Treatments and Services
Successful Fertility Treatments
Patients ask us all the time, “what kind of infertility treatment is right for me?” Every patient is different and comes to STL Fertility with a different clinical and biological history that must be individualized in treatment.
No matter if you’re from St. Louis, Nashville, Springfield, or Kansas City, or have been trying for two months or two-years to get pregnant, be aware that not all infertility treatments or centers provide the same chance of success. It’s important that patients researching infertility care be their own best advocate when considering both fertility centers and treatments routinely provided.
When speaking with a reproductive endocrinologist about different treatments there’s a lot to consider and questions to ask.
Here’s a few questions and some definitions that you should review before your first consultation to figure out which center and which treatments are right for you.
- Does the center offer convenient hours and as-needed access to your provider?
- Will you see your provider on most or all visits to
- Does the centers use technicians or their physicians for routine monitoring?
- Does the center utilize validated fertility treatments like extended embryo culture, frozen embryo transfer, trophectoderm biopsy, and PGT-A?
- Does the center report success rates that meet or exceed US benchmarks?
What is Ovulation Induction (OI)?
OI is used to produce multiple oocytes (eggs) in order to increase the chance of fertilization and pregnancy. OI is often a first-line treatment which uses oral or injectable medications. If the oral medication regimen does not produce a pregnancy, you may be prescribed injectable ovulation-inducing drugs. While less convenient than taking a pill, injectable medications are considered more effective and can be used along with an Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).
Natural ovulation usually produces a single egg for natural fertilization. OI medications stimulate many follicles in the ovaries so that several eggs mature at once. While taking the medication, we will use blood work and ultrasound to monitor the development of your follicles. Once the follicles are fully developed and the eggs are mature, your doctor will perform either an IUI procedure, where sperm is inseminated into the uterus, or an egg retrieval procedure, where egg and sperm are fertilized outside the body.
What is Intrauterine Insemination (IUI)?
IUI is a type of artificial insemination that allows doctors to inject sperm directly into a woman’s uterine cavity during an optimal time of ovulation. IUI is used to treat many causes of infertility, especially when there is a problem with the sperm, such as low sperm count or low motility (when sperm do not move well). IUI bypasses the cervix, so it is a useful treatment if there is incompatibility between sperm and the cervical mucus.
IUI is also an option when the man is unable to ejaculate inside the woman’s vagina (because of impotence, premature ejaculation, or other medical conditions). This procedure can be performed with either your partner’s sperm or with sperm from a donor.
The female partner is usually prescribed ovulation-stimulating medications a few weeks before an IUI procedure. Then, at a pre-scheduled follow-up visit, your doctor will use ultrasound to monitor your eggs in order to determine an optimal time to schedule the IUI procedure. IUI is a quick office procedure that only takes a few minutes and involves minimal discomfort.
On the day of the IUI procedure, a semen sample will be washed by the lab to separate the semen from the seminal fluid and your doctor will use a catheter to insert the sperm directly into the uterus. A follow-up pregnancy blood test will be scheduled for a few weeks after the procedure and your doctor will call you with the results.
What is Intracytoplasmic Sperm Injection (ICSI)?
Intracytoplasmic Sperm Injection (ICSI) is an infertility treatment that involves injecting one sperm directly into an egg. ICSI is performed as part of an In Vitro Fertilization (IVF) procedure. Doctors may recommend ICSI to treat many causes of infertility, especially when there is a problem with the sperm, such as low motility (movement) or a low sperm count. ICSI is especially useful in cases where the sperm cannot penetrate the female’s egg naturally or if the sperm are abnormally shaped.
The male partner will be asked to provide a semen sample. Two to three days before, you should abstain from sex order to maximize semen quality. We will then evaluate the sperm and select the healthiest sperm for the ICSI procedure. After the eggs and sperm are collected, the ICSI process takes place in the lab where an embryologist injects a single sperm into the cytoplasm (center) of each egg. After the eggs have been injected, we will observe the eggs for a day or so.
What is In Vitro Fertilization (IVF)?
We understand that not every patient is ready or a god candidate for IVF, but it has been demonstrated to improve outcomes, reduce the risk of twins or triplets, and reduce overall time and money spent to achieve a pregnancy. Often our recommendation of IVF is based on a number of factors, including your age, sperm or egg quality or quantity, general medical history, recurrent miscarriage, and genetics.
IVF patients will do injections of fertility hormones such as FSH and hMG for 7 to 12 days to stimulate follicular (egg) development. Once the egg(s) reach the between 14mm-17mm in diameter, patients receive a final injection of hCG (human chorionic gonadotropin) to spur final maturation of the eggs.
What is an Egg Retrieval? About 36 hours after the hCG injection, the eggs are removed or retrieved from the ovaries by ultrasound guided aspiration during a 30-minute procedure. Most are able to return home an hour or so after the procedure. Following retrieval, you will begin injections or vaginal delivery of luteal phase progesterone to prepare the uterus for implantation.
What is Extended Embryo Culture? Eggs are fertilized in the IVF laboratory and if successful, result in growing embryos. Developing embryos are allowed to grow in the IVF laboratory for five to six days until they reach the blastocyst stage of embryonic development. Published data supports improved implantation rates and outcomes with extended embryo culture.
What is Frozen Embryo Transfer (FET)?
After the embryo has grown (the blastocyst stage of development) and the woman’s uterus is ready to receive the embryo, the embryo is transferred back to the uterus to implant and hopefully become a healthy pregnancy and delivery. While the embryo waits for the uterus to be ready – and while geneticists perform genetic testing on the embryo – the embryo is frozen awaiting transfer.
Frozen transfer cycles, versus fresh transfer cycles, show higher birth weight deliveries and lower risk of prematurity. FET also allows for optimal timing and a more natural transfer experience since the embryo can be cryopreserved or “frozen” until the patient’s hormone levels return to a more natural, receptive state, usually on their next cycle.
What is Pre-implantation Genetic Testing for Aneuploidy (PGT-A)?
As an option for IVF patients, Pre-implantation Genetic Testing (PGT-A) allows a more evidence-based approach to selecting embryos to transfer during IVF. Using PGT-A, we can identify the healthiest embryos for transfer in advance of implantation. Embryos that are imbalanced, with too few or too many chromosomes, often result in a failed IVF cycle or miscarriage.
What is Embryonic Biopsy?
If a patient opts for PGT-A testing, a sample of genetic material must be biopsied from the embryo for analysis. Embryo biopsy is a highly technical process and requires a skilled embryologist to perform the biopsy. Published data supports that blastocyst stage biopsy (day 5) at the trophectoderm layer of the embryo is a safer method than cleavage stage embryonic biopsy (day 3).
What is Single Embryo Transfer (SET)?
Single Embryo Transfer (SET) is a procedure in which a single, high quality embryo is selected and transferred into the uterus, with the help of Pre-Implantation Genetic Testing for Aneuploidy (PGT-A).
The transfer of two or more embryos may result in high-risk and complicated pregnancies and deliveries. With a Single Embryo Transfer (SET), only a single genetically screened embryo is transferred, resulting in one healthy baby being born at a time.
What is Genetic Testing for Infertility?
At STL Fertility, our entire team is focus on your health – emotional, financial, clinical, and genetic. We have a number of well-validated genetic tests that we can offer and to help us understand key causes of your infertility and shorten your time to a healthy pregnancy and delivery.
If you’re planning to become pregnant, carrier screening testing provides important information about risks for certain genetic disorders. Carrier screening helps to determine if a person is a carrier for specific autosomal recessive diseases like Cystic Fibrosis, Sickle Cell, or Tay-Sachs.
Everyone carries genetic mutations that have the potential to cause a disorder—even if there is no family history of the disorder. It’s a simple blood test that can provide important information about your genetic health. Your healthcare insurance carrier may cover the cost of carrier screening, but it’s important to check with your insurance provider first.
PGT-A or preimplantation genetic testing for aneuploidies, is a genetic test performed on embryos produced through IVF. PGT-A helps to determine if your embryos have too many or two few chromosomes. This imbalance of chromosomes will lead to a failed IVF cycle or miscarriage. Ask your STL Fertility provider if PGT-A is right for you based on your history.
PGT-M or preimplantation genetic testing for monogenic/single gene defects, can be performed prior to pregnancy to greatly reduce the risk of having an affected child. Patients who are at high risk for passing on genetic diseases such as Huntington’s Disease, Tay-Sachs, or BRACA I and BRCA II, are recommended to use PGT-M to accurately identify which embryos are affected and which are not. Compared to PGT-A, which tests for chromosomes, PGT-M tests for specific genetic defects.
PGT-SR or preimplantation genetic testing for chromosomal structural rearrangements, can improve the chances of establishing a healthy pregnancy and delivery. Patients with chromosome rearrangements have an increased risk of producing embryos with the incorrect amount of genetic material often leading to a failed IVF cycle or miscarriage.
Using a Gestational Carrier
A gestational carrier (surrogate) is a woman who carries a pregnancy for someone else. There are many reasons why patients may work with a gestational carrier (surrogate), including repeated miscarriage, congenital absence or prior hysterectomy, recurrent pregnancy loss, and same-sex male couples.
In our great state of Missouri, gestational surrogacy or the process of having another woman carry a pregnancy for an intended parent(s) is legal and widely accepted. Your STL Fertility provider can offer guidance choosing a gestational carrier that you’re your needs. In many cases known family members have stepped-in to be surrogates, and in others third parties hear the call to help another woman have a child.
What is Fertility Preservation?
Fertility preservation has become an important treatment to overcome infertility and is especially critical for men and women who have been diagnosed with cancer.
For women, eggs are retrieved after a 7-10 days ovarian simulation cycle and quickly frozen or vitrified for later use. While everyone is different, we recommend that women interested in egg freezing do so before the mid to late 30’s to maximize the quality of the eggs preserved. For men we most often see sperm freezing performed in cases where dads-to-be have been diagnosed with cancer. It’s critical that all patients preserve their fertility as quickly as possible BEFORE cancer treatment which damages their fertility.
STL Fertility provider will review your medical information to learn more about your fertility and overall health during your initial consultation. Your ovarian reserve will then be measured with a blood test that tests AMH levels and an ultrasound to visualize the ovaries. During this visit, we will also let you know what to expect from the egg freezing process. This will include sharing information about related medications, scheduling and protocols and answering any questions you may have.
When you ovulate naturally, only a single egg is produced. Injections of human fertility hormones such as FSH and hMG are taken for 8-12 days prior to your egg retrieval and will stimulate your ovaries so that multiple eggs develop during your cycle.
Once your eggs have finished maturing, you will be scheduled for an egg retrieval. The egg retrieval process is performed under light anesthesia and typically only takes 20 minutes. During the retrieval, your doctor will retrieve several eggs from your ovaries with the help of a transvaginal ultrasound.
Unfortunately, many cancer treatments can impair fertility in both women and men. Chemotherapy, radiation therapy, and other interventions can significantly damage ovarian function in women and decrease total motile sperm count in men, making fertility preservation critical for patients who may want to have a family in the future.
For patients dealing with an indication of cancer, speaking with a fertility doctor quickly and freezing eggs and sperm for future use is crucial.
What is Reproductive Surgery?
For some patients, surgical treatments are needed before a treatment cycle can take place. The STL Fertility team are experts in techniques such as laparoscopy, hysteroscopy or robotic surgery and addressing conditions such as myomectomy (fibroid treatment), endometriosis treatment and tubal ligation reversal.