Thank you for subscribing to the Reproductive Care Infertility Center Newsletter. This issue features information on the 2nd. Annual Utah Infertility Awareness event, the Annual Patient Party, an article entitled "What's Next?" and information on male infertility (the semen analysis).  We hope you enjoy our newsletter.  If you received the newsletter by mistake there is an unsubscribe link at the bottom of the page.

All Reproductive Care Infertility Center patients and family members are invited to join us for the "Annual RCC Patient Party" on Saturday June 11, 2011.

  

This years party will be held at Heritage State Park, 2601 East Sunnyside Ave., Salt Lake City, Utah. Drawings will be held for 50% off the price of an IVF cycle plus several $1,000 and $500 awards.

  

A barbecue lunch will be served from 12:00 PM until 2:00 PM. Many activities for the children including pony rides, train rides, etc. Please RSVP to PatientParty@FertilityDr.com.

Time: Saturday April 30, 2011 from 9am - Noon (Free Event)

Location: University of Utah, Health Services Education Building,

Room 175

Register: www.utahinfertilityawareness.com

Topics will include: Strengthening Relationships, Fears and Concerns of Third Party Reproduction, and Coping with Infertility

Rewards at Each Drawing will Include: 50% off an IVF/ET Cycle, 10% off an IVF/ET Cycle, $100 off any Service (1 per couple in attendance)

*Reward certificates can only be used for services not covered by insurance.

Patients often call wanting the answer to this question. Although it may seem like a simple question it rarely is. It becomes important to schedule a follow up appointment to really answer that question. It is important to remember this is a specialized arm of medicine and requires detailed care to navigate treatment.

 

It is similar to working with a trainer. The trainer doesn't give exercises and wish you good luck; it requires frequent interaction with the trainer to modify the diet and exercise plan along the way to get the best results. Infertility treatment is much the same. It is necessary to fine tune the treatment to best fit the individual needs of the patient; especially as those needs may change over time.

 

It may be helpful to understand the process of being a patient. With an initial consultation, the physician will review past records, testing and history to determine what testing still remains. Often the initial consult may be only an opportunity to share information as an accurate diagnosis can not yet be determined until all testing is completed. This will prompt the first follow up. Most patients will have some list of recommended testing to be completed.

 

The common areas of diagnosis are male factor, non ovulatory, ovarian reserve and tubal/uterine factors. Depending on the type of testing will determine the amount of time to complete, as many of the tests are cycle dependent for timing. Often, the physician will offer to do an insemination with the testing as semen analysis and hormone tests using Clomid is frequently recommended so this feels useful to the patient and still completes the testing.

 

The nurse or nurse practitioner will review timing of testing as many of the tests can be completed simultaneously. Doing the insemination with your testing is simply a "diagnostic cycle" and not truly considered a treatment cycle. So it is common to be requested to return after testing is complete to determine the best treatment plan based on the test results.

 

We strive diligently to communicate all test results. The patient portal is a great tool for patients to look at lab results and general communication with RCC staff. Although the access is available; it will not give you the complete picture of what to do with the results. Scheduling a follow up is simple and can often be done on the phone (a fee may still apply) for convenience. This follow up will then help determine the type of treatment best suited based on the testing. Some patients may go directly to IVF with or without ICSI and/or TESE. Other patients may be recommended to try less aggressive treatment.

 

Less aggressive treatments can be as simple as Clomid to help with ovulation or intrauterine insemination (IUI) for borderline semen parameters. Often it is recommended to try a particular treatment regimen 3-4 cycles prior to changing medications. Most of the transitions for change in medication while doing IUI or timed intercourse can be managed with the nurse practitioner team. These discussions on medication changes are brief and can be included at the time of IUI treatment to review plan for the next cycle and ensure all testing is completed. Patients may be asked to meet with their physician prior to adding injectable medications to appropriately determine starting dose.

 

A routine semen analysis typically assesses the volume, concentration, percent motility and progression of the sample. While these components are essential for understanding a possible male factor source of infertility, sperm morphology determined by the "Kruger strict morphology" method has the greatest correlation to successful in-vitro fertilization (IVF). In fact, the Kruger method is the only morphology scoring system shown to have a clinical predictive value for the sperm being able to actually fertilize an egg in-vitro.

The Reproductive Care Center is the only IVF center in Utah that routinely performs this test as part of the initial semen analysis evaluation. Kruger strict morphology testing can also be completed at the time of intrauterine insemination (IUI) (for an additional cost) if desired. This is often done if an initial semen analysis was completed in an outside lab.

For this test, freshly ejaculated sperm are smeared on a slide and stained using a morphology staining product for human sperm. Sperm are judged as normal based on the following criteria: 1) Head must be oval in shape with smooth contours, 5-6 µm in length and 2.5 to 3.5 µm wide with the acrosome taking up 40-70% of the head. 2) Neck and mid-piece must have no abnormalities and a cytoplasmic droplet (a remnant from sperm production) if present must not be larger than half the size of the head. 3) Tail must not be coiled or bent and should not have a droplet at the end. After 200 individual sperm are counted at a magnification of 1,000 times, the percent normal forms is calculated. The prognosis is based on the following scale:

• >=15% normal: Normal range- Good prognosis
• 5-14% normal: Sub optimal range. Prognosis is fair to good, however, the lower the percent normal, the lower the chance of successful fertilization
• 0-4% normal: Poor prognosis- Will usually need IVF with ICSI

Based on our experience we currently recommend a couple consider IVF with ICSI if the Kruger strict morphology is 5% or lower. Intrauterine insemination is often recommended for couples with Kruger results in the sub optimal but good prognosis range if there are no other factors that would prevent pregnancy.

When a couple is undergoing IVF we usually recommend ICSI if the Kruger strict morphology is 8% of less in order to minimize the likelihood of no fertilization and to maximize the number of eggs that fertilize. Each individual is different and your physician will review the complete semen analysis results in order to make a specific recommendation.

The Kruger strict morphology test can be highly subjective, therefore choosing a lab with extensive daily experience that can also correlate the results with fertilization in vitro is extremely important. The Andrology Lab at the Reproductive Care Center is supervised by an andrologist with over 10 years experience.  The lab also participates in a proficiency testing program every 6 months, and routinely compares slides scored by Dr. Kruger's lab.