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Becoming a Patient IVF PHOENIX™

[/vc_column_text][vc_toggle title=”How long will the first visit take?” style=”round_outline” open=”true” el_id=”1447064341323-f6ee47d8-32bf”]When you become a patient at IVF Phoenix™, Dr. John Couvaras will begin a very thorough evaluation of your individual condition and take the steps necessary to understand your medical history and other possible conditions that may be affecting your ability to become pregnant. You should plan on your first appointment to take at least 45-90 minutes with the doctor and a total of two full hours at the office.[/vc_toggle][vc_toggle title=”What happens on the first visit?” style=”round_outline” open=”true”]At your first visit, one of the most important elements in determining the correct course of care is to completely understand your general medical history and the efforts you’ve taken to become pregnant thus far. Dr. Couvaras will spend ample time with you to discuss your history and the steps you’ve taken to attempt pregnancy. Dr. Couvaras will also perform a physical examination of the female anatomy while performing a transvaginal ultrasound of your uterus, tubes, and ovaries and assess your antral follicle count and placement of ovaries. Following the physical examination, you will move to a consultation room where you can comfortably discuss a treatment plan with Dr. Couvaras.[/vc_toggle][vc_toggle title=”Does my spouse/partner need to accompany me?” style=”round_outline” open=”true”]We believe that the spouse/partner is critical to supporting the process you will be going through. Although it is not mandatory that your partner attend, the first appointment is designed to evaluate the history of both patient and partner in order to best determine possible underlying causes of infertility.  Approximately 40% of infertility is related to men, we believe it is important that we address both the woman and man efficiently.[/vc_toggle][vc_toggle title=”Does it matter where I am in my cycle?” style=”round_outline” open=”true”]No. For your initial appointment, the menstrual cycle is not a relevant factor. However, when you book future appointments for diagnostic testing (e.g. blood work and HSG) your point in your menstrual cycle is a key factor.  Though, if you are from out of town, it is best for you to be 4-6 days post ovulation, or a week before your period.  This will allow us to try to get the luteal phase blood testing locally, to maximize efficiency.[/vc_toggle][vc_toggle title=”Do I need to bring any records with me?” style=”round_outline” open=”true”]Absolutely. If you have had any prior testing related to fertility, or any procedures that could possibly affect your ability to achieve pregnancy. Please contact your treating physician or gynecologist and kindly provide the medical records at least 2 days PRIOR to your appointment.[/vc_toggle][vc_toggle title=”Will my insurance cover the cost?” style=”round_outline” open=”true”]Before your first visit, we will attempt to perform complimentary benefit verification on your behalf. Because the level and scope of fertility benefits vary widely, you should take every step needed to be sure you understand your benefits prior to your visit. We encourage you to contact your Health plan or employer to verify any information we were able to obtain. In most cases, we are able to file claims for the office visits and tests related to the diagnosis of infertility. However, there will be instances for some people where services provided related to infertility are specifically excluded. In these instances, you will be personally responsible for the payment for services. IVF Phoenix™ participates in most commercial insurance plans. We do not accept Tricare or ACCCHS.[/vc_toggle][vc_toggle title=”Will there be anyone that can help me understand the costs and how I can afford treatment?” style=”round_outline” open=”true”]At IVF Phoenix™, we have financial counselors who are specially trained to understand insurance benefits and the resources available to help you afford treatment. Whether you have insurance or are paying out of pocket, we make every resource available to you to help you achieve the outcome you desire.[/vc_toggle][vc_toggle title=”Who do I contact if I have more questions?” style=”round_outline” open=”true”]Should you have questions during normal hours, we are available to take your call. After hours, for non-emergency calls, you are free to leave a message in our general mailbox, and we will get back to you on the following business day.

If you have an emergency after hours, on the weekend or a holiday, we have a clinical team on on-call to assist you. Simply call our main number and you will be connected to someone who will assist you. As always, for true medical emergencies, call 911 or go to your closest Hospital’s Emergency Room.[/vc_toggle][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Infertility testing at IVF Phoenix™

[/vc_column_text][vc_toggle title=”What is an AMH test and what does it mean?” style=”round_outline” open=”true”]AMH or anti-mullerian hormone is a hormone produced by the viable follicles (which contain eggs) that remain in the ovary. It is an excellent indicator of ovarian reserve. Young women with large numbers of healthy eggs tend to have high AMH levels whereas older women or women with a low number of healthy eggs will have lower levels of AMH.  New information is suggesting that very high levels of AMH may not simply indicate a plethora of antral follicles, but may indicate a follicular dysfunction.

AMH levels do not fluctuate very much throughout the cycle and are not impacted by the levels of other hormones such as estrogen or progesterone.

Abnormal AMH levels are usually determined by comparing a woman’s own AMH level with that of a large group of women her own age who do not have infertility. For example, an AMH of 1.4 would be considered very low for a fertile 18-year-old but would be considered average for a 36-year-old.

Fertility decreases with age. This decrease is most likely due to aging of the eggs and the chromosomes inside them. The risk of miscarriage and chromosomal abnormalities in babies also increase with age. The most successful method for achieving a pregnancy and taking home a baby at advanced female age is with the use of egg donation.[/vc_toggle][vc_toggle title=”What is a Sonohysterogram?” style=”round_outline” open=”true”]A sonohysterogram or SHG is a saline ultrasound, saline sonogram, or saline infusion sonogram. A sonohysterogram is a minimally invasive ultrasound procedure that can determine if there are abnormalities inside the uterus that might interfere with pregnancy. It is important to have an evaluation of the uterine cavity with a sonohysterogram or other method before proceeding with an IVF cycle. This test involves no radiation, and there are very few risks from the procedure. Compared to a regular ultrasound, a sonohysterogram is better at detecting abnormalities on the inside walls of the uterus because it involves infusing sterile fluid inside the uterus. This way, the walls of uterus separate from each other and any abnormalities that might have been hiding right along the sides of the walls will be easily identified.

Here is an example to help understand why we do a sonohysterogram. Think of your uterus like a collapsed balloon. If there was a small growth or bump on the inside wall of the collapsed balloon, it might be hard to see since the top and bottom walls are touching each other. However, if we inflated the balloon, the small growth will be easier to see since it will likely be able to hang away from the wall.

Traditionally, the “best” way to look for abnormalities inside the uterus was a test called a hysteroscopy, which involves an out-patient surgery using a type of endoscope to look inside the uterus. However, in recent years, the techniques for a sonohysterogram have become so advanced that it has usually replaced hysteroscopy as the first procedure to look for abnormalities in the uterus. Compared to a hysteroscopy, a sonohysterogram is less invasive, less expensive and nearly as effective at detecting abnormalities.[/vc_toggle][vc_toggle title=”What kind of problems can a hysterosonogram diagnosis?” style=”round_outline” open=”true”]A hysterosonogram is often recommended for women who are having difficulty conceiving a pregnancy or for women who are having recurrent miscarriages. In some cases, a hysterosonogram may be used for a woman who is having abnormal vaginal bleeding. Since a sonohysterogram gives such a detailed view of the inside walls of the uterus, it can identify many abnormalities that might prevent a normal pregnancy from developing. Studies have shown that it can detect over 90% of abnormalities inside the uterus. Some of these abnormalities include:

• Polyps
• Fibroids
• Scar tissue
• Uterine septum
• Bicornuate Uterus

[/vc_toggle][vc_toggle title=”How is a sonohysterogram performed?” style=”round_outline” open=”true”]The procedure for performing a sonohysterogram is very simple and usually takes about 5 minutes. In order to schedule a sonohysterogram, you will need to call with the first day of your period. You will be given an appointment for some time point after the bleeding from the period has ended but before it is thought that ovulation might occur. This ensures that the uterine lining is as thin as possible. This is important since it will assist the doctor in the visualization of the cavity. The hysterosonogram is performed in the office. Using a speculum, a very thin, soft, flexible plastic catheter will be inserted through the vagina and cervix into the lower part of the uterine cavity and a balloon is inflated.  The speculum is then carefully removed so as not to disturb the catheter. A vaginal ultrasound probe is then placed into the vagina. Through the catheter, a small amount of saline (sterile salt water) is injected into the uterine cavity to separate the walls.

During a sonohysterogram, the ultrasound probe can be rotated to show the long axis of the uterus or a transverse axis. In the long axis, the uterine cavity appears long and ovoid. Sometimes after the procedure, a small amount of the saline fluid may leak out of the vagina. It is also possible that the patient may experience some bleeding or spotting. It is recommended that the patient wear a light pad or tampon for the rest of the day.[/vc_toggle][vc_toggle title=”What do you need to do before a hysterosonogram?” style=”round_outline” open=”true”]

Occasionally, a woman might experience some cramping during or after a hysterosonogram. If she desires, she may take 1-2 tablets of ibuprofen (Motrin or Advil) 1-2 hours before the procedure to decrease cramping. This may be repeated 3-4 hours later in the unlikely event that cramping persists.

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You will be able to watch the sonohysterogram on a monitor while it is being performed. Afterwards, the doctor will review the findings with you and answer any questions about those findings. If there are any abnormalities that are found on the inside of your uterus, don’t worry! Nearly all of these conditions are easily corrected with minimally invasive, outpatient surgery (usually with hysteroscopy).

[/vc_toggle][vc_toggle title=”Hysteroscopy for Fertility and Reproductive problems” style=”round_outline” open=”true”]Hysteroscopy is the inspection of the uterine cavity that allows for the diagnosis and treatment of various uterine conditions. Some of which, could lead to fertility problems.

Uterine Septum (Septate uterus)

This is the most common uterine malformation and a common cause of miscarriage. It is unclear whether a uterine septum increases the chances for infertility or not. A wedge of tissue is present inside the uterine cavity, which divides it into two halves (also called uterine horns).

When seen through a hysteroscope, the uterine horns are seen as two dark openings separated by a wedge of tissue. By introducing an electrode through the hysteroscope, the septum can be shaved or vaporized all the way to the top of the cavity. The finished product is a uterine cavity that is unified into one large space instead of divided in two.

Polyps

These are uterine growths a few millimeters to centimeters in size. Polyps arise from the uterine lining (endometrium). A polyp may be attached to the uterine wall directly or by a thin “stalk”.

Patients often have no symptoms from polyps but will occasionally notice irregular vaginal bleeding. This bleeding may occur in between periods or cause the period to be longer in duration or heavier than normal.

Polyps are also associated with an increased risk for miscarriage. Large polyps, which occupy the majority of the uterine cavity, are also probably responsible for infertility. Small polyps can be most easily vaporized in place. Polyps which are attached by a stalk can sometimes be removed by cutting through the stalk and removing the entire polyp through the cervix. Larger polyps may have to be removed by shaving small strips one at a time until the polyp is completely gone, or slightly deeper, taking a margin of the myometrium.  This tissue is sent out for pathology.

Fibroids

These benign tumors arise from the muscle layers of the uterus. Often they will stay in the muscle layer but on occasion, fibroids can grow into the uterine cavity. Like polyps, fibroids can cause bleeding, infertility, and as well as miscarriage. Removal of fibroids from the uterine cavity is performed using the same methods as for polyps.

Scar tissue

Scar tissue inside the uterine cavity, also called adhesions, can arise from infection or trauma to the uterine lining. Although rare, the most common cause for uterine adhesions to form is from a previous D&C procedure. Scar tissue inside the uterus can be small and isolated to a certain spot. This type of adhesion looks like a band running from one wall of the uterus to another. Sometimes adhesions take the form of two walls that are stuck together causing the cavity at that spot to be completely obliterated. In rare instances, the entire cavity can be obliterated. Uterine adhesions can cause infertility or miscarriage. If the uterine cavity is partially or completely obliterated, a woman may notice that her period are lighter or even stop altogether. Band adhesions can be easily cut restoring the normal anatomy of the uterine cavity. When the walls are stuck together, the surgeon must carefully dissect between them in order to separate the walls. This can be a very difficult process if there is little normal uterine cavity that remains to serve as a guide.[/vc_toggle][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

All about the IVF Process:

[/vc_column_text][vc_toggle title=”WHY IS IVF DONE? :” style=”round_outline” open=”true”]In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in your uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 35, and especially 40 or more.  IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

• Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
• Premature ovarian failure. Premature ovarian failure is the loss of normal ovarian function before age 40. If your ovaries fail, they don’t produce normal amounts of the hormone estrogen or have eggs to release regularly.
• Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
• Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
• Previous tubal sterilization or removal. If you’ve had a tubal ligation — a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy — and want to conceive, IVF may be an alternative to tubal ligation reversal.
• Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist determine if there are correctable problems or underlying health concerns.
• Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
• A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic diagnosis — a procedure that involves IVF. After the eggs are harvested and fertilized, they’re screened for certain genetic problems, although not all genetic problems can be found. Embryos that don’t contain identified problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions. If you’re about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use. Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman’s eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier’s uterus.

[/vc_toggle][vc_toggle title=”What are my options if I decide not to use my stored embryos? ” style=”round_outline” open=”true”]If you have stored embryos that you have decided not to transfer into your uterus to attempt pregnancy, you have four options for their final disposition. First, you can donate your embryos to another woman with fertility problems that you don’t know so that she can attempt pregnancy through a process called “anonymous embryo donation.” Second, you can donate your embryos to another woman that you do know so that she can attempt pregnancy though a process called “directed embryo donation.” Third, you can donate your embryos for laboratory research to help improve pregnancy rates for infertile couples in the future. Finally, you can ask that your embryos be thawed and discarded. In both of these last two situations, your embryos will not be transferred into another person and no child will be born as a result.[/vc_toggle][vc_toggle title=”What if I don’t respond to the drugs for ovarian stimulation? ” style=”round_outline” open=”true”]

A response to ovarian stimulation depends on a number of different factors, the most important include available eggs, appropriate hormone levels, proper administration of any medications and lifestyle/environmental factors.
In order to respond to ovarian stimulation, a woman must have eggs available to respond; this is sometimes referred to as ovarian reserve. If a woman has diminished ovarian reserve (identified by high blood levels of follicle stimulation hormone (FSH), low blood levels of Anti Müllerian Hormone (AMH) or a low antral follicle count on ultrasound), she may not have as robust (or any) response to stimulation. For these patients, an alternate stimulation protocol may be tried or donated eggs may be used (from a woman known or unknown to the patient).
It is possible that a woman does have the necessary eggs but lacks the appropriate pituitary hormones to respond. In this case, using a different medication- one which may contain both FSH and luteinizing hormone (LH) may allow for an optimal response.
Lifestyle factors can also affect a woman’s response to stimulation. Optimizing weight, diet and stress and cessation of use of tobacco, alcohol and recreational substances can also improve a response to ovarian stimulation.

[/vc_toggle][vc_toggle title=”Should we have genetic testing? ” style=”round_outline” open=”true”]Preimplantation genetic screening (PGS) is a technique in which one or more cells are taken from an egg or embryo (fertilized egg) for testing to provide information about the genetic make-up of the rest of the cells in that embryo. In order to utilize PGS, couples must undergo in vitro fertilization (IVF), where the eggs (oocytes) are removed from a woman’s body and mixed with her partner’s sperm in a laboratory. The embryos which are created can be tested on Day #5-7 after egg harvest. At IVF Phoenix, these embryos will be frozen after the cells are removed for testing and implanted in a subsequent frozen embryo transfer cycle attempts.

Patients with many inherited familial diseases can have their embryos tested with preimplantation genetic diagnosis (PGD) to determine if a specific gene is present or absent. Specifically, this would include patients with a history of single-gene disorders (such as cystic fibrosis or sickle cell anemia) and patients with a history of sex-linked disorders (such as Duchenne muscular dystrophy and Fragile X syndrome). In addition, even families in search of a bone marrow donor may be able to use PGD to bring a child into the world that can provide matching stem cells for an affected sibling.

Other patients may also decide to use genetic screening called PGS. For some patients with recurrent pregnancy loss, severe male factor infertility, advanced reproductive age or recurrent IVF treatment failures, genetic screening may be used. Genetic screening is different than other types of genetic testing because the testing is looking for any gross chromosomal abnormality instead of a specific disease, and as a result is associated with higher rates of false results.  The literature has shown the highest rates of ongoing pregnancy rates for all age groups when transferring a chromosomally normal or euploid embryo with frozen embryo transfer.

If you are uncertain about genetic testing for you, speak with Dr. Couvaras about whether preimplantation genetic testing is right for you.[/vc_toggle][vc_toggle title=”What is third party reproduction? ” style=”round_outline” open=”true”]

The first and second parties involved in a pregnancy are the male and female couple wishing to become parents. The three principal components required to achieve a successful pregnancy are a healthy egg, sperm and uterus. If any of these components are absent, then an option is to have a third party, or someone besides the couple, become involved. Third-party reproduction is when a couple uses a sperm donor, egg donor or a gestational carrier to help them become parents.

Each third party becomes involved in very distinct and completely different ways. A sperm donor’s involvement, for example, may simply be to produce a semen sample at a sperm bank, while a gestational carrier is committed for at least the nine months of pregnancy. Each has its own intricacies, processes, regulations and procedures that a certified IVF center can help a patient navigate through. It often involves a multi-team approach including the reproductive endocrinologist, the IVF team, an experienced attorney, a psychologist, third-party agencies, etc.

[/vc_toggle][vc_toggle title=”Do I need intracytoplasmic sperm injection (ICSI)? ” style=”round_outline” open=”true”]The purpose of ICSI is to assist the fertilization process when a man’s sperm count is abnormal. Whether it is because the number of motile sperm is very low or the morphology is excessively poor, the technique involves the delivery of a single sperm into a single egg. Since 1991, when it was first described, it has revolutionized the treatment of male infertility. Most clinics started out recommending ICSI if there is a fear that poor fertilization may occur by traditional IVF where sperm are merely added to the egg culture dish.   Currently with most IVF, ICSI is utilized to obtain the highest likelihood of fertilization, and to reduce the risk of polyspermia, (more than one sperm fertilizing the egg).  Accordingly, efforts are made to assess sperm by function or morphology to help determine those most likely to require ICSI, and at IVF Phoenix, we use a more physiological approach to selecting sperm for ICSI called PICSI. This involves having sperm bind to hyaluronic acid, then selecting those sperm for ICSI.  The egg shell is made of hyaluronic acid, and it is show that sperm which bind to HA, have higher intact DNA and less DNA fragmentation.   It is best to discuss this option with Dr Couvaras and our Embryologist prior to treatment.[/vc_toggle][vc_toggle title=”Do I need donor eggs? ” style=”round_outline” open=”true”]A principal limitation to human reproduction is the natural loss of healthy eggs as a woman ages. At birth, a woman is born with her total reserve of eggs. Over her lifetime, waves of them degenerate through a natural process called atresia so that by her mid thirties, we begin to see a greater difficulty to achieve a pregnancy and a higher chance of chromosomally affected children. By her early forties, the majority of women experience infertility and eventually a loss of reproductive capacity. This is due to the eventual loss of her remaining healthy eggs. Egg donation, like sperm donation, is a means to realize parenthood when the loss of gametes (i.e., egg or sperm) occurs. This may be due to the natural process of aging or may occur prematurely from other disease states or because of medical treatments for cancer, for example. When gametes are depleted, replacement by egg donation is an exceptional option to enable one to become a parent. There are many young women who want to help others overcome infertility. They serve as egg donors by expressing interest and then going through a rigorous screening process to ensure they are appropriate candidates. Typically, they provide a detailed health history of themselves and genetic history of their ancestors. Medical and psychological evaluations are performed, in addition to FDA mandated infectious disease testing. Once a patient has chosen to pursue egg donation, the process typically involves coordination of their two menstrual cycles so that the eggs may be retrieved, fertilization by the sperm of the patient’s partner and transfer into the patient’s womb can occur during the same month, or at a later time with frozen embryo transfer. The egg donor treatment cycles rate among the highest success in assisted reproduction.[/vc_toggle][vc_toggle title=”Should I have my IVF center perform Assisted Hatching on my embryos before transfer? ” style=”round_outline” open=”true”]In vivo hatching of the blastocyst is a critical component of the physiologic events culminating in implantation. Conversely, the failure to hatch may be one of the many factors limiting human reproductive efficiency. The clinical application of assisted hatching has been proposed as one approach toward the enhancement of implantation and pregnancy rates following in vitro fertilization.  The assisted hatching procedure entails the creation of a gap in the outer area of the embryo called the zona. In the past, this was done either by drilling with an acid medium or by using a piezomicromanipulator, but currently we and most other centers are using laser vaporization of a portion of the egg shell.  Success rates following the use of assisted hatching in different ART programs have varied considerably. Well-designed studies suggest that assisted hatching might best be used in patients > 38 years old or with multiple prior failed IVF cycles.  Please note that assisted hatching with laser is the safest way to promote hatching, and this is needed if the lab is planning on doing embryo biopsy at Day 5-7.[/vc_toggle][vc_toggle title=”How many embryos should I have transferred back? ” style=”round_outline” open=”true”]The objective of infertility treatment should be the birth of a single, healthy child. Many of the treatment options presented to infertile couples, however, are associated with high risks of multiple gestations. Moreover, many couples view multiple gestations (twins) as desirable and are unaware of the risks they pose to both mother and babies. Couples should understand these potential risks before starting treatment.
The ability to limit the number of embryos or eggs transferred is an effective approach to limit multiple pregnancies. The Society for Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM) have published guidelines recommending an optimal number of embryos for transfer based on patient age, embryo quality, and other criteria.

In the United States, the decision regarding the number of embryos to transfer is made jointly by the physician and the patients. This decision should be based upon the best interests of the patient and the future offspring. However, ART is centrally regulated in England, and no more than three embryos on Day 3, or two on Day 5, may be transferred in most circumstances.

The ultimate goal is to achieve a high pregnancy rate while transferring a single embryo. Recent laboratory improvements have allowed programs to transfer two embryos while maintaining acceptable pregnancy rates. Eventually, the transfer of one embryo will resolve the issues surrounding multiple pregnancies.

At IVF Phoenix™, we see more than the average number of patients with difficult infertility problems, such as advanced maternal age or low AMH (<1.0). Some clinics are not willing to offer ART to those who have a low probability of success and encourage them to use donor eggs, a practice that results in higher success rates among older women. At IVF Phoenix, we have been focusing on low AMH patients and are seeing a 30% on-going pregnancy rate in low AMH patients, (<0.5) under age 40. Unfortunately, this does not apply to a woman 40 and older with low AMH.[/vc_toggle][vc_toggle title=”I am considering Acupuncture during my IVF?” style=”round_outline” open=”true”]Acupuncture is the insertion of thin metallic needles into anatomically defined locations on the body to affect bodily function. Acupuncture needles are regulated by the FDA just like other medical devices such as surgical scalpels and hypodermic needles. This helps ensure that the needles meet standards for quality and sterility. In Illinois, practicing acupuncturists must show proof of adequate training by an approved acupuncture program and be licensed.

The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body, which are essential for health. Disruption of this flow is believed to be responsible for the disease. Acupuncture can correct imbalances of flow at identifiable points close to the skin. These acupuncture points correspond to specific areas on the surface of the body. Attempts to study these areas have found that they do have unique identifiable properties such as temperature and electrical conductance.

Some studies have shown that acupuncture has an effect on brain chemicals called endorphins. Endorphins, in turn, can affect the levels of the pituitary hormones which control the function of the ovaries. It is possible, therefore, that acupuncture may be used to influence ovulation and fertility.
Several studies have shown that acupuncture apparently affected the levels of these hormones in the blood as well as the levels of estrogen and progesterone from the ovaries.

A small series of women who had problems with ovulation found that that about half of them responded to acupuncture treatment.

A larger group of patients was studied by a German group. These women had various types of ovulation problems. They were divided into two groups. One group received medical fertility treatments and the other group had acupuncture. Although the investigators concluded that the acupuncture group had better results, the actual data is not that clear. For example, seven pregnancies in the acupuncture group were actually achieved with hormone treatment 6 months after acupuncture was stopped. Another study used electro-acupuncture in PCOS patients in an attempt to induce ovulation. Before treatment, about 15% of menstrual cycles were associated with ovulation. After treatment, about 66% of the cycles were ovulatory.[/vc_toggle][vc_toggle title=”What is your age cut-off for doing IVF with your own eggs?” style=”round_outline” open=”true”]We do not recommend IVF for patients wishing to use their own eggs, if they are older than 42 . Excepting for cases with high AMH and high antral follicle counts. In these situations, we are expecting to do PGS and freeze all embryos till we find a euploid embryo. Even so, we discourage woman 44 or older from considering ART with their own eggs, since the likelihood of finding a chromosomally embryo will be around 5-8%. Your reproductive endocrinologist will recommend an appropriate fertility treatment for you depending on your medical history and diagnostic test results.[/vc_toggle][vc_toggle title=”How long does it take to get started with IVF?” style=”round_outline” open=”true”]From the point of your initial consultation with IVF Phoenix™, you may potentially start an IVF cycle within weeks. Dr Couvaras will determine the appropriate time frame for your fertility treatment but each individual patient or couple decides when it is right for them to begin. The initial consult and diagnostic evaluation usually takes a week up to a couple of months (depending on your menstrual cycle, logistical and financial details such as your travel schedule, availability, insurance requirements, etc.)

After reviewing all diagnostic testing results with Dr Couvaras, the next step is to focus on logistical details such as reviewing the calendar, obtaining IVF medications and learning how to mix and administer them. There are consent forms to be signed, financial details to finalize and possibly some other small details that your primary nurse coordinator will assist you with so you are comfortable before officially starting. This may be done within a couple of weeks or months, again depending on your schedule, insurance, and availability.

Once the IVF cycle starts, it typically takes about 10 – 12 days on average until it is the appropriate time to schedule the egg retrieval. During this time you will be taking injectable fertility medications and will need to return to IVF Phoenix™ for several visits during that time to evaluate the response to the stimulation medication with blood work and trans-vaginal ultrasound. Once you reach the time of the egg retrieval, this is but another hurdle to cross, and we need to make and find a euploid embryo (s). Once we get to the frozen embryo transfer, you’ve almost reached the finish line and the pregnancy test will occur 11 days after the thawed blastocyst transfer, (day5), to determine the outcome of the IVF treatment cycle. At IVF Phoenix, we have been seeking protocols to improve the outcomes for frozen embryo transfers, and recently, in a small cohort of patients, have been seeing 18 out of 23 FET continuing with ongoing pregnancies. This may be a fluke or the law of small numbers, but the improvement from 50% to 76% is startling and impressive. Unfortunately, we can not be sure what recent changes may be responsible for the dramatic improvement. Thus, we counsel our patients to follow all of the parts of the new protocol until we are able to discern what may be leading to the high outcomes.[/vc_toggle][vc_toggle title=”What are my choices if my tubes have been tied?” style=”round_outline” open=”true”]Basically there are two choices, surgery to attempt to repair the tubes or IVF. There are pros and cons to each choice and the best choice depends on your personal situation. Surgery offers the option of attempting pregnancy naturally indefinitely without repeated treatments, but carries the rare risks of surgery and in some cases is not successful depending on the type of tubal ligation or tubal damage done initially. IVF offers the chance for pregnancy without having to undergo an operation and maintaining contraception or birth control against future pregnancies after completion of your family.[/vc_toggle][vc_toggle title=”How much does IVF cost?” style=”round_outline” open=”true”]The cost of IVF depends on the treatment and options selected. A member of the IVF Phoenix™ team would be pleased to sit with you to review the costs.[/vc_toggle][vc_toggle title=”When will my egg retrieval be scheduled?” style=”round_outline” open=”true”]We won’t know the exact date of egg retrieval until two days prior to the procedure. We typically estimate it about 12-15 days from the start of your  superovulation medications.[/vc_toggle][vc_toggle title=”Can I exercise while I’m undergoing IVF treatment?” style=”round_outline” open=”true”]Yes, but you should refrain from high-impact exercise and opt for workouts such as walking, swimming, yoga, or cycling during IVF treatment. Leading up to the beginning of the IVF cycle you may exercise as you normally do, but as you get closer to the egg retrieval we will ask that exercise be modified for health and safety reasons.[/vc_toggle][vc_toggle title=”If I live out-of-town or internationally, how often will I need to visit IVF Phoenix™? How long will I need to stay?” style=”round_outline” open=”true”]IVF Phoenix™ requires out of town egg donors or recipients to visit our clinic initially, then if coordinated efficiently and if there is good offsite monitoring, we can expect the patient, to be seen by us at the end of the stimulation cycle, or at the peak of estrogen administration for endometrial development.  Unlike many other clinics, mock cycles are not necessarily required. Depending on your circumstances, you will most likely need to be here for five to nine days. This is something your donor egg/ART coordinator will help determine.

One option that some couples choose is to have the male partner visit IVF Phoenix™ for sperm collection prior to the couple’s visit for the woman’s cycle. This option requires the man to travel to IVF Phoenix™ one time, and the couple to travel to IVF Phoenix™ one time.[/vc_toggle][vc_toggle title=”On the day of Egg Retrieval. What do I need to bring with me?” style=”round_outline” open=”true”]Photo ID: For your safety, IVF Phoenix™ requires that all patients provide photo identification prior to undergoing any surgical procedure within our facilities.

Responsible Adult: It is our responsibility to insure that you get home safely after your procedure, post- anesthesia. Therefore, you must have a responsible adult, over the age of 18, with whom you have a relationship, accompany you to this surgical appointment. They must stay at the center during your procedure, and be available to take you home after you are discharged. If both you and your partner are having procedures on the same day, we require a 3rd party be available to drive the couple home. We prefer that this person also be available to make sure that you are doing well once you get settled in your home.

No Children: Children are not allowed in the practice on the day of your procedure. Please arrange for childcare prior to arrival. Unfortunately, children cannot be brought with you to your surgical procedure at any time or under any circumstances.

 

Preparing for My Surgical Procedure with Anesthesia

Diet: Conscious sedations is used in our surgical procedures. If you have never been sedated before, there are important things to remember. For your safety, one important rule is to ensure that you do not eat or drink anything after midnight the night before your procedure. If you have a specific medical condition or special situation, please discuss with your nurse before this time frame.

Appropriate Clothing: Patients should follow these guidelines:

• Wear comfortable clothes
• No jewelry
• No perfume
• Refrain from makeup
• No contact lenses

 

Semen Collection

For most patients arriving to the practice for their egg retrieval, a semen sample will be required by the Embryology Team in order to fertilize the egg(s) after your procedure. Male partners are encouraged to collect their sample at home prior to arriving for the retrieval. Once you arrive, please inform the Reception Desk staff that you have your sample so they can notify the Embryology Team. If you are traveling more than one and a half hours to the practice, you may collect a sample in our offices after you arrive. The period of abstinence from ejaculation is 3 days and no more than 4 days, as sperm DNA fragmentation increases with longer abstinence.

 

Arrival and Departure for Surgical Procedures

Patients should arrive 90 minutes before your scheduled procedure, or as instructed by your nurse. After checking in at the Reception Desk, the clinical team will bring you and your partner back to the procedure area. Your nurse will check your photo ID, review your recent food and beverage consumption and have you change into a surgical gown. Next, you will meet your Nurse Anesthetist, who will start an IV (intravenous) in your arm for medication administration. The office will review your medical history before beginning your sedation medication. During your procedure, your partner or accompanying adult will wait in the Reception Area. Most of the procedures are completed within 30 minutes. Most of our patients take about 30-60 minutes to recover before they return home. We find that our patients recover best when they are in a familiar, comfortable place usually in their home. From start to finish, patients should expect to be at the practice for 2½ to 3 hours.[/vc_toggle][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Understanding Male Infertility:

[/vc_column_text][vc_toggle title=”Many individuals assume that the term “fertility” relates specifically to women.” style=”round_outline” open=”true”]However, nearly one-third of all infertility cases are related to male factors such as low sperm concentration, poor motility, and abnormal sperm shape. While some men require treatment for their infertility, there are a number of things you can do on a daily basis to boost your male fertility naturally.

Avoid Extreme Physical Activity

It’s no surprise that exercise is essential to a healthy lifestyle. However, too much exercise may interfere with your fertility. In fact, a 2009 study showed that intense exercise may impair sperm count, motility, and morphology. For this reason, experts recommend that men not exceed one hour of moderate exercise three times per week.

Eat a Healthy Diet

Certain foods have been shown to increase fertility in men by promoting the development of healthy sperm. Consider incorporating more antioxidant-rich foods into your diet, such as avocados, pomegranates, tomatoes, and other fresh fruits and vegetables. Filling up on pumpkin seeds is also a great way to boost fertility, as they contain substantial amounts of zinc and therefore can help increase testosterone and sperm count.

Avoid Overheating

Overheating of the testicles is a major cause of infertility in men. You can reduce the risk of overheating and infertility by avoiding frequent use of hot tubs or saunas, wearing tight clothing, or sitting for long periods of time.

Don’t Smoke

Smoking cigarettes, cigars, and using other tobacco products has been linked to male infertility. In most cases, the nicotine and other chemicals in cigarette smoke can lead to a lower sperm count.

Don’t Drink to Excess

A good way to prevent low sperm counts is to avoid drinking excessive amounts of alcohol. Limiting your alcohol intake can also help decrease the risk of low testosterone levels and erectile dysfunction.

Whether you and your partner are struggling with male factor infertility, female infertility, or are interested in in vitro fertilization, the team at IVF Phoenix™ is here to help. Contact our infertility clinic online or call (602) 765-2229 to get started.

Limit days of abstinence from ejaculation to 4 or less.

Sperm DNA fragmentation is higher in ejaculates over 4 days.[/vc_toggle][vc_toggle title=”What are Male Infertility Risk Factors?” style=”round_outline” open=”true”]Infertility isn’t solely a women’s challenge. At IVF Phoenix ™ we want you to understand male infertility factors, which account for half of all cases, according to the American Society for Reproductive Medicine.

Sperm disorders – the most common male infertility factor

Difficulties making healthy sperm can cause male infertility. There may be too few sperm or sperm may be immature, abnormally shaped or unable to swim. Several causes of sperm disorders are commonly reported in men who experience male infertility.

• Infections or inflammatory conditions such as having the mumps after puberty
• Hormone or pituitary gland irregularities
• Immune problems that generate antibodies against sperm
• Genetic diseases such as cystic fibrosis or hemochromatosis
• Erectile dysfunction or premature ejaculation
• Men who have had groin injuries or surgeries either as an adult, or when they were children
• Men who have taken anabolic steroids, most notably testosterone

Structural or inherited male factors can cause issues

Anything blocking the genital tract can hamper the flow of semen. Some items that our fertility specialists or urologists look for:

• A history of a sexually transmitted disease that causes infection or inflammation
• Scar tissue from surgery or twisted or swollen veins in the scrotum
• Liver or kidney disease
• Treatment for seizure disorders
• Any trauma to the testicles, or a prior vasectomy or major abdominal or pelvic surgery
• A history of undescended testicles
• Medication history, most notably the use of testosterone
• Being born with a fertility disorder or having a blood relative with a fertility disorder
• Certain medical conditions such as tumors or chronic illnesses such as sickle cell disease

[/vc_toggle][vc_toggle title=”What about environmental male factors?” style=”round_outline” open=”true”]Many researchers believe environmental causes explain an ongoing decline in make infertility. Exposure to toxic substances can be harmful, as can exposure of the genitals to elevated temperatures (such as with hot baths, whirlpools or steam rooms), Also problematic is in-utero exposure to Diethylstilbestrol (DES), a synthetic form of estrogen, the female hormone. Finally, men facing the burden of a cancer diagnosis should be aware of the negative effects on fertility of medical treatments such as surgery or radiation.

Behavioral male factors

A higher risk of male infertility is tied to unhealthy behaviors such as smoking, using alcohol or illicit drugs, and being overweight. Other behavioral factors are having certain past or present infections or taking medications for ulcers, psoriasis, depression or high blood pressure.

Get help with male factors

Infertility challenges are frustrating, but we can address all the factors associated with male infertility. Call us today at (602)765-2229 or email us at info@ivfphoenix.com to learn more and get tested. We’ll give you all the information and assistance you need to achieve your goal of starting a family or adding another child.[/vc_toggle][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

The Process of obtaining an Egg Donor

[/vc_column_text][vc_toggle title=”How does egg donation work exactly?” style=”round_outline” open=”true”]Egg donation is a modification of the process of IVF. There are several steps involved.

• Recruitment of an egg donor
• Screening / testing of the egg donor
• Synchronization of the egg donor and recipient, but most commonly these days, is to freeze all embryos, then return for frozen embryo transfer.  In woman 35 year and older, we are recommending biopsy and PGS, and freeze all embryos.
• Stimulation of the egg donor with fertility medication and preparation of the recipient uterus
• Retrieval of the egg donor‘s eggs
• Fertilization and culture of the egg donor‘s eggs
• Transfer of the embryos into the recipient’s uterus

[/vc_toggle][vc_toggle title=”How does one secure or recruit an Egg Donor?” style=”round_outline” open=”true”]An egg donor can be someone who is either known to the recipient couple or anonymous. A known egg donor can be anyone who is not closely related to the male partner who will be providing the sperm. An egg donor CAN be related to the female partner. Sisters, nieces, cousins or even daughters from previous partners are acceptable candidates to be a known egg donor.

If a couple does not have a suitable known egg donor or does not feel comfortable with a known egg donor then they can try to find an anonymous egg donor. There are many resources for finding an anonymous egg donor. Many of our patients are choosing to recruit their own egg donors by placing advertisements in local newspapers or by placing signs up at local colleges or beauty salons. Some of our recipients have found potential egg donors on the internet and still others will use an egg donor agency (though this is a very expensive option).[/vc_toggle][/vc_column][/vc_row]