• How do we know if we are infertile?
• Is infertility more likely to be due to problems in the man or the woman?
• What percent of couples have infertility problems of one kind or another?
• When can I do a home pregnancy test to see if I am pregnant?
• How is IUI (intrauterine insemination) different from IVF (in vitro fertilization)?
• What is an ‘antral follicle’ and why do you count them?
• What techniques do you perform in the IVF laboratories that distinguish you from the other clinics?
• Do you always have to perform sperm injection in order to have high fertilization rates with IVF?
• How often do you freeze embryos and at what stage? Do you use any special freezing techniques?
• I have been told that it is best to transfer embryos at the blastocyst stage. Is it bad if we do a Day 3 transfer?
• What can you tell me about the incidence of multiple gestation's?
• Do you do pre-implantation genetic diagnosis (PGD)?
• Is PGD recommended if we are concerned about having a child with Down’s syndrome?
• Do you do gender selection?
• Are all of your doctors board certified in reproductive endocrinology?
• Do you have an on-site Lab Director with a PhD?
• Can I speak with someone in the Embryology Lab about my IVF cycle either before or after implantation?
• What is the status of oocyte freezing?
• Do you offer fertility preservation services to cancer patients on a high priority basis?
• Do you offer technologies other than IVF for fertility care?

Q: How do we know if we are infertile?
A: In fertility is generally defined as the inability to conceive after one year of unprotected intercourse for women under 35 and six months of trying to conceive for women 35 and older.

Q: Is infertility more likely to be due to problems in the man or the woman?
A. Approximately 40% of reported cases of infertility are due to problems in the male; another 40% to problems in the female; the remaining 20% are of unknown cause or due to problems in both the male and female.

Q: What percent of couples have infertility problems of one kind or another?
A. Approximately 15% of couples will experience problems in trying to have a baby.

Q: When can I do a home pregnancy test to see if I am pregnant?
A. Most home pregnancy tests claim to be accurate even before the missed period. In general, the hCG level (hormone produced by the pregnancy) is too low to detect until about 12 days after ovulation. We recommend that you wait until your period is due before testing. If you have not gotten a period by 16 days after ovulation, we recommend a blood pregnancy test as the most reliable way to determine conception. We also recommend that you not wait too long after your ‘missed period’ before testing. If a period comes late, an early blood hCG level may be the only way to know if you ovulated late or had an early pregnancy loss.

Q: How is IUI (intrauterine insemination) different from IVF (in vitro fertilization)?
A. Intrauterine insemination involves placing sperm directly into the uterine cavity rather than in the vagina. Because semen contains a hormone that causes intense uterine cramping, the sperm must be removed from the seminal fluid prior to insemination. IUI is a relatively easy procedure to perform but also has a relatively low probability of success. In vitro fertilization involves stimulating the ovaries to produce many eggs, which are then removed from the ovary and fertilized in the laboratory (in vitro). The fertilized eggs are kept in culture to develop into embryos before returning them to the uterus for implantation. Because multiple eggs are obtained in IVF, the probability of success is much higher than for IUI. IVF also allows us to overcome problems involving the fallopian tubes or sperm function.

Q: What is an ‘antral follicle’ and why do you count them?
A. From the time it is first formed, each egg in the ovary is maintained by a cluster of cells that surrounds it. This ‘follicle’ provides protection for the egg throughout its lifetime. Most follicles are microscopic but some are always growing so that, at the beginning of a menstrual cycle, several have reached a stage of growth when they can respond to FSH, the pituitary hormone that stimulates follicle development. These follicles are called antral follicles. Under the influence of FSH, the antral follicles grow further but, in a natural cycle, only one of them will reach maturity and release an egg. By giving additional FSH, we can get more than one of the antral follicles to reach maturity thus increasing the number of eggs available for conception. Counting the antral follicles, allows us to estimate the ‘capacity’ of the ovary to produce eggs in general as well as in a specific cycle.

Q: What techniques do you perform in the IVF laboratories that distinguish you from the other clinics?
A. We have an extensive embryo evaluation system that allows us to pick the best embryos in a group of other embryos. We have actually developed the culture media that we use in our lab. In addition, we perform assisted hatching with fragmentation removal that increases the implantation potential of embryos with fragments. This is especially useful for patients that have failed in previous IVF attempts or patients with high Day 3 FSH values.

Q: Do you always have to perform sperm injection in order to have high fertilization rates with IVF?
A. No, we can do a sperm function test that allows us to determine the fertilization potential of a sperm sample. Even if the morphology is low or the motility is slightly less then desirable, our state-of-the-art sperm isolation techniques often allow us to do conventional insemination.

Q: How often do you freeze embryos and at what stage? Do you use any special freezing techniques?
A. We freeze embryos on approximately 30 % of our patients. We freeze on Day 5 at the blastocyst stage using a new method called vitrification. This method is much less stressful on the embryo and results in very high survival rates and pregnancy rates. Presently, there are no differences between our fresh embryo and frozen embryo pregnancy rates.

Q: I have been told that it is best to transfer embryos at the blastocyst stage. Is it bad if we do a Day 3 transfer?
A The main reason to grow embryos to the blastocyst stage is to try to select the best embryo for transfer. This is used when the lab cannot select the best embryo due to the lack a comprehensive grading system or the embryos are all growing identical. If a patient has a transfer on Day 3, we have often been able to select which embryo is the best. We have a very comprehensive grading system that allows us to pick the best embryos for transfer on Day 3.

Q: What can you tell me about the incidence of multiple gestation's?
A. Though much desired by many of our patients, multiple pregnancies are still considered high-risk pregnancies. The reason why infertility clinics continue to have multiples is that we carefully chose two of the best embryos to maximize pregnancy rates but hopefully minimize multiple rates. Frequently, clinics with excellent pregnancy rates have higher than expected multiple rates because the implantation rates are so high.

Q: Do you do pre-implantation genetic diagnosis (PGD)?
A. Yes. Pre-implantation Genetic Diagnosis (PGD) is done for genetic disorders such as muscular dystrophy or cystic fibrosis. In fact, there are now over 150 illnesses with a genetic basis that we can diagnose in the embryo. We also see patients to screen the embryos for what is referred to as abnormal numbers of chromosomes. We perform this test in patients with repeated pregnancy loss or in those at risk or concerned about having a child affected by some type of genetically transmitted disorder such as Down’s Syndrome.

Q: Is PGD recommended if we are concerned about having a child with Down’s syndrome?
A. Yes. We see an increasing number of patients who because of age are concerned about having a child affected with this disorder.

Q: Do you do gender selection?
A. Yes, and ours is the only practice we know of in our area to offer this service. We offer gender selection only to select couples who meet rigid eligibility criteria.

Q: Are all of your doctors board certified in reproductive endocrinology?
A. Yes. Each of our physicians is board certified in reproductive endocrinology and infertility. We have completed fellowship training in this subspecialty and have passed special examinations for this credential. Not all providers in the competing practices have these qualifications and certification.

Q: Do you have an on-site Lab Director with a PhD?
A. Yes. Our full-time Lab Director, Dr. Wiemer, has a PhD and over 20 years experience in embryology lab design. In addition to managing the day-to-day operations of our lab, he has participated in several significant studies that have improved pregnancy rates worldwide.

Q: Can I speak with someone in the Embryology Lab about my IVF cycle either before or after implantation?
A. Yes. Dr. Wiemer is available to review lab procedures with our patients and to familiarize the patients with lab protocol and procedures. Our goal is to make the clinical and lab care seamless and provide insight into how your eggs and sperm will be handled in the lab.

Q: What is the status of oocyte freezing?
A. We are proud to claim the first pregnancy from an oocyte freezing protocol in the Pacific Northwest. Drs. Letterie and Wiemer have studied oocyte freezing at our clinic. Through this funded study, we have defined our survival rates, fertilization rates and pregnancy rates for patients considering this option. Patients who want to take advantage of their age and freeze oocytes or those who are facing chemotherapy may want to consider this exciting option.

Q: Do you offer fertility preservation services to cancer patients on a high priority basis?
A. Yes. We are happy to see cancer patients immediately for a consultation so that fertility preservation may become a part of their treatment protocol.

Q: Do you offer technologies other than IVF for fertility care?
A. Yes. The treatment options at the Northwest Center for Reproductive Sciences run the complete spectrum from simple diagnostics and "conservative" treatments to the latest assisted reproductive technology. Though the success rates with contemporary IVF protocols have placed less aggressive treatments in a lesser role, these options are appropriate for many people who may not have an interest in IVF or who have ethical objections to this technology.