Ask Courtney: Infertility Limbo

Smart Shoppers, Read This!

My fellow New Patient specialists and I speak at length with patients on a daily basis about the Shared Risk 100% Refund option and what the program involves. Most times, patients are equal parts bewildered, in a good way of course, and delighted to hear that we offer such a well-rounded program. But for some, the news isn’t so welcome. The Shared Risk 100% Refund IVF option for women using their own eggs, is only available for women who are up to 38 and 11 months of age. So where does that leave women falling between 39 and 43? It’s like they’re just hovering in some sort of limbo. In a typical conversation, this is usually the point where patients let out a long, slow sigh of disappointment after we explain that the only other refund program we can offer them is the donor egg program. The response goes generally something like this: “Well, I’m not ready for that.” Can’t say I blame them. Alternatively, I often explain, patients in this age range (up to age 44) can still do IVF using their own eggs, but each cycle must be paid for individually. You try one time, and if doesn’t work, you’ve paid that money with no positive result. You can opt to try again, sure, but those same fees would have to be paid out-of-pocket again. To say it’s expensive might just be a bit of an understatement.

But today, I shall not be the bearer of bad news. Oh no, because Shady Grove Fertility is pleased to announce the debut of our new Multi-Cycle Discount Program for IVF open to all women requiring IVF up to our standard age cap of 44. I can practically hear your squeals of enthusiasm from here, but save yourself for the best part! With our new Multi-Cycle Discount Program, you have the option to pay a flat discounted rate for 2 fresh IVF cycles. There’s even more: it always includes unlimited use of any frozen embryos (so every Frozen Embryo Transfer – or FET – is included at no extra charge), all of your monitoring for the 2 cycles as well as your first year of cryopreservation storage. For the savvy shoppers out there, it’s discounted by over 40% verses paying for individual IVF and FET cycles. Additionally, if assisted hatching is required we also include that service at no extra cost. Don’t faint just yet because this program can also be used in conjunction with our fantastic Shared Help discount program. Much like our Shared Risk 100% Refund program for 6 fresh cycles, if you successfully complete the Multi-Cycle program there is no refund; however should you complete a cycle and opt out under your physician’s recommendation prior to your 2 cycles being completed, you will receive a partial refund. We also offer the Multi-Cycle plan for ICSI and Gestational Carrier as well! As with any package deal, there are exclusions and acceptance into the program is at the discretion of the physician. If you would like more information on this wonderful new program and on pricing, please feel free to submit questions to us or to give the New Patient Center a call at 877-767-2299. I can say in complete earnest that each and everyone one of us are anxiously awaiting the opportunity to spread the word on this amazing opportunity for our new, current, and past patients!

To contact Courtney, simply comment on this post or email blog@shadygrovefertility.com.

Ask Courtney: The Kicker

Cue Captain Obvious: Fertility treatment is indescribably stressful. The months and years of trying with no success, the realization that having a child takes more work and money than you ever dreamed, the countless hours you spend waiting and hoping for a positive pregnancy test. Perhaps a scarier notion is just picking up the phone and calling the New Patient Center and scheduling an appointment? But you’ve done that, so what now?

Consider this for a moment: you’re playing in the Super Bowl and the stakes are high. As the underdog team, you’ve been through an entire season struggling to make it to this stage and here you are, so close to victory – but it’s never over until it’s over. Your quarterback just got sacked to complete the third down and your offensive line is 35 yards out from the field goal. Just seconds remain in the game and all eyes go to your kicker. It could be the moment where the Cinderella story comes to life. The often overlooked kicker steps up to the football and prepares to change history with the kick of a lifetime. No pressure, right?

All-Star Nurse Tina from GBMC

You may be scratching your heads wondering if I’ve lost my mind, but here is my point: you and your clinical team comprise your team. In recent weeks it seems as though we have taken many calls from patients who have met with their physician for their initial visit and want to know what they need to do next. Who do they talk to? The simple answer: their nurse. Their kicker.

Here is what patients of Shady Grove Fertility can expect from their nurse:

Following the New Patient appointment, the nurse will contact the patient to answer any additional questions and to help schedule diagnostic tests around the start of the patient’s menses. A patient should receive their nurse’s direct contact information (i.e. phone number and/or email address) so that contact can be maintained. The nurse should also call following each appointment to keep active communication with their patients. I will submit that our nurses truly do their best to make sure this expectation is met. So if you don’t receive a prompt call back or if they are not immediately reachable, please do not fret – they have not forgotten about you. They work very hard to make sure they can attend to everyone as soon as possible. Given that, if you are having difficulty reaching your nurse and need assistance, please refer to the following schedules to reach a contact:

• Answering Service for Emergency Questions — 5:00 p.m. to 7:00 a.m. is answered daily by one nurse with a physician on-call for questions. Patients should call (800) 239-5613.
• Weekend and Holiday Service — 7:00 a.m. to 12:00 p.m. is answered by a nurse for non-emergency calls at (301) 340-1188. Patients may be prompted to leave a message and the call will be returned within 30 minutes.
• Weekend Front Desk Line to Make/Change/Cancel Appointments — 7:00 a.m. to 3:00 p.m. Patients should call (301) 340-1188. There may be a prompt to leave a message and calls will be returned as soon as possible.

During the New Patient appointment, the nurse will help their patients to schedule a time to come in for a follow-up visit after the diagnostic tests are conducted to discuss results with their physician. From there, treatment plans may progress as prescribed by the physician.

As the old adage goes, there is no I in TEAM and the same can be said for your clinical care team here at Shady Grove Fertility. Should you have any positive feedback, questions, or grievances regarding your clinical staff, please submit to Kathy Bugge, RNC/Service Quality Supervisor, at kathy.bugge@integramed.com or 301-545-1221.

Seeking infertility treatment is certainly a journey, to say the very least, but the good news is you are now a part of a fine-tuned team dedicated to winning the game – thanks in large part to our hardworking kickers.

To contact Courtney, simply comment on this post or email blog@shadygrovefertility.com.

Do I Have to Do a Semen Analysis?

by Dr. Naveed Khan, MD

Men often ask me this question when they visit for their initial consultation.  “But I feel fine”, “There is nothing wrong with me!” or “I’ve had a child before, so I don’t need one”- these are also common responses when men are asked to have their sperm tested. And they may be correct, but it is important to check. It is sometimes surprising to couples that roughly 40% of the time, infertility lies with the male.

During basic fertility testing, men are required to submit a sperm sample for analysis. By comparison, women must undergo blood work, ultrasounds, and radiology tests. So gents, how bad can one test be?

The semen analysis is used to check for any male factor fertility issues that can contribute to a couples’ infertility.  Regardless of whether a man has previously fathered a child, the semen analysis still needs to be performed since we all age and our bodies change.  A man may not display any clinical symptoms of infertility, so measures must be taken to assure that all bases are covered. After all, we do treat patients as couples.

Some of the parameters that are checked in a semen analysis include:  volume, sperm count, motility (movement), and morphology (shape) of the sperm.  It can detect abnormalities or the existence of infection that is producing white blood cells in the semen. It can also determine the maturity of the sperm being produced.  Most men collect the semen via ejaculation into a clean sample cup which can either be obtained from any one of our office locations or at most pharmacies.  Additionally, sterile latex free condoms can also be used. Following ejaculation, the entire condom is placed into the collection container.

Prior to producing a sample, a man should ideally abstain from ejaculation 2-3 days prior to collection for the actual test, but never more than 5 days.  From the time of collection, the patient has about 60-90 minutes to get the specimen to the office for analysis. It is best not to expose the sample to extreme temperatures, which is often achieved by transporting the specimen container in close contact with the body to maintain a stable temperature.

Once a specimen is delivered for analysis to our andrology lab, results are often available for the physician within 3-5 business days. It is imperative to understand that the individual parameters of a semen analysis can vary significantly, so it is not uncommon to have more than one test performed. If the results of the analysis show abnormal levels, it may indicate the need for further testing of hormones and genetics. Sometimes it warrants a visit to a fertility urologist who specializes in assisting with male infertility.

The silver lining is that today there are very effective treatments for male factor infertility, many of which we offer at Shady Grove Fertility.  Some of these treatment options include intrauterine insemination (IUI) and in vitro fertilization with intracytoplasmic sperm injection (ICSI). ICSI is achieved by infusing a single sperm with a woman’s egg to ensure fertilization.

> Learn more about ICSI

It often comes as a shock to many men that the prevalence of male infertility is so frequent; probably because it isn’t a topic eagerly discussed amongst men, or couples even. But in keeping with our goals to treat patients as couples, it is very important to know exactly what a couple is dealing with in order to make the most effective and optimal treatment plan possible, so men – have no fear. By contributing in this small fashion, we can help both you and your partner have the family you both desire.

> Read our Male Infertility Q&A

Ask Courtney: The Gift That Keeps On Giving

With the growth of egg donor program worldwide, there has been a surge in women pursuing this avenue to fulfill their family building goals. Shady Grove Fertility’s New Patient Center takes calls daily from patients with in-depth questions about our donor egg program. The process for receiving donor egg can be complex and time consuming. It involves a new patient consultation, meeting with the donor team, scanning through our donor database and selecting the right donor for you. These are the preliminary stages before a recipient couple can go into an actual cycle. Already, I can bet your head is spinning, and that’s just a broad generalization of the process. Completely understandable, I assure you. But surprisingly, the biggest concerns our potential recipient couples have, has less to do with the process and more to do with the actual donors.

> Read “Why Donors Donate”

“Why would they want to donate to a complete stranger?” a woman asked me last week. The answer isn’t really simple, but more often than not, our donors donate because they realize there is a need. Yes, they are compensated, but not for their eggs. We compensate our donors for their time and commitment. Trust me when I say, and I think many of you will find this surprising, they spend an unimaginable amount of time going through the donation process. It isn’t a fly-by-night, check in, donate, and check out deal. It involves months of intense testing, loads of paper work, and dedication with the ultimate goal of helping some couple out there to have the family they’ve always dreamed of having. Let me give you a brief overview of the steps a potential donor must take in order to be accepted by Shady Grove Fertility as an egg donor:

• They first complete a brief questionnaire to apply for consideration. Within 24 hours, they may be prompted to continue on to…

• A very lengthy medical questionnaire covering their medical history, their family’s medical histories, etc. One of our pre-screeners on our donor team will review the submission and within a few days notify the applicant if they may proceed to the next step, which involves…

• Having the applicant come in for our “donor education day”. Some donors drive up to an hour and a half to our Rockville location to participate in a battery of tests, questioning, and analysis that can last up to 6 hours. A full day committed to being in the hot seat. They complete an overwhelming amount of paperwork. They complete the 500+ question MMPI personality test to assess whether there is any suspicion of psychological issues. They are taught how to self-administer two sets of medications via injection to stimulate their bodies to produce multiple eggs. They go through blood tests, urine tests, and further genetic testing. Tests, test, tests, and then…more tests.

• Following the donor education day, applicants are notified further as to whether or not they can be accepted as a donor. If given the go-ahead, their profile will then be created to be included in the donor database – which is what you, our recipients see.

• Once selected by a recipient couple, the donor must begin to stimulate their bodies and prepare to cycle.

I could go on and on about the process, but instead I recommend reading Michelle’s blog, My Deviled Eggs, as she writes about her experiences of becoming a donor. I will say, just as a reference point, that each year thousands of potential donors apply to be a donor with us at Shady Grove Fertility and of those thousands only about 8% are accepted. I think it goes without saying, then, that we’re very, very selective. Why? Well, quite frankly, we want the best of the best for our recipient couples. We also want to provide a well-rounded database with plenty of options. And to our donors, past, present or future, on behalf of Shady Grove Fertility, we thank you for your gift of helping couples build their families.

> Become an Egg Donor

To contact Courtney, simply comment on this post or email blog@shadygrovefertility.com.