her obstetrics and gynecology residency training at Duke University Medical Center and a fellowship in Reproductive Endocrinology and Infertility at the National Institutes of Health in Bethesda, Maryland. During her fellowship, Dr. McCarthy-Keith s research focused on the molecular mechanisms of uterine fibroid regulation. She has special interests in fertility evaluation, uterine fibroids and reproductive health disparities. She has authored several peer-reviewed publications on reproductive and infertility topics and has presented her research nationally. Prior to joining GRS, Dr. McCarthy-Keith practiced general obstetrics and gynecology in Virginia and South Carolina. Most recently, she engaged in the evaluation of patients with reproductive endocrine and fertility disorders at the National Institutes of Health and Walter Reed Army Medical Center. Dr. McCarthy- Keith was a lieutenant commander in the United States Public Health Service Commissioned Corps and held the position of assistant professor of Obstetrics and Gynecology at the Uniformed Services University of the Health Sciences. Dr. McCarthy-Keith is board certified in obstetrics and gynecology. She is a fellow of the American College of Obstetrics and Gynecology and a member of the American Society for Reproductive Medicine. A native of North Carolina, Dr. McCarthy-Keith is married with two children. In her free time she enjoy reading, cooking and outdoor activities with her family. 10 Georgia Reproductive Specialists

11 Mark Perloe, MD - Medical Director As Medical Director at Georgia Reproductive Specialists, Dr. Perloe has expertise in treating conditions related to infertility including polycystic ovary syndrome, recurrent pregnancy loss, menstrual disorders, fibroids, male fertility problems and endocrine and other reproductive health problems. He also has extensive experience in in vitro fertilization. A clinical assistant professor in obstetrics and gynecology at the Medical College of Georgia, Dr. Perloe completed his fellowship in reproductive endocrinology and infertility at the University of Minnesota. He holds an MD degree from the Pennsylvania State University, Hershey Medical Center and served his residency in obstetrics and gynecology at the University of Wisconsin. Dr. Perloe has conducted and published research in medical journals including Obstetrics & Gynecology, Southern Medical Journal, Human Reproduction and the International Journal of Obstetrics and Gynecology. In 1986, he co-authored Miracle Babies and Other Happy Endings for Couples with fertility problems. Dr. Perloe is a frequent speaker at international medical conferences, serves as a medical consultant for a number of pharmaceutical companies and Web sites and is active as an advisory board member for INCIID, OBGYN.net, American Society for Reproductive Medicine, Georgia Obstetrical and Gynecological Society and Electronic Communication Resource Committee. He is married, has two children, and enjoys theatre, playing with computers, sailing and traveling. Michael J. Tucker, PhD, HCLD, FI Biol - Scientific Director Recognized in his field as one of the world s top ten scientists in early human reproduction, Dr. Tucker is widely known and respected for his breakthrough achievements in assisted reproductive technology. A fulltime clinical embryologist since 1983, he pioneered the first intracytoplasmic sperm injection (ICSI) birth in the United States, the nation s first birth resulting from a testicular biopsy, the world s first birth from frozen donor eggs and the first pregnancy in the world from immature eggs that were matured after thawing in the IVF lab. Since 1983, Dr. Tucker has been scientific director and chief embryologist at major fertility centers in London, Hong Kong, Philadelphia, Atlanta, Rockville, MD, and Jackson, MS and served as a scientific consultant in more than 50 clinics worldwide. His current research interests include pre-implantation genetic diagnosis, egg and embryo freezing, blastocyst cultures, embryo growth and selection and gamete/embryo micromanipulation. Dr. Tucker is a zoology and physiology graduate of Bedford College, University of London. He earned a doctorate in reproductive physiology from the University of Birmingham in the UK and is a Fellow of London s Royal Institute of Biology. A frequent speaker internationally and locally, he also serves on the advisory board of Child of My Dreams, an online resource for adoption and infertility. Dr. Tucker is married and enjoys motorcycling, soccer, animals and hiking. What Our Patients Are Saying They re not just doing a job, they are answering a calling Everyone there from the front office staff to the physicians is friendly, professional and invested in making your dreams of expanding your family a reality I had an uphill climb with infertility and GRS was with me every step of the way If you want results, compassion, individualized protocol and a good experience, GRS is the place They planted hope within us that we thought didn t exist anymore and other doctors would never care to talk about They made us feel like a friend and not just a patient 11

12 Infertility Does Not Always Mean IVF By Desireé McCarthy-Keith, MD Georgia Reproductive Specialists Thanks to continued advances in reproductive medicine, in vitro fertilization (IVF) has become a highly successful treatment for infertility. IVF treatments are more invasive than other treatments and can be a costly option, particularly for patients lacking fertility insurance coverage. Many patients believe that IVF provides their only chance of having a baby; however this may not be the case. There are a few absolute indications for needing IVF, such as absent or damaged fallopian tubes, desire for preimplantation genetic testing, severe male factor or unsuccessful attempts with less invasive treatments. If one of these indications does not exist, we at Georgia Reproductive Specialists (GRS) can often provide less invasive, lower cost fertility treatments with good chances of success. Before starting fertility treatment at GRS, we conduct a thorough assessment of your general health, ovarian function and hormonal balance. Detection and treatment of thyroid disease and high prolactin levels can restore normal reproductive function for some women. Screening for and correcting metabolic abnormalities like insulin resistance can also improve reproductive and overall health. Our initial evaluation also includes assessment of the uterine cavity. Uterine fibroids are the most common non-cancerous gynecologic tumor in women and are often diagnosed in women having difficulty conceiving. Uterine polyps are soft tissue growths that are also commonly detected in women seeking fertility care. Fibroids or polyps inside the uterine cavity can interfere with implantation and chance of pregnancy and removing them can restore fertility. Ovulation problems affect up to 20% of women who are having trouble getting pregnant. Women who are overweight or underweight may ovulate less frequently and this can contribute to trouble conceiving. For overweight women, losing 5-10% of your body weight can return ovulation and menstrual cycles to normal without further fertility treatment. Women who are underweight can also see a return of regular menstrual cycles when they gain weight. Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder in reproductive aged women and many women with PCOS also experience problems with ovulation. A common treatment for women with irregular ovulation is ovulation induction (OI). We conduct OI by administering an oral medication like clomid or letrozole and then performing an ultrasound to determine how the ovaries respond. OI can be combined with intercourse timed around expected ovulation or coordinated with an intrauterine insemination (IUI) procedure. The same medications used for OI can be used for superovulation in women who ovulate regularly, but are having difficulty conceiving. Clomid or letrozole treatment in ovulatory women will usually stimulate 2-4 eggs to develop. We then combine the superovulation treatment with either timed intercourse or an insemination procedure. A good candidate for OI or superovulation has at least one open and normal fallopian tube and normal partner or donor sperm. The natural fertility rate for fertile couples is 20-25% per cycle, and rates for couples treated with medication and IUI can reach 15-20% per cycle. At Georgia Reproductive Specialists, we are committed to providing individualized and effective treatments for our patients. While some patients have an absolute indication for IVF, many will not. Often times, medical treatment of a hormonal imbalance or correction of a metabolic disturbance can improve reproductive function. Surgical removal of fibroids and polyps from inside the uterine cavity can also increase the chance of pregnancy. Ovulation induction or superovulation treatments cost a fraction of IVF treatments and can achieve pregnancy rates close to those of fertile couples. At GRS, we leave no stone unturned as we seek answers to your fertility questions and strive to provide practical and cost-effective treatment solutions for you. 12 Georgia Reproductive Specialists

13 Getting Started at GRS What Should I Expect? The first appointment at GRS is a very important one and we encourage both partners to attend. During this appointment, you will meet your physician to discuss your medical history and, based on initial information, some tests may be performed. Your physician will take this time to learn about your condition and medical history. The most successful initial consultations occur when your physician knows as much information as possible about your medical history and prior tests or treatments. We encourage our patients to be open with their physician and to become an active participant in their healthcare. This first appointment will start the process of formulating a comprehensive and individualized treatment plan. You will have the opportunity to ask questions about infertility and treatment as it pertains to your personal situation. You will also meet with a nurse from your care team who will be the one to review medication details and additional tests that need to be performed, based on the initial test results, during follow-up visits. A Financial Coordinator will also be available to meet with you in order to maximize your insurance benefits. Ready to make your first appointment with GRS? Please call Diane, our New Patient Coordinator, at x154. Diane is constantly on the phone scheduling appointments so it may be necessary for you to leave a message in her voic . She ll return your call within 24 hours and give you all the information you will need to get started at Georgia Reproductive Specialists. We look forward to meeting you! Give the Gift of Life and Love and Receive $6,000 The longing to build a family and nurture a child is one of the most basic and natural desires for many women. Unfortunately, some women are unable to conceive due to poor egg quality or ovarian function, genetic issues or damage to ovaries resulting from chemotherapy. Through the Egg Donation Program at Georgia Reproductive Specialists these women are given hope. Because caring and compassionate young women make the ultimate gift by donating their eggs, these women are given the opportunity to conceive, carry and deliver a child. Egg donation has been offered in the United States since 1986 and is a widely accepted practice that is safe for both the donor and the recipient. If you are a non-smoking female between the ages of 21 and 31 and are interested in more information about egg donation, please visit our website at

14 Buckhead Acupuncture & Herbal Center IVF + Acupuncture = Baby! East Enhancing West, Helping You Realize the Dream of Parenthood. Offering Evidence-Based Medicine to Increase your Chances for Success! Mark Schwartz, L.Ac. Board Certified, American Board of Oriental Reproductive Medicine Jenny Karns, L.Ac. Call Today for your Free Consultation: GRS Offers Free Infertility Seminar We understand that the thought of undergoing infertility treatment can be very overwhelming and confusing. Couples interested in learning more about the basics of infertility treatment and how GRS can assist in building a family are encouraged to attend a Fertility Options: After Hours seminar. During this free monthly seminar, a GRS physician will discuss the latest diagnostic and treatment options. We cover issues related to the diagnosis and treatment of infertility with ovulation induction and insemination, surgery as well as in vitro fertilization including the emotional, scientific and financial aspects. Discussions include information about age related infertility, fallopian tube obstruction, male infertility, PCOS, endometriosis and use of donor sperm and donor eggs. You will also have the opportunity to tour our state-of-the-art medical facilities and ask any questions you may have related to infertility and IVF. 7:00-8:30 p.m. Second Wednesday of each month 5445 Meridian Mark Road, Suite 270 Atlanta, Georgia Register online at 14 Georgia Reproductive Specialists

15 Sleep like a baby with RMS managing your computers. GRS has trusted their network to RMS Since Visit us at mysupportguys.com or Call Our Urologists Bring Excellence To Your Community! GRS and MediGogy.com Provide FREE Online Webinars The urologists at Georgia Urology Infertility Services have the experience and expertise necessary to properly evaluate male infertility. They understand the underlying conditions that may be causing the problem and have the specialized training to manage the treatment. Under the expert care of our fellowship trained urologic microscopic surgeons, a diagnosis of infertility may simply mean the road to parenthood may be challenging but possible. Georgia Urology Male Infertility Services include all aspects of procreation management such as: Microsurgical Sperm Extraction and Aspiration (MESA) Sperm retrieval (IVF) Testicular Biopsy for Infertility (TESE) Varicocele Repair Vasectomy Reversal Call today to schedule an appointment with an urologist at Georgia Urology Infertility Services. Georgia Urology Infertility Services is a division of Georgia Urology, PA, the largest private practice urology group in Atlanta and the Southeast. Georgia Urology, P.A. offers the finest urological care available for men, women, adolescents and children. At Georgia Reproductive Specialists, we are always finding new ways to help educate our patients, expand our patient resources and offer patients the most current news about infertility and reproductive health matters. Visit MediGogy.com to learn about Dr. Perloe s upcoming webinars and his archived MediGogy presentations on Optimizing Male Fertility, IVF Fertility Options 101, Recurrent Pregnancy Loss, PCOS and There are No Silly Questions. These sessions are free to attend and archived presentations are also available for viewing

16 Ruth F. Claiborne*, Lori M. Surmay*, Amy Wallas Fox William R. Claiborne ~ Savannah Office Georgia s Only Law Firm Dedicated to Both Assisted Reproduction and Adoption Assisted Reproduction Planning, Contracting, and Securing Parentage Orders in Court Egg, Sperm & Embryo Donation Gestational Surrogacy Adoption Planning, Counseling, & Finalization in Court Atlanta & Savannah We Welcome Singles, Partners, & Married Couples Executive Director: Atlanta, GA Shannon Savannah, GA M. Spartanburg, Matteson* SC Charleston, SC Georgia: Ruth F. Claiborne*, Lori M. Surmay*, Amy Wallas Fox, William R. Claiborne South Carolina: James Fletcher (Jim) Thompson* Guiding You Along the Path to Parenthood Through Surrogacy Screening & Matching Intended Parents with Surrogates, Case Management Funds Management Including Medical Bills, Insurance Reviews Legal Coordination for Contracts & Pre-Birth Parentage Orders Following the Highest Standards of Professionalism, Experience, Ethics & Understanding Schedule an appointment at one of our 4 offices: Atlanta, GA Savannah, GA Spartanburg, SC Charleston, SC Call Toll Free: *Fellows of the American Academy of Adoption Attorneys and the American Academy of Assisted Reproductive Technology Attorneys, the only credentialed associations of ART & Adoption Attorneys in all 50 States.