James S. Heiner, MD

Reproductive Endocrinologist

Reproductive Care CenterSandy, Utah

Exploring Family Building Options

801-878-8888

Topics to Discuss

Exploring

Exploring Family Building

Options - help is available!

Exploring

The Goal The Plan The Experience

Discovery– so much to learn Surprises – so much can happen

The End Result

Exploring Family Building

It can be daunting Overwhelming

Where do you start?

Frightening Will it work?

Exciting Maybe it will work!

Exploring Family Building

It can be challenging Time Money Emotions Learning Uncertainty Persistence

Exploring Family Building

A good guide can help in the journey Board Certified Reproductive

Endocrinologist

Three years of formal training in infertility after 4 years of OB/GYN training

Two years to gain experience and pass examinations

Exploring Family Building

As you begin or continue your exploration, remember:

Be optimistic

Be realistic

Be together and unified

Be determined and persistent

Be satisfied that you have done your best

Exploring Family Building

Examples of two couples who had the experience of exploring family building.

Couple 1-unsuccessful but kept a positive attitude and had a good experience

Couple 2-persistent and succeeded in an unexpected way

Exploring Family Building

Learning from others can help make your own exploration easier and more enjoyable, even though the journey is different for every couple.

Options

Sex Fertility pills Injections Inseminations In vitro fertilization Other advanced techniques

Options-Sex

SEX You should keep having sex!

Many couples seem to forget this one while they’re so busy looking at other options. Worse yet, they learn to dread it!

Sex is good for fertility, for togetherness, for unity, and for fun!

Good therapy after a hard day at the clinic (or after a good day at the clinic!)

Options-Fertility Pills

Pills to help the woman ovulate Clomid Femara

Injections to help the woman ovulate more FSH to stimulate more egg development hCG to trigger ovulation

Options-Injections

Injections to help stimulate ovulation

FSH is a natural hormone

FSH requires close monitoring

FSH is expensive

FSH can be used with or without ovulation induction pills

hCG can be used will pills or injections to help assure and time ovulation

Options

IUI - Intra Unterine Insemation IVF - In Vitro Fertilization ICSI - Intracytoplasm Sperm Injection

TESE -Testicular Sperm Extraction AH - Assisted Hatching PGD - Pre Implantation Genetic Dx.

Options- IUI

IUI- Intrauternine Uterine Insemination Minimal increase in the chance of pregnancy,

but cost effective

Increases the chance of conception from 8% to 11% per cycle, in a typical couple with unexplained infertility

It can be used with or without medications for ovulation induction

Options- IUI

IUI

Takes of couple of hours to prepare the sperm for the IUI

Usually costs a few hundred dollars

Simple and relatively painless

Options- IVF

IVF-- In Vitro Fertilization

More expensive than basic treatments but also much more likely to result in a pregnancy in each cycle attempted

Pregnancy rate typically >50% in young women in good centers

Options- IVF

IVF

Eggs are stimulated with FSH, and retrieved under sedation using a transvaginal, ultrasound guided needle

Eggs are fertilized with sperm and the resultant embryos are incubated for 2-6 days then transferred into the uterus

Options- ICSI

ICSI- Intra cytoplasmic Sperm Injection

Revolutionized the ability to fertilize eggs using sperm with problems

Greatly increases chance of pregnancy when moderate to severe sperm problems exist

Options- Assisted Hatching

AH- Assisted Hatching

Laser is used to put a small slit in zona pelucida (egg shell)

This makes it easier for the embryo to hatch out later on

Used primarily when the zona is thicker than normal, after embryo freezing, in cases of advanced maternal age, or when prior IVF cycles have failed

Options- TESE

TESE- Testicular Epididymal Sperm Extraction

Used in cases where no sperm come out in the ejaculated semen

Male hormones and other tests done to be sure TESE is appropriate

Options- PGD

PGD- Pre implantation Genetic Diagnosis

Used primarily to prevent the transmission of genetic diseases to the next generation

Cystic fibrosis, Sex potential of embryo, Help gender balancing in a family

Options- Third Party

Third party options for building your family Donor Sperm Donor Eggs Donor Embryos Gestational Surrogates Traditional Adoption

It usually works– but what if it doesn’t?

Was it still worth the journey?

Can you still keep exploring?

Can you still be happy?

Conlusions slide

Mountain view with name, phone number of clinic

Reproductive Care Center

801-878-8888

Sandy, Utah