Evaluation and Diagnosis

Evaluation and Diagnosis

Welcome to Bloom! We’re glad to have the opportunity to meet with you during an initial consultation. Your first appointment initiates the evaluation stage, not just for us, but for you as well.

From our perspective, the most important facet of treating infertility is an accurate diagnosis and understanding of underlying causes, of which there could be many. Common causes of infertility include: ovulation or hormonal disorders, uterine or cervical abnormalities, fallopian tube dysfunction or blockage, endometriosis, ovarian insufficiency, pelvic adhesions/scar tissue, uterine fibroids, thyroid problems, and cancer and its treatment. Some not so common causes include: amenorrhea, kidney disease, diabetes, or genetic abnormalities. Male factor causes of infertility can include: abnormal sperm production or function, sperm delivery issues, overexposure to chemicals or toxins, and cancer.

During your initial appointment, Dr. Behera will perform a thorough review of your medical and personal history. She will also address any questions you may have related to your evaluation, the causes of infertility, and all available treatment options. The next step may involve an ultrasound evaluation of the uterus, ovaries and pelvis and physical exam, along with further diagnostic testing for both partners as required based on information gathered from the initial visit. This may include hormone testing, evaluation of fallopian tubes with an hysterosalpingogram test (HSG), and semen analysis for male partners. Finally, Dr. Behera will review your results with you and together, come up with a treatment plan optimized specifically for both your medical and personal fertility needs. (See below for information about the various treatments we offer.)

Services

IVF - In-Vitro Fertilization
IVF - In-Vitro Fertilization
IVF - In-Vitro Fertilization

IVF (In vitro fertilization) is the most common of high-tech fertility treatments. It entails retrieving eggs from ovaries, and fertilizing them with collected sperm in a laboratory. The embryologist monitors and nurtures the fertilized egg (embryo) until it is ready for the physician to transfer into the uterus.

The process usually takes 4-6 weeks per cycle and involves a number of steps.

Step 1 – Suppressing female hormones with medication in order to prepare the body for treatment.

The intent here is to create a baseline state (the body’s natural state during the initial days of a menstrual cycle). Suppression medication maximizes the chances for an optimal baseline, which in turn yields a better environment to begin stimulation of the ovaries. Once parameters for a baseline state have been met, an IVF cycle can begin. Specific criteria that we evaluate to define a healthy baseline state include:

  • absence of ovarian cysts
  • proper hormone levels
  • adequate uterine lining

 

Step 2 – Hormone therapy to stimulate ovaries into producing follicles (eggs)

During this step, medication composed of Gonadotropins, which are hormones (FSH and LH) naturally produced by the pituitary gland to stimulate ovarian function and ovulation, is administered daily. This will gradually induce the ovaries to produce multiple follicles (small sacs that contain immature eggs). The medication allows the ovaries to support growth of more mature follicles, rather than the usual one or two produced during a typical menstrual cycle. On average, stimulation continues for a period of 10-14 days to encourage production of multiple follicles.

Step 3 – Monitoring the progress of healthy follicle production

During these 10-14 days of hormone therapy, Dr. Behera and her staff will periodically use ultrasound and blood testing to monitor the progress and growth of follicles. At this time, they will also be checking on how the patient’s body is responding to the medication, as well as closely following the patient’s hormone levels to fine tune and customize the protocol and dosing. This step is necessary in order to maximize both, patient safety and successful outcome.

Step 4 – Retrieval of eggs and collection of sperm

Once follicles reach the appropriate stage, Dr. Behera and the staff at Bloom will prepare the patient for an egg retrieval. The medication hCG will be used to cause eggs to reach maturity and break free from follicle walls. This process is often called the ovulaton trigger. The actual egg retrieval will take place approximately 2 days later (35-38 hours post-trigger).

During the retrieval, Dr. Behera will draw fluid from each follicle and then pass it to the embryologist. The embryologist carefully isolates the eggs from within the fluid and keeps them in an ideal, highly-controlled environment so that they can fertilize and grow. The Bloom lab staff will be able to provide an exact count of the number of eggs retrieved that day.

That same day, sperm will be collected and prepared to mix with eggs for fertilization.

Step 5 – Fertilization of eggs

Immediately after the egg retrieval, our embryologists work carefully to fertilize the eggs. Through the insemination technique, eggs and sperm will be brought together is a glass dish and incubated in a highly controlled environment for 48 to 120 hours.

Another commonly-used method of fertilization is through ICSI – intra-cytoplasmic sperm injection. During ICSI, a single healthy sperm is selected and directly injected into an egg for fertilization. ICSI is typically recommended for those couples with male factor infertility issues or who have had prior difficulties of achieving pregnancy through regular infertility treatment.

Embryos are then nurtured with close and continuous monitoring as they grow over the following 3-5 days. At this point, the embryo health and quality can be assessed, which allows the embryologist and Dr. Behera to determine and select the appropriate embryo(s) for implantation to achieve the best chances of conception. 

Step 6 – Embryo transfer

Embryos are transferred into the uterus either 3 or 5 days after the egg retrieval. Dr. Behera and the lab staff will recommend, while conferring with patients, which and how many embryos to transfer based upon embryo quality, and best chances to obtain a healthy pregnancy outcome. 

Typically embryos are transferred on Day 3 if there aren’t many eggs retrieved or embryos developed. If the embryos are deemed too fragile to go through the self-selection process of growth until Day 5, then it may be advisable to transfer those embryos on Day 3, rather than Day 5.

The goal at Bloom Reproductive Institute is to achieve the highest pregnancy rates with the lowest chances of multiple pregnancy. This is best accomplished with Day 5 transfers. After 5 days, the cells in the embryo have divided many times, resulting in a compact group of cells. The embryos that survive to this stage are typically stronger and known as blastocysts. Hence, fewer embryos need to be transferred to obtain high pregnancy rates, compared to earlier stage embryos.  

Step 7 – Pregnancy testing

Approximately 11 days after embryo transfer, pregnancy hormone testing (hCG test) is done. Other hormone levels are also reevaluated to ensure the environment is most supportive for the early pregnancy. These levels will be monitored every 2-3 days for the first week to measure the appropriate progression of pregnancy hormone, rising hCG levels, which should increase as the pregnancy progresses in the first trimester. Once the pregnancy hormone levels have reached the threshold where an early pregnancy can be seen, the staff at Bloom will arrange the first early obstetrical ultrasound between the fifth and eighth week of gestation. During this ultrasound, Bloom staff will monitor early signs of pregnancy health, including fetal heartbeat and serial growth.

Once we have met the goals of achieving a healthy onset of first trimester pregnancy, the patient then graduates from Bloom to continue prenatal and obstetrical care with the OB/GYN provider of their choice. 

IUI - Intrauterine Insemination
IUI - Intrauterine Insemination
IUI - Intrauterine Insemination

Intrauterine Insemination (IUI) is a procedure that involves the placement of washed sperm inside a woman’s uterus to assist with conception. It is both, less expensive and less invasive, than IVF. IUI can be very effective for patients with low sperm count, decreased sperm mobility, or unexplained infertility. It is also effective when there are problems with anatomy of the cervix or cervical mucus.

During an IUI, a semen sample is “washed” so that a concentration of optimal sperm can be used for the procedure. For the best IUI outcome, coordination of ovulation timing is everything. The goal is to expose the egg to the best sperm at the right time. Hence, the woman is closely monitored during the cycle for optimal timing and signs of ovulation before IUI is performed. Most often, the precision of ovulation is planned with the administration of an ovulation "trigger" medication (hCG).

Approximately 36 hours after the ovulation trigger, the IUI is performed. Concentrated sperm is placed in the uterus through a soft catheter so that it gets a jump start on its course to the egg for fertilization within the fallopian tube. 

Genetic Testing
Genetic Testing
Genetic Testing

Preimplantation Genetic Screening and Diagnosis (PGS/PGD) both involve testing embryos for genetic or chromosomal disorders. Both tests are conducted at the embryo stage, and require an analysis of cells. Biopsies are conducted on the embryos at the blastocyst stage (day 5), taking a sample of cells from the trophectoderm, which is a precursor to the placenta. The remaining cells of the embryo are left unharmed. Typically, the embryo is then frozen for future transfer, and will not be thawed until results can be reviewed by both the physician and patient.

PGS is a screening of the number of chromosomes found in the embryo. Essentially, it alerts us to chromosomal disorders such as Down’s syndrome or Edward’s syndrome.

PGD is a test to evaluate single gene disorders in the embryo. Single gene disorders include: cystic fibrosis, hemophilia, Huntington’s disease, Marfan’s disease, muscular dystrophy, thalassemia, Tay Sachs, spinal muscular atrophy, and sickle cell anemia to name a few.

Egg Freezing / Fertility Preservation
Egg Freezing / Fertility Preservation
Egg Freezing / Fertility Preservation

Fertility preservation involves the cryopreservation (freezing) of eggs, sperm, or embryos for patients who are concerned about future fertility. The frozen tissue will be stored in liquid nitrogen tanks at lower than 300 degrees below zero (Fahrenheit) to later be used for in vitro fertilization (IVF) or intrauterine insemination (IUI) treatments.

A number of factors can lead to the desire for fertility preservation, including:

  • the onset of cancer and other severe diseases
  • the effects of the treatment of cancer (chemotherapy or radiation)
  • other severe diseases affecting fertility (endometriosis, lupus, autoimmune disorders)
  • surgical impact on reproductive organs
  • delaying child bearing for social reasons (career, lifestyle, etc.)
  • advancing age

 

The technology for fertility preserving treatments has advanced significantly over the last few years. Our IVF embryology team at Bloom Reproductive Institute is highly skilled and knowledgeable in the latest techniques, including vitrification (freezing) of eggs and embryos with high success.

Fertility Enhancing Surgery
Fertility Enhancing Surgery
Fertility Enhancing Surgery

At times, specific conditions can contribute to a patient's infertility and may require surgical intervention. Such conditions include:

  • tubal blockage/obstruction
  • uterine fibroids
  • endometriosis
  • pelvic adhesions
  • uterine or vaginal anatomic variants
  • ovarian cysts
  • intra-uterine adhesions

 

Dr. Behera specializes in minimally invasive surgical methods to enhance the patient’s fertility. She is highly skilled in the area of advanced laparoscopic surgery, operative hysteroscopy, and robotic surgery.

Minimally invasive surgery offers a number of advantages over traditional surgery. They include:

  • shorter recovery times
  • shorter inpatient time
  • smaller incisions for better cosmetic appearance

 

Procedures that Dr. Behera performs include:

  • laparoscopic-assisted robotic myomectomy (removal of fibroids)
  • laparoscopic / robotic tubal reanastomosis (tubal ligation reversal)
  • laser laparoscopy for treatment of endometriosis (mild to moderate)
  • laparoscopic removal of benign ovarian or tubal cysts / masses
  • operative and diagnostic hysteroscopy

 

In fact, Dr. Behera was the first to conduct a robotic tubal reanastomosis at Scottsdale Healthcare, Shea Hospital.

Dr. Behera teaches many surgical courses in advanced fertility preserving surgery techniques throughout the country. She has been selected as a member of Scottsdale Shea’s Center of Excellence for Minimally Invasive Gynecological Surgery (COEMIG). Prior to that, she has held numerous prestigious surgical appointments, one being Clinical Director for the Center of Fibroid Biology and Therapy at Duke University Medical Center.

Donor Egg Program
Donor Egg Program
Donor Egg Program

Bloom’s donor egg program is another option for those patients faced with infertility due to egg factors. This includes women who have suboptimal egg quality or reduced egg number (decreased ovarian reserve), ovarian failure, or haven't had success with other fertility treatments. It involves taking the eggs from a donor, fertilizing them with a partner’s or donor’s sperm, and then transferring the resulting embryo into the patient.

Success rates for donor egg cycles are significantly higher than traditional IVF for patients with egg factor infertility.

Egg donors, either known or anonymous, are thoroughly screened prior to donation according to the guidelines set forth by the FDA and ASRM. They are screened for personal, family, social, medical, and genetic history. Typical items we screen for include: HIV, hepatitis, STD’s, drug use, infectious disease, psychological issues, and genetic abnormalities.

Once a match has been selected, the reproductive cycles are synchronized for both donor and patient. The donor will go through the IVF process up through the egg retrieval stage, while the recipient will prepare the uterus and continue the process from the embryo transfer stage onward. Many times, we may plan for the egg donor to complete the treatment cycle in advance, and freeze the resulting embryos. Once the outcome of the cycle is reviewed by the recipient couple, including the number and quality of embryos, they may choose to schedule the implantation phase of the cycle at their convenience.

Become an Egg Donor
Become an Egg Donor
Become an Egg Donor

Egg donation is a magnificent gift to give a couple! Through egg donation, donors provide willing parents the ability to have children. Egg donors are essentially making dreams come true. 

In order to become an egg donor, the candidate must go through a screening process according to guidelines established by the Food and Drug Administration (FDA) and American Society for Reproductive Medicine (ASRM). Once passing the screening process, donor candidates undergo fertility treatment, specifically the IVF process, up through the egg retrieval stage. Donor candidates that do pass screening are compensated for their gift of eggs. Egg donation is an anonymous process, where the identity of donors is protected.

Please contact us for more information relating to our Egg Donation program. 

BECOME AND EGG DONOR

Thank your interest in giving the gift of fertility. Please send an email to
donoregg@fertilitybloom.com
with your name and contact number so that we may provide you with more information

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