Reproductive Medicine: Infertility services and more

The WVU Center for Reproductive Medicine provides help for infertility and more. We offer a range of health services for both males and females, from infants to seniors, with problems that affect the reproductive system, including help for individuals with gender identity disorders.

Our mission

For both men and women, reproductive problems can be confusing and overwhelming. The WVU Center for Reproductive Medicine offers you the best in care, comfort, and convenience in our state-of-the-art facility.

We will help you:

  • learn about your condition
  • give you appropriate literature
  • answer any questions that you may have

We also involve you in your treatment plans so we can design a therapy that suits your needs. And, if you need it, we offer counseling to help you with the emotional components of your condition.

Our philosophy: A single, healthy infant

We are dedicated to working with you to reduce your potential for having a multiple birth. The staff of the WVU Center for Reproductive Medicine shares the philosophy that infertility treatment should result in the birth of a single, healthy infant.

Some see this philosophy as inefficient due to the financial and emotional costs of infertility and its treatment. However, we feel that the potential for adverse physical, emotional, economic, and social outcomes associated with a multiple birth far exceeds anything that would be expected to occur during the evaluation and treatment of infertility.

Location

We are conveniently located in a private, off campus location on Pineview Drive in Morgantown, West Virginia.

Although we are physically separate from the medical campus (we’re about two minutes away from WVU Hospitals), the Center for Reproductive Medicine is part of the Department of Obstetrics and Gynecology at West Virginia University. We have easy access to specialists in other health fields, which contributes to the exceptional level of care we provide our patients.

The bulk of our clinical services are associated with treating infertility but the WVU Center for Reproductive Medicine does more than that. Our world-class physicians and staff help people of both genders and all ages overcome abnormal reproductive conditions they were either born with or have acquired.

Our services range from basic lab tests to complex assisted reproductive technologies (ARTs). When you visit our Center, we want you to be a partner in your treatment plans so we can design a therapy that best suits your needs.

Registered Dietitian Helenia Sedoski works with patients at the WVU Center for Reproductive Medicine who seek help in making healthy lifestyle choices. For appointments or questions, please call us at 304-598-3100, extension 203.

Technologies and services

Our state-of-the-art Center has its own:

  • ultrasound
  • operating suites
  • recovery rooms
  • laboratories

all with the latest technology and equipment. In vitro fertilization and other procedures are performed on site for the comfort and convenience of our patients. Our laboratory is certified by the federal government and undergoes yearly inspections by the College of American Pathologists.

Out-of-town patients

If you travel from out of town, we are equipped to meet your needs. Accommodation in WVU Medicine’s Rosenbaum Family House or local hotels can be arranged with advance notice.

Zika virus recommendations

Zika virus infection is a growing concern for both pregnant women and couples who may become pregnant. While we do have some cases of Zika in West Virginia, there are no locally transmitted cases. However, there have been cases in West Virginia and surrounding states acquired during travel to affected areas. All patients should consider recent travel and possible exposure.

If a woman is exposed to Zika, she should not become pregnant for six months.

Click below to learn more about Zika virus.

Female reproductive health

Some of the female reproductive health issues that we treat include:

  • birth defects of the reproductive tract
  • problems with puberty development
  • absent or irregular periods
  • abnormal hair growth
  • abnormal milk production
  • polycystic ovary syndrome
  • managing symptoms of menopause

Male reproductive health

The WVU Center for Reproductive Medicine provides comprehensive treatment for problems that men may experience. Some of the services we provide include:

  • semen analysis (detailed below)
  • hormone assays
  • post-vasectomy semen analysis
  • cryopreservation (freezing) of sperm
  • sperm preparation for assisted reproductive techniques
  • testicular biopsy for sperm extraction

Semen Analysis

The test is performed in the lab at the Center.

  • The specimen will be collected at home or in a special room within the clinic (preferred).
  • Prior to collection of the semen sample, observe at least two days, but not more than five days, of abstinence (i.e., no ejaculations).
  • Please wash hands thoroughly before collection.
  • Do not use lubricants or condoms, because they may contain substances that will kill or immobilize sperm.
  • Collect semen in a sterile specimen cup. Sterile cups are available at the Reproductive Endocrine Lab or from your doctor. Collect all of the ejaculate. If some or all of the semen is lost during collection or if you are unable to ejaculate, we will reschedule the test.
  • If you are collecting the specimen at home, take the specimen to the lab as soon as possible, but no later than one hour after collection. The specimen should be kept at body temperature during transport. This can be achieved by keeping the container next to your body in your clothing. If possible, you should deliver the sample yourself to confirm your identity and to sign a consent form. Write your name on the sample cup and bring your specimen along with your doctor’s orders to the Reproductive Endocrine Lab at the Center for Reproductive Medicine.
  • You do not need an appointment for a semen analysis. You may collect or deliver your sample during our working hours, which are: Monday-Friday from 8 am-noon and 1:30 – 3 pm, except for holidays.
  • All other procedures including sperm freezing, fructose, viability, and antibody testing require an appointment 24 hours in advance.

Semen evaluation

semenMicroscopic evaluation – To evaluate sperm concentration, motility, and morphology (shape), the specimen is examined under a microscope.

Concentration – A lack of sperm can mean you’re not producing sperm or it can mean obstruction or absence of the tube system responsible for transporting sperm. New technologies can help men with very low sperm counts to conceive children.

Motility – Active, healthy sperm move quickly in a straight, forward direction individually, not in clusters. Motility is a measure of how many and how well the sperm are moving. A four-point grading scale is used to describe the speed and direction of sperm progression. Sperm with poor forward progression (grade one or two) can have difficulty fertilizing an egg.

Morphology (shape) – Sperm are considered abnormal if any part of the structure deviates even slightly from rigid criteria. Abnormally shaped sperm can have problems with motility and fertilization.

  • Debris is common in low levels.
  • Round cells are typically either immature sperm cells or white blood cells, which in high numbers indicate trauma or infection.
  • Crystals are rare, but their presence is always abnormal. Uric acid crystals, which form kidney stones, are the most common.
  • Occasionally cells besides sperm are identified.

Visual examination – After semen collection, the specimen should liquefy quickly. Next, the specimen is transferred to a test tube for visual examination.

Volume – A lack of ejaculate can indicate retrograde ejaculation, a condition common in diabetics with neuropathy or absence or obstruction of portions of the reproductive tract.

Color- Urine can color semen yellow, and blood from trauma to the testes can color the semen pink, red, or brown. Semen is often clear if it contains no sperm.

pH – Altered pH can indicate inflammation within the reproductive tract or potential problems with accessory sex glands.

Viscosity – Viscosity (thickness of the specimen) is measured on a four-point scale. A thicker specimen (three or four) can impair transport of sperm in the female reproductive tract.

Gel clumps – The presence of gel clumps within the specimen is always abnormal and can cause inaccurate counts for sperm concentration.

 

Possible Causes of Infertility and Basic Treatment Options

Infertility is defined as failure to conceive after one year of intercourse without using contraception. Since approximately 15 to 20 percent of all couples experience some form of infertility, it is important to consider all potential causes when we do an evaluation.

If you want to learn more about possible causes for infertility, follow these links:

Female factors

  • Menstrual Cycle
  • Cervical Factors
  • Uterine Factors
  • Tubal Factors
  • Peritoneal Factors

Male factors

  • Sperm Production

Couple factors

Diagnosing Infertility

Diagnosis begins with a full review of the patient’s medical history and a complete physical examination. It is best if both partners attend the initial visit, as testing may be required for both.

Testing

Treatment Options

Treatment for infertility ranges from the use of medications to induce ovulation in the woman to a variety of assisted reproductive technologies (ART), which may also involve treating male partners.

Female Factors

Menstrual cycle factors

Normal menstrual cycle – In the absence of pregnancy or the use of hormonal contraception, a single egg is released approximately once a month during the reproductive life of a woman. The length of the menstrual cycle is calculated by counting the number of days from day one of menses (period) until day one of the next menses. Although a 28-day cycle is considered normal, cycle intervals of 21 to 35 days may also be normal. The menstrual cycle is the result of a carefully coordinated interaction between the brain, the pituitary gland, the ovary, and the uterus.

  • An area in the brain called the hypothalamus tells the pituitary what to do with the hormone, gonadotropin releasing hormone (GnRH).
  • The pituitary tells the ovary what to do with the two hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH).
  • The ovary produces hormones (estrogen and progesterone) and proteins that send information back to the hypothalamus and pituitary as well as directing normal development of the uterine lining.

When all of the hormonal signals interact normally, ovulation occurs. The normal menstrual cycle can be considered as consisting of three parts:

  • Follicular phase -“ When the egg is developing, the egg plus the surrounding cells and fluid make up a cyst, known as a follicle. The dominant hormone is estrogen and causes the lining of the uterus (the endometrium) to thicken. The length of the follicular phase can vary.
  • Ovulation – The follicle ruptures and the egg is released.
  • Luteal phase – After the follicle ruptures, the cells that originally surrounded the egg undergo changes and form a structure called the corpus luteum. The corpus luteum may exist as a cystic structure of varying sizes and primarily secretes the hormone progesterone, which causes the endometrium to change in preparation for implantation of the fertilized egg. The length of the luteal phase is usually 12-14 days.

Abnormal menstrual cycle – Absence of periods (called amenorrhea) or periods occurring at irregular intervals implies absent or infrequent ovulation. Lack of ovulation can occur even when the menstrual cycle is fairly regular. Other abnormalities of ovulation associated with regular menstrual intervals include the luteal phase defect, which occurs when a woman’s body produces too little progesterone, causing the lining of the uterus to be under-developed. Also, the age of the woman impacts her fertility. A woman is born with a fixed number of eggs, and there is a progressive loss of eggs throughout her reproductive years, even if she is pregnant or on oral contraceptives. A shortage of responsive eggs has been called decreased ovarian reserve. The eggs that remain may be more resistant to stimulation and may be more likely to carry genetic abnormalities, which can result in:

  • a diminished chance for achieving pregnancy in a given cycle, which begins to become noticeable in a woman’s mid-30s
  • an increased risk of miscarriage

The premature loss of functional eggs is known as premature ovarian failure.

Tests for defects of ovulation
The patient can perform basal body temperatures or home monitoring with ovulation predictor kits. Ultrasound monitoring, measuring hormones, and biopsies of the lining of the uterus can also be used to assess whether ovulation is normal. Decreased ovarian reserve can be assessed by ovarian reserve testing, which involves the measurement of specific hormones at certain times in the cycle.

Treatment
The initial consideration for treating ovulation defects is to use medications or surgery to restore a normal hormonal environment that will result in spontaneous ovulation. When that goal cannot be achieved, medications are used to:

  • replace, increase, or decrease the release of gonadotropin releasing hormone (GnRH)
  • replace or increase the release of follicle stimulating hormone and luteinizing hormone (FSH and LH)
  • replace or increase the mid-cycle surge of LH
  • replace or increase progesterone during the luteal phase

Diminished ovarian reserve or premature ovarian failure may require assisted reproductive technologies, including donor eggs.

Female Factors

Cervical factors

Normal – During a normal ovulation cycle, the estrogen that is produced by the cells surrounding the egg causes an increase in the amount of cervical mucus and causes the mucus to become thin and watery. These changes allow the sperm to more easily penetrate and move within the mucus.

Abnormal – Birth defects involving the cervix, prior treatment of abnormal pap smears (cryotherapy, laser therapy, cone biopsies), or exposure to specific medications can have an adverse impact upon the cervical mucus.

Tests
The post-coital test is intended to evaluate the interaction between the cervical mucus and the semen. After the couple has intercourse, the patient comes to the clinic where mucus is removed from the cervix and observed under a microscope. Another test called the sperm-mucus interface test involves placing a drop of sperm and a drop of mucus on a slide and observing their interaction.

Treatment
Various hormonal and non-hormonal therapies have been suggested, such as:

  • discontinuing problem medications or adding other medications
  • bypassing the cervix via intra-uterine insemination

Female Factors

Uterine factors

Normal – A normal uterine cavity is essential for implantation of the fertilized egg. The lining of the uterus (endometrium) must be exposed to appropriate levels of estrogen and progesterone in order to adequately develop.

Abnormal – Defects of ovulation or exposure to certain medications may interfere with normal uterine lining (endometrium) development. Anatomical problems with the uterine wall or the endometrial cavity may also prevent normal implantation. Such abnormalities include birth defects, intrauterine scarring from prior surgical procedures, or tumors of the uterine lining or uterine wall.

Tests
An X-ray study called a hysterosalpingogram (HSG), in which dye is injected through the cervical canal into the uterus and tubes, is used to detect any abnormalities. Sonohysterography is a procedure in which fluid is injected into the uterus, and ultrasound is used to look at the shape of the uterine cavity. Hysteroscopy is a procedure where the uterine cavity is directly observed with a scope. The choice of evaluation will be determined by you and your provider.

Treatment
Changing the type of medications used to treat ovulation abnormalities or using additional hormonal therapy can treat inadequate endometrial (uterine lining) development.

  • Surgical therapy is required for treating anatomical abnormalities. The surgery may be able to be performed during diagnostic hysteroscopy, but sometimes the abdomen will need to be opened in order to perform the appropriate procedure.

Male Factors

Sperm Production

Normal Sperm Production – Sperm production is a complex series of events that requires approximately 74 days to complete. Just as with ovulation in the female, the hormonal component of sperm production requires a coordinated effort between the brain, the pituitary gland, and the testes.

  • The hypothalamus communicates with the pituitary by way of the gonadotropin releasing hormone (GnRH)
  • The pituitary communicates with the testes via the follicle stimulating hormone (FSH) and luteinizing hormone (LH)
  • The testes are stimulated to produce sperm and the male hormone testosterone as well as other proteins and hormones that are needed for normal sperm development and function.

Abnormal Sperm Production – Several conditions may affect a man’s ability to produce sperm, including:

  • Chronic medical conditions and the medications used to treat them
  • Infections
  • Exposure to environmental toxins (heavy metals or other industrial exposures)
  • Conditions that interfere with normal sperm transport from the testes to the penis or normal ejaculation
  • Anatomical problems, such as obstruction or abnormal external genitals
  • Neurological problems, such as nerve injuries or conditions like diabetes
  • Antibodies or abnormalities of sperm function that might prevent the sperm from penetrating the egg
  • Conditions that affect glands other than the testes, such as the thyroid, pituitary, or adrenal gland, may lead to abnormal sperm production.


Tests
Basic semen analysis measures the quantity and quality of the sperm. If an abnormality is found, the following may be done:

  • a complete history and physical examination,
  • hormonal studies, and
  • more advanced evaluation of sperm and sperm function may be required.

Treatment

  • Treatment of other medical conditions, use of antibiotics for infections, or elimination of toxic exposures may resolve the problem.
  • Abnormalities of sperm number and motility are sometimes responsive to hormonal or surgical therapies.
  • Assisted reproductive technologies provide the opportunity for a couple to conceive when other forms of therapy are not appropriate or have been unsuccessful.

When no sperm is available or if the couple does not want to use advanced assisted reproductive technologies (ARTs), then donor insemination is an option.

Couple Factors

Normal – Fertilization occurs when a single sperm penetrates the egg. In order for this to occur, the sperm is deposited in the vagina, makes its way through the cervix and uterus into the fallopian tubes, and comes in contact with the egg. Sperm are stored in the cervical mucus that then acts like a sperm bank, releasing sperm on a continuous basis, so that the couple does not have to have intercourse right at the moment of ovulation. Data suggests that having intercourse within a short period of time prior to the egg’s release gives a better chance for pregnancy than having intercourse after the egg has been released.

Abnormal

  • Timing of intercourse may be off-schedule with ovulation and may be a cause of infertility.
  • The use of douches or lubricants can affect the ability of the sperm to survive within the vagina or the cervix.
  • Abnormalities of the penis or ejaculation may prevent sperm from being deposited in the vagina.
  • Abnormalities of the vagina may prevent sperm from being deposited.

Treatment

  • Timing and use of douches or lubricants are handled better by the couple.
  • Anatomical or physiological abnormalities may require intrauterine insemination or assisted reproductive technologies (ARTs).

Infertility Testing

Endometrial biopsy

The ideal time to perform an endometrial biopsy has been debated. WVU’s Center for Reproductive Medicine maintains that the biopsy should be performed 10 to 12 days after ovulation or right before the next expected period. The biopsy is performed in the office, and since the procedure causes cramping, you might want to take 400 to 600 mg of ibuprofen before arriving at the office.

A pregnancy test is obtained prior to the procedure.

A speculum is placed, the cervix cleansed with an antiseptic, and a plastic catheter is passed into the uterine cavity. Suction is applied and a sample of tissue is removed.

There are no restrictions on activities for the remainder of the day.

Hysterosalpingogram (HSG)

The test is usually scheduled right after your period has stopped and before ovulation occurs. Therefore, you need to call 304-598-3100 when your period starts so that the test can be scheduled. This test is performed in the radiology department, which is on the third floor of Ruby Memorial Hospital. Since the procedure causes cramping, 400 to 600 mg of ibuprofen is suggested prior to arriving at the hospital.

  • Arrive 15 minutes prior to the scheduled test for registration. From the third floor guest elevators, turn right and the registration desk will be on the right side of a large hallway that goes off to your left.
  • After registration, you will be taken to a changing area.
  • After you have changed into a gown, you will be taken back to the X-ray room.
  • A speculum will be placed, and the cervix cleansed with an antiseptic solution. An instrument will be attached to your cervix and a small catheter placed into the cervix.
  • A special dye will be injected and continuous X-rays will be performed to observe the dye as it fills the uterus and goes into the tubes.
  • It is recommended that you bring someone with you to the hospital to drive you home. We recommend that you do not return to work.

Ovarian reserve testing

This test usually consists of ultrasound and hormonal testing.

  • On day three of your menstrual cycle, a baseline ultrasound might be obtained. Blood levels of follicle stimulating hormone and the estrogen, estradiol, are obtained.
  • Clomiphene citrate challenge test: clomiphene citrate, 100 mg, is taken on days five through nine of the cycle.
  • Return on day 10 for ultrasound and a serum follicle stimulating hormone level.
  • Different labs and clinics may use different methods to measure these hormones. Therefore, the levels that are considered normal are specific for the clinic that you are attending.

Post coital test

The ideal time to perform this test is immediately prior to ovulation.

  • Have intercourse the evening prior to your scheduled test. Do not use lubricants or douche.
  • You will be scheduled to come into the clinic the following morning.
  • A speculum will be placed in the vagina, and a syringe attached to a soft plastic catheter will be used to remove mucus from your cervix.
  • The mucus will then be examined under a microscope.
  • A vaginal ultrasound may be performed at the same time to make sure that the test was scheduled at the appropriate time.
  • There are no restrictions on your activities for the remainder of the day.

Sonohysterography

This test is performed in the Center for Reproductive Medicine. The test is usually scheduled right after your period has stopped and before ovulation occurs. Call 304-598-3100 when your period starts so that the test can be scheduled.

  • The procedure is performed in the ultrasound room.
  • A baseline vaginal ultrasound is performed.
  • A speculum is placed, and the vagina and cervix cleansed with an antiseptic solution.
  • A small catheter is inserted into the uterine cavity, and a small balloon is inflated to keep the catheter in place.
  • The speculum is removed, and the vaginal ultrasound is inserted again.
  • Sterile fluid is injected into the uterus while simultaneously performing ultrasound.
  • After satisfactory images are obtained, the procedure is ended.
  • Most women experience little or no discomfort with this examination, but you can choose to use 400-600 mg ibuprofen one hour prior to the procedure.
  • There are no restrictions on your activities for the remainder of the day.

 

For many people, the dream of having a family is not easily realized. At WVU’s Center for Reproductive Medicine, our doctors can help couples have a child using assisted reproductive technology (ART).

ARTs are treatments that help increase the likelihood of the successful union of a sperm and egg, leading to the development of a viable fetus, and, ultimately, to the birth of a healthy baby.

ART procedures include:

  • Superovulation and intrauterine insemination (detailed below)
  • In vitro fertilization and embryo transfer (IVF-ET) (detailed below)
  • Cryopreservation and frozen embryo transfer (detailed below)
  • Micromanipulation (detailed below)
  • Intracytoplasmic sperm injection (ICSI)
  • Preimplantation genetic diagnosis (PGD)
  • Testicular biopsy and testicular sperm extraction (TESE)

Success rates

Society for Assisted Reproductive Technology
American Society for Reproductive Medicine

Superovulation and Intrauterine Insemination

The simplest form of ART is superovulation [SO] (also called controlled ovarian hyperstimulation [COH]) plus intrauterine insemination (IUI).

The process involves:

  • Using fertility drugs to increase the number of eggs that are released at the time of ovulation
  • Placing sperm directly into the uterine cavity around the time that ovulation is occurring
  • Supplemental progesterone may be prescribed after ovulation and is continued for the first 10 weeks of pregnancy. The progesterone is usually administered in the form of creams or suppositories.

The concept is that an increased number of eggs in close proximity to an increased concentration of sperm will improve the chances for pregnancy.

The success of this form of therapy requires:

  • the release of the egg(s) from the ovary
  • that the egg(s) are picked up by the tubes
  • that the sperm is able to reach the egg in the tube
  • that fertilization takes place

This therapy has been used for patients with unexplained infertility, cervical factor infertility, male factor infertility, or in cases of endometriosis in which the tubes are unobstructed. Intrauterine insemination is also used with inducing ovulation in patients with ovulation defects who have not conceived with timed intercourse.

Risks – The use of superovulation creates the potential for ovarian hyperstimulation syndrome and for multiple gestation. The use of IUI carries the potential for pelvic infection due to bypassing the normal defense mechanisms of the cervical mucus.

Intrauterine insemination

  • Inseminations usually are performed the day of or the day following a luteinizing hormone (LH) surge as detected by ovulation predictor kits or 34-36 hours after administration of human chorionic gonadotropin (hCG).
  • The semen is collected by masturbation at home or in the clinic.
  • Do not use lubricants or condoms, because they may contain substances that will kill or immobilize sperm.
  • Collect the semen in a small, clean, wide-mouthed container (sterile urine containers are preferable). Attempt to collect all of the ejaculate.
  • If you are collecting the specimen at home, bring the specimen to the lab as soon as possible but no later than one hour after collection. The specimen should be kept at body temperature during transport. This can be achieved by keeping the container next to your body in your clothing.
  • The semen will undergo special preparation in the laboratory and will be placed in a syringe attached to a special catheter.
  • When the concentrated sperm is ready, a speculum is placed in the vagina.
  • The catheter is inserted into the uterine cavity, and the prepared sperm is injected into the uterine cavity.
  • You will need to lie still for the next 10 minutes.
  • There are no restrictions on your activities for the remainder of the day.

In Vitro Fertilization and Embryo Transfer (IVF-ET)

In vitro fertilization and embryo transfer consists of:

  • Removing the egg(s) from the ovary, followed by insemination, fertilization, and early embryo development in the controlled environment of the laboratory.
  • This early embryo is then transferred directly into the uterine cavity.

The process of IVF-ET was originally developed to treat women with damaged, blocked, or absent tubes. Since the first successful pregnancy in 1978, thousands of babies have been conceived, and the indications for using IVF-ET have been expanded to include all causes of infertility that have not responded to simpler forms of therapy.

The usual steps in IVF-ET are as follows:

  • Superovulation – In contrast to the natural cycle in which one egg is available for fertilization, superovulation involves the use of various combinations of hormones in order to make multiple eggs available. Treatment strategies that are used are undergoing constant revision in an attempt to obtain the highest quality eggs with the least amount of risk to the woman who is having treatment. Ultrasounds and hormonal studies are performed frequently to assure that the medications are working and to reduce the risk of ovarian hyperstimulation. When sufficient eggs are ready, other medications are administered to induce or mimic the normal mid-cycle surge of luteinizing hormone (LH).The medication that has been most commonly used has been human chorionic gonadotropin (hCG), a hormone. This hormone is similar in structure to LH, so the ovary will respond to hCG as it would to the natural mid-cycle LH surge. Purified luteinizing hormone can also be administered as well as drugs that cause the pituitary to release LH.
    Ovulation will usually occur approximately 36 hours after administration of hCG.
  • Retrieval – Retrieval is timed to occur just prior to when the eggs would normally be released in response to the mid-cycle hormonal surge. Thus, egg retrieval is scheduled for approximately 34 hours after administration of hCG.

Technique

  • Egg retrieval is done under conscious sedation, a type of anesthesia where medication is given through an IV to cause drowsiness. Most patients say that they do not remember most of the procedure.
  • The procedure is done using vaginal ultrasound to visualize the ovary. A needle attached to the ultrasound probe is used to aspirate the fluid from the follicles (egg, fluid, and surrounding cells), and the fluid is immediately examined to determine whether an egg is present.
  • The procedure generally takes 30 to 45 minutes.
  • The patient will spend approximately two hours in the recovery room.
  • She should plan to spend that day in bed, resting.

Insemination and fertilization

On the day of retrieval, the partner will need to provide a semen specimen, or donor sperm must be available.

  • Approximately four hours after egg retrieval has been performed, and the semen has been collected and prepared, the eggs are inseminated, i.e., exposed to sperm.
  • On the following day, the eggs are evaluated to see if fertilization has occurred. The fertilized egg still consists of a single cell, but within the egg are two structures called pronuclei. One pronuclei contains the genetic material from the egg, and one pronuclei contains the genetic material from the sperm. The term for a fertilized egg is an embryo.

Embryo development

The embryos are maintained in the laboratory in a carefully controlled environment. After fertilization has occurred and the genetic material from the egg and sperm have joined together, the embryo begins to divide.

  • The embryo is described by the number of cells that are present, two-cell, four-cell, eight-cell, etc.
  • If the embryos are left in culture for more than three days, they will develop more cells than can be counted and are called morulas.
  • At five to six days, the cells begin to separate into those that will form the placenta and those that will develop into the fetus. A small amount of fluid accumulates in the center of this mass of cells. This structure is called a blastocyst.

Transfer – A great deal of controversy exists as to whether one should transfer embryos on day three or transfer blastocysts on day five. The transfer of high quality day-three embryos or day-five blastocysts can result in a greater than 60 percent “take home baby rate.” Just as the number of embryos to be transferred differs based on the patient’s age, we feel that the optimum time for transfer also differs between patients. The response to superovulation and the number and quality of the developing embryos enters into this decision. Our goal is obtain high-quality embryos and blastocysts that will allow us to meet or be more stringent than the recommendations of the American Society of Reproductive Medicine in hopes of obtaining a single healthy pregnancy. Extra embryos will not be transferred during that cycle but can be frozen and saved for later use.

Technique – Whichever day it is done, the embryo transfer takes place in the same procedure room as the egg retrieval.

  • The discomfort of embryo transfer is minimal, similar to that of a pelvic exam and Pap smear or intrauterine insemination, so no anesthesia is required.
  • We use the “full bladder” technique for embryo transfer, asking the patient to arrive for the transfer with a full bladder. With this technique, an ultrasound scanner is placed on the patient’s lower abdomen over the bladder, allowing the uterus to be viewed. In this way, the passage of the catheter containing the embryos can be seen on the ultrasound screen to assure optimal placement of the embryos.
  • After the transfer is completed, the patient stays in the recovery room for one hour on complete bed rest with the pelvis elevated. She is then allowed to return home.
  • Following ovulation, supplemental progesterone is administered and is used for the first 10 weeks of pregnancy. Different preparations of progesterone can be used, including oral doses, creams, suppositories, and intramuscular injections.

Cryopreservation and Frozen Embryo Transfer

In cases where there are multiple embryos, we offer cryopreservation (freezing).

  • Specimens are frozen in separate, labeled, specially developed catheters or straws and are stored in tanks of liquid nitrogen at a temperature of about -196°C. This method is considered safe and non-destructive to human cells. By using cryopreservation, it is possible to preserve specimens for an extended period of time.
  • The availability of the frozen embryos means that superovulation and retrieval does not have to be repeated.
  • Specimens are specially thawed and prepared for transfer into the uterine cavity. Transfer is performed after having prepared the uterine lining with estrogen and progesterone as is done in donor egg cycles.
  • The transfer is done as with IVF-ET, and the recipient remains in the recovery room for one hour after the procedure.
  • The recipient is then placed on supplemental estrogen and progesterone for the first third of the pregnancy.

Micromanipulation

Micromanipulation is a laboratory term for procedures that are used to assist in fertilization and implantation of embryos.

  • Intracytoplasmic sperm injection (ICSI) – The normal sperm is able to attach to and penetrate a special layer or “shell” that surrounds the egg called the zona pellucida. When there are sperm antibodies, inadequate numbers of sperm, inadequate sperm function, or unexplained failure to achieve fertilization with standard insemination during IVF-ET, an individual sperm must be directly inserted into the egg to achieve fertilization. The process of ICSI captures one sperm and by using special microscopes, a micro-needle is pushed through the zona pellucida into the interior of the egg (cytoplasm) and the sperm is injected.
  • Assisted hatching – Under normal circumstances, the embryo is able to escape (hatch) from the surrounding zona pellucida. This step is necessary for normal implantation to occur. In some cases, this shell is too thick. Using various techniques, the zona is altered so as to allow “hatching” of the embryo. This procedure may be required more often in older patients.
  • Defragmentation – As some embryos develop, a portion of the newly developed cells are abnormal and form fragments. This may be a mechanism whereby the embryo rids itself of abnormal cells. When a significant number of fragments are present, they may interfere with the development of a normal pregnancy. Prior to transfer, these fragments can be microscopically removed. Removal of these fragments does not injure the normal cells and this procedure improves the chances for a successful pregnancy.
  • Pre-implantation genetic diagnosis – This procedure is used for couples who are carriers for serious genetic conditions that might be transmitted to their offspring. After embryos are available as a result of IVF, one of the cells from the developing embryo can be removed and submitted for genetic evaluation while allowing the remaining cells in the embryo to continue developing normally. The couple then has the option of transferring only the unaffected embryos.

Sperm Preservation

spermn2The WVU Center for Reproductive Medicine offers a way for a man to still father children, even if an illness or its treatment severely affects his fertility. Sperm can be frozen and preserved indefinitely and then thawed to use for impregnating a partner.

What treatments can affect fertility?
Treatments that may affect a man’s fertility include

  • chemotherapy
  • radiation
  • some surgeries

The closer radiation treatment is to the testicles, the higher the risk of infertility.

What cancers can affect fertility?
Testicular cancer, Hodgkin’s disease, non-Hodgkin’s lymphoma, leukemia, and other kinds of cancer may also affect a man’s ability to reproduce.

Endocrine tumors, thyroid cancer, brain tumors, acromegaly, Cushing’s disease, and virilizing adrenal tumors can cause infertility in rare instances. Recent surgery, fever, or physical stress from cancer can also affect semen quality.

Who is eligible?
The sperm preservation program is available to any post-pubescent male cancer patient whose treatment may affect his ability to reproduce. Every patient’s situation is different. Ask your doctor if this program would be suitable for you.

How does it work?
After diagnosis, you or your physician should contact WVU’s Center for Reproductive Medicine at 304-598-3100 as soon as possible. Our experts determine the ideal number of samples needed. In many cases, one or two samples may be sufficient.

When should I start the program?
Men should start making sperm deposits as soon after their diagnosis as possible to produce an adequate supply to achieve a pregnancy.

How much does it cost?
Sperm preparation, banking, and yearly storage are provided at a cost significantly lower than the national average.

WVU Health Report: Male Infertility Part 1

WVU Health Report: Male Infertility Part 2

Female Puberty Issues: Help for Teen Girls

Some girls entering adolescence find they’re having problems with irregular periods, acne, unwanted hair, and obesity. These conditions, which can last for years, may be caused by hormonal problems that modern medicine can help.

The experts at WVU Medicine have years of experience treating teenagers and young adults with abnormalities of puberty and reproductive endocrinology, including polycystic ovary syndrome (PCOS). Our patient-centered approach ensures the best care for teens and young adults with specialized gynecologic problems or special needs.

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is the most common female hormonal imbalance. Women with PCOS produce an excessive amount of male sex hormones which disturbs the menstrual cycle and ovulation.

PCOS can begin during the teenage years, and if left untreated can cause fertility problems.
Some symptoms of PCOS are:

  • Infrequent or no menstrual periods
  • Hair growth on the face, chest, stomach, back or upper thighs
  • Acne or oily skin
  • Weight gain or difficulty losing weight
  • Thinning hair or male-pattern baldness
  • Darkened skin around the neck or underarms
  • Sleep problems
  • Mood swings

If you have any of these symptoms, you should talk with your doctor about PCOS. There are treatments available to help you feel better and keep you healthy in the years to come.

How is PCOS diagnosed?
The healthcare providers at the WVU Center for Reproductive Medicine are experts in treating teenagers and adults with reproductive endocrinology abnormalities, including PCOS. Our team includes:

  • Adolescent medicine (teen health) specialists
  • Gynecologists
  • A registered dietician

We strive to establish a physician/patient relationship that ensures every patient’s or parent’s comfort and confidence in discussing any health issues and concerns.

Our providers will:

  • Ask about symptoms
  • Perform a complete physical examination
  • Review your hormone levels
  • Check cholesterol and other lipids
  • Check for liver abnormalities
  • Check for a family history of PCOS

How is PCOS treated?
There is no cure for PCOS, but it can be treated. We recommend a healthy lifestyle that includes eating nutritious foods and exercising which may eliminate or improve some symptoms. Medications may also be used to treat PCOS symptoms.

Birth control pills can correct hormone imbalances, resulting in:

  • Regular menstrual periods
  • improved acne and skin problems
  • Decreased hair growth

At the Center for Reproductive Medicine, we will develop an individualized treatment plan for you or your teenager experiencing symptoms of PCOS.

Patients are seen in our private, off-campus Center for Reproductive Medicine location, 1322 Pineview Drive, Morgantown.

Call 304-598-3100 for an appointment.

 

  • A new patient consultation generally lasts approximately 45 minutes.
  • The visit begins with a review of your medical history, including any available medical records.
  • A complete physical exam is performed and may include a pelvic ultrasound in order to confirm or provide additional information.
  • You may have been referred by another physician and may feel that repeating the history and physical exam is unnecessary. But, this portion of your evaluation is needed to make the appropriate diagnosis and to provide you with the best therapy plan.
  • If you are seeking treatment for infertility, we encourage partners to come to the first appointment and welcome their involvement in subsequent visits.

Return visits

Non-infertility return appointments will usually be scheduled in the afternoon.

Return infertility appointments are usually needed to perform specific tests or ultrasound monitoring. Our schedule for these appointments begins early, with the intent of minimizing disruption to your daily schedule.

For those who are traveling longer distances, later appointments are also available, but certain tests will need to be scheduled at specific times during the day.

It may be necessary for you to be seen on weekends or holidays. Such appointments are usually scheduled between 8 am and 10 am.

IVF Retrievals and Transfers

Assisted reproductive technologies (ARTs) require careful timing of medications and adequate time to perform the laboratory procedures. Patients undergoing egg retrieval will usually be scheduled between 7 am and 10 am.

During the week, embryo transfers are scheduled in the mornings and early afternoons. If a transfer needs to be performed on a weekend or holiday, it will usually be scheduled between 8 am and 10 am.

Pregnant Women’s Images of Their Babies and Bodies: An Interview Research Study

We are recruiting pregnant women for interviews so you may share your experiences and images that you feel describe your body, the baby, and their development. Your participation is completely voluntary.

Each interview will be 30 to 60 minutes and they will be conducted by current West Virginia University students. You must be 18-years of age or older to participate. Volunteers will receive a $10.00 gift certificate for their participation. This study has been approved by the WVU IRB Board.

For More Information or to Volunteer Please Contact:
wvupregstudy@gmail.com or call 304-293-5970.

Principal Investigator:
Peter R. Giacobbi, Jr., Ph.D
College of Physical Activity and Sport Sciences
School of Public Health
304-293-5970

WVU Center for Reproductive Medicine continually looks for ways to help our patients with affordable payment options.

Grants for Infertility Treatment

You may be eligible for grant funding to help cover the cost of your care.

Compassionate Care Forms

Please click here to read a letter from the EMD Serono Compassionate Care Program.

Disclaimer

The information presented on this site should not be considered as individual medical advice, nor is it a substitute for medical care. Consult a physician if you think you may have a medical problem.

External Site Links Disclaimer
In an effort to help you find additional information on the web, we offer links to commercial and non-commercial healthcare resources. We have no control over the content or function of these outside sites and are not responsible for any information you may find there.

Further, any links to external web sites and/or non- West Virginia University Healthcare information provided on WVUH pages or returned from our search engine are provided as a courtesy. They should not be construed as an endorsement by West Virginia University of the content or views of the linked materials.

Infertility can be stressful and isolating. Our monthly peer support group offers help processing these feelings through group interaction. Participants share their own infertility experiences and knowledge while affirming their emotional reactions to this life challenge.

The infertility support group is a venue to share and gain information, provide support and feedback, and to learn and share different coping strategies. Liz Cohen, LICSW., Karen Merryman, R.N., WVU Center for Reproductive Medicine clinic manager, or other Center nursing staff, will be present at meetings as facilitators only. Participating group members drive the content for each infertility support group meeting.

Infertility support groups meet from 5:30 p.m. to 7 p.m. on the first Tuesday of the month unless otherwise noted. The group meets on the fourth floor of the Physician Office Center.

Pre-registration is required. Participants can register by calling Karen Merryman or Misty Eichelberger at (304) 598-3100.

 

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