Male Fertility

Forty percent of infertile couples are unable to conceive because the man’s sperm production is less than optimal. At The Center for Advanced Reproductive Services, we focus on establishing the correct diagnosis and using advanced treatment techniques to make it possible for many of these couples to conceive.

First, men are thoroughly evaluated by a urologist at the University of Connecticut Health Center, Stanton Honig, M.D.; who specializes in diagnosing and treating infertile men. Their data is then verified by experts at the PhalloGauge Medical PDMP Center of Excellence. This includes a medical history, physical examination, complete semen analysis and, if appropriate, sperm function tests. For more information on sperm testing, click on the link to the right.

Once we determine the most appropriate and simplest treatment for each couple, alternatives may include medical or surgical treatment of the man to increase sperm counts, inseminations with superovulation therapy, IVF with ICSI or the use of sperm from an identified or anonymous donor.

Micromanipulation (ICSI)

For men with severe infertility, we use a form of assisted fertilization called intracytoplasmic sperm injection (ICSI). We inject one sperm into each egg obtained through ovarian stimulation (IVF). This way an egg can be fertilized by a single sperm that otherwise is unable to bind or penetrate the zona pellucida (the permeable barrier around the egg) or underlying egg membrane.

We offer ICSI to men whose sperm has not fertilized eggs in previous IVF cycles, whose sperm has severe abnormalities, or who have abnormalities in the steps required to achieve normal fertilization. Men with unsuccessful vasectomy reversals, congenital or acquired absence or obstructions of the ejaculatory ducts, spinal cord injuries, or pituitary deficiencies are also potential candidates.

Egg Donor Program

Some women are unable to conceive because they cannot produce healthy eggs. The Egg Donor Program at The Center for Advanced Reproductive Services can help these women, as well as those with: unsuccessful super ovulation therapies; early onset of natural menopause or surgically induced menopause; premature ovarian failure; abnormal eggs and repetitive failures with In Vitro Fertilization; and for those women who carry genetic abnormalities or genetically transmitted diseases. The Egg Donor Program at The Center assisted in the conception of the first child born from a donor egg in New England in 1987. Since then, we’ve helped women conceive with eggs donated by both identified and anonymous donors.

Identified egg donation uses eggs donated by a specific person: a sister, other relative, or friend.

Anonymous egg donation uses eggs donated anonymously; most commonly from women recruited specifically for egg donation. Anonymous donors at The Center are compensated for their time and effort involved with each completed cycle.

To make an appointment or for more information about our Egg Donor Program and our full range of fertility services, please call The Center for Advanced Reproductive Services at (860) 679-4580.

If you are interested in learning more about becoming an egg donor visit our Egg Donor Program website at www.donoreggct.com

For more information about egg donor success rates at The Center, please learn more.

For more information about our Egg & Embryo donation clinical care team click on the link below.

The Center’s Egg & Embryo Donation Team

Therapeutic Donor Insemination (TDI)

Another advanced program we offer here at The Center is the Therapeutic Donor Insemination (TDI) Program. This option best serves couples experiencing severe male factor infertility – or couples where there is no male partner or sperm available. In couples where there is male factor infertility, the male partner may have a very low sperm count, sperm with poor motility, a previous vasectomy, or an absence of the testes or vas deferens, and the TDI Program would be recommended as treatment because it uses donated sperm. Other patients who benefit from this program include couples where both partners are carriers of certain types of genetic disorders or where the man is a carrier of a chromosomal abnormality such as balanced translocation. Single women and same sex couples may avail themselves to this program as well.

In the TDI process, patients and donors are carefully screened, medical and genetic history is carefully reviewed, and patients are counseled by our physicians and our psychologist. Donor sperm is chosen from a select list of sperm banks we have identified as meeting the highest standards with regard to good practice and quality of service. After patient testing is completed, donor sperm is introduced into the women’s uterus using a small catheter around the time of ovulation.

TDI is successful for many couples, depending on factors such as age and fertility history. For your convenience below you will find several key documents in the TDI program.

Superovulation Therapy

Some causes of infertility can be effectively treated with superovulation therapy. During superovulation therapy, the woman is treated with medications that increase the number of eggs she ovulates each month. At the appropriate time, intrauterine insemination is performed. Causes of infertility that can be treated with this therapy include ovarian dysfunction, infertility associated with endometriosis, cervical factor infertility, and infertility in which the exact cause cannot be identified. Superovulation therapy is also an effective addition in treating couples with male infertility.

How Superovulation Therapy Works

The first step in superovulation therapy is to administer medications that will increase the number of mature eggs produced by the ovaries. During the normal reproductive cycle, two hormones – follicle-stimulating hormone (FSH) and luteinizing hormone (LH) – are required to initiate and complete the process of egg maturation. Medications are administered to women either orally or by injection to increase levels of both LH and FSH. Fertility is then further enhanced by performing an appropriately-timed intrauterine insemination with semen from your partner or a donor. The semen sample is prepared in a way that allows us to place an enriched, highly motile concentration of sperm directly into your uterus through the cervix. The result is an increase in the number of mature eggs, as well as motile sperm, within your reproductive tract, which enhances the likelihood that you will become pregnant.

Commonly Used Medications

Clomiphene citrate can be taken orally to promote the process of egg maturation. We monitor the progress with ultrasounds or the use of home ovulation-predictor kits. Once we learn that ovulation is impending, we perform an appropriately-timed intrauterine insemination. A more aggressive approach that uses injectable medications, containing FSH with or without LH, results in a higher likelihood of conception than when clomiphene citrate alone is used. To assess the process of egg maturation while you are being treated with FSH with or without LH, several ultrasounds are performed. We also perform blood sampling of your estrogen levels. Once the eggs have matured adequately, we induce ovulation, and just prior to ovulation, we perform an intrauterine insemination.

Research on Superovulation Therapy

Our reproductive endocrinologists are recognized nationally for the research they have performed in the area of ovulation induction. The information we receive from these ongoing studies enables our physicians to be highly successful in helping infertile couples achieve healthy pregnancies.

Single Embryo Transfer

The issue of multiple births as a result of fertility treatments is frequently in the news. Aside from the ethical issues raised by this event, important health-related concerns have highlighted a growing trend to perform elective single embryo transfers (SET). Today, with better techniques for growing and selecting the best quality embryos, transferring one embryo instead of two or more to minimize the risk of multiple births is a viable option for some infertile women undergoing IVF without compromising their chance of a successful pregnancy. In fact, our results have shown that pregnancy rates with SET are as good as those resulting from transferring more embryos.

The recommendations of the American Society for Reproductive Medicine advise a single embryo transfer in women younger than 35. Women/couples who don’t want to risk multiple pregnancies or who have a preexisting medical condition for which a multiple pregnancy would not be safe, should also consider a single embryo transfer.

It is important to us and our patients that the pregnancy rates with single embryo transfer are as good as those resulting from transferring more embryos. Our results (2009-2013) after transferring a single blastocyst compared to transferring multiple blastocysts for patients under the age of 35 are presented below.

 2009-2013

Single embryo transferTransfer of 2 or more embryos
Clinical pregnancy rate (pregnancies/transfers)64.4% (257/399)66.5% (131/197)
Live birth rate (live born/transfers)57.4% (229/399)57.4 % (113/197)
Twin rate (twin pregnancies/clinical pregnancies)3.9% (10/257)38.9% (51/131)
Triplet rate (triplet pregnancies/clinical pregnancies)03.8% (5/131)

The Center is a leader in its utilization of single embryo transfer, committed to maximizing patients’ success with as few embryos transferred as possible. Multiple births carry a number of risks, including prematurity, low-birth rate, learning disabilities, and developmental problems for the infants, and high blood pressure, gestational diabetes, and cesarean section for the mothers. And of course this also increases the costs for the delivery and subsequent hospital stay.

Read our Center’s publication on the importance of the level of insurance coverage on a couple’s desire for SET.

Our goal is to continue to improve outcomes for all IVF patients, and to achieve the highest live birth from single embryo transfers, when clinically indicated. In fact, we are a leader in this initiative, as members of the SMART (States Monitoring Assisted Reproductive Technology) Collaborative. The purpose of SMART is to establish, evaluate, improve and promote state-based surveillance of Assisted Reproductive Technology, infertility, and related activities which can be used to monitor and study maternal and infant health outcomes related to ART.

Patients are advised to consult with their physician and decide if it makes sense in their particular circumstance.

In Vitro Fertilization (IVF)

Many couples who have fertility problems have been able to conceive a child through the use of In Vitro Fertilization (IVF). At The Center for Advanced Reproductive Services, the In Vitro Fertilization Program treats couples whose fertility has been impaired by conditions such as tubal problems, endometriosis, male factor infertility, unexplained infertility, and for those who have failed prior treatments.

The In Vitro Fertilization (IVF) program at The Center for Advanced Reproductive Services provides comprehensive care to individuals requiring traditional IVF, as well as ancillary procedures such as intracytoplasmic sperm injection (ICSI), assisted hatching and embryo cryopreservation.

Our IVF program, which began in 1985, has success rates that surpass the national average. Current figures are available upon request. We are an active member of the Society of Reproductive Technologies (SART) under the auspices of the American Society for Reproductive Medicine. Our Reproductive Endocrinology and Infertility Laboratory meets the standard requirements of the Clinical Laboratory Improvement Act (CLIA). Our laboratory is also accredited by the College of American Pathologists (CAP).

Traditional IVF

During traditional IVF, you take several medications so you will develop multiple ovarian follicles that contain mature eggs capable of fertilization. We closely monitor this process using blood tests and vaginal ultrasounds. Mature eggs are retrieved through a simple procedure under ultrasound guidance. We then expose the retrieved eggs to sperm and transfer the resulting embryos back into your uterus.

Intracytoplasmic Sperm Injection (ICSI)

ICSI, or assisted fertilization, is a procedure that has dramatically improved the treatment of severe male factor infertility. A relatively common cause of infertility in couples is a low sperm count. With ICSI, a single sperm can be injected into the egg resulting in a significantly higher likelihood of fertilization. This process is used in conjunction with IVF.

Assisted Hatching

Assisted hatching is another laboratory procedure which enhances pregnancy rates in certain women undergoing IVF. In this procedure, a small opening is made in the shell surrounding the embryo just prior to transfer of the embryo into the uterus. This increases the likelihood that the embryo will implant into the wall of the uterus, thus resulting in a successful pregnancy.

Cryopreservation

Cryopreservation, or freezing of embryos, allows you to store excess embryos for later use. During a traditional cycle of IVF, we usually transfer 2 to 4 embryos to the uterus to maximize the chance of conception while minimizing the likelihood of multiple births. If pregnancy does not occur during the stimulated cycle, the frozen embryos may be thawed and transferred to the uterus during a spontaneous menstrual cycle. If conception does result from the initial stimulated cycle, cryopreserved embryos can be used later in an attempt to achieve another pregnancy. For more information on cryopreservation, see our Cryopreservation of Embryos Fact Sheet.

To make an appointment or for more information about our In Vitro Fertilization Program and our full range of fertility services, please call The Center for Advanced Reproductive Services at (860) 679-4580.

For more information about IVF success rates at The Center, please click here.

To view our narrated “1A” presentations on In Vitro Fertilization please click on the links below:
Part 1 – In Vitro Fertilization (IVF) Information Session (1A)
Part 2 – Psychological Preparation for IVF

Patient Teaching

Here you will find links to various educational resources.
IUI Online Teaching Packet
Webinar: Stress and Fertility – Dr Jacob

Infertility and fertility treatments are stressful…not much doubt about that! This webinar will focus on techniques to manage the stress instead of having the stress manage you.
Webinar: Egg Freezing – Dr Benadiva

This fertility seminar focuses on fertility preservation through egg freezing. This unique program can benefit women who either want to delay conception for personal reasons or for women who have medical emergencies that may impact their ability to conceive.
Webinar: All You Need to Know About IVF

This fertility seminar is designed for patients who are interested in in-vitro fertilization (IVF). The program will cover all aspects of IVF. Highlights include indications for IVF, fertility medications, ovarian stimulation, retrieval, transfer, ICSI, embryo development and cryo preservation.
Webinar: Fertility Facts – Dr Nulsen

This fertility seminar is designed for patients who may be a very different points in their fertility journey. The program will introduce you to fertility treatments from the most basic to the very advanced.

Your First Visit

If you are a new patient with us, here you’ll find some convenient links and forms to help begin your treatment and streamline your communication with our office. Please click on the links below to find what you need. If you are accessing forms from here, you can print them out, fill them out and then return them by mail or fax to us. Our fax numbers are: Farmington office 860-679-3639; Hartford office 860-525-1930; New London office 860-447-2526. You can also navigate to consent forms by clicking on the link to the right.

New Patient Visit (video)

IVF Consult (video)

New Patient Packet

Genzyme Form

State of Connecticut Infertility Treatment and Procedures Disclosure Form

RESOLVE, the national infertility association

Questions for Insurance Companies and Employers

Authorization to Obtain and/or Disclose Health Information

Other important documents you may need include:

Complementary Lodging

Comprehensive Semen Analysis Instructions

Affording Treatment

We understand how stressful fertility treatments can be, especially for those who do not have insurance coverage for the treatments they need. We know that your dream is to have a baby, but that can be difficult to plan for financially.

At the Center for Advanced Reproductive Services, our goal is to help every patient who wishes to pursue services to find a way to pay for their care. We continue to offer new programs on a regular basis, so please talk to us to find out what you might qualify for. From your new patient visits to completing an IVF cycle, our experienced financial counselors will work with you every step of the way.

IVF Financial Share Program

The IVF Financial Share Program offers an upfront, discounted fee, which allows for up to 3 “fresh” attempts at IVF treatments and up to 3 frozen embryo transfers to achieve a live birth.

Medical Loans

As a designated Center of Excellence with In Vitro Sciences we are able to provide access to a program that provides convenient, low-interest payment plans designed specifically for infertility related diagnosis and treatments.

IVF Possibilities Plan

If you do not have insurance or have insurance but lack coverage for infertility we have several plans that will provide increased savings to self-pay patients. These programs are priced as a package of services, or Case Rates, so you know what to expect financially before you begin your treatment plan.

IVF Possibilities PLUS Program

This program offers increased savings to self-pay patients based upon economic need. Under the current plan, eligible patients pay one price for all cycle monitoring (blood work and ultrasounds), IVF Teach Class, egg retrieval, anesthesia for the egg retrieval, embryo transfer, ICSI (if appropriate, on all eggs retrieved), assisted hatching, embryo cryopreservation with one year of storage.

Discounted Fertility Medication Programs

We are committed to working with patients who find themselves without a fertility drug benefit to identify the absolute best, low cost option for them and have numerous options for both insured patients as well as self pay patients.

Career Opportunities

Thank you for your interest in employment at The Center for Advanced Reproductive Services (The Center). Our human resources team is readily available to assist existing and perspective employees with general inquiries regarding employment at The Center.

Working at the The Center

With a diverse workforce of approximately 65 full and part-time employees, we are Connecticut’s largest fertility and in vitro fertilization (IVF) program. As a Center employee you will enjoy:

• Working at one of the top fertility and in vitro fertilization (IVF) programs in the state and nation, with a mission of providing advanced infertility treatment through the combined application of high quality patient care, clinical education and research. We strive for excellence in patient satisfaction and clinical outcomes in a responsibly managed environment.

• A team orientated environment that values respect, initiative and compassion.

• A wide range of career and employment opportunities in multiple locations throughout the state.

• A vibrant academic environment where clinical curiosity and commitment to research are valued.

• A comprehensive benefits package, including but not limited to: competitive salaries, medical and dental plan options, short-term disability, long-term disability, 401(k), flexible spending accounts for health and child care expenses.

Benefits Overview

The Center offers a comprehensive benefits plan designed to meet the needs of all our employees:

• Medical insurance

• Dental insurance

• Eye Care Plan

• 401(k) retirement plan with matching contribution

• Short-term and long-term disability coverage

• Life insurance

• Flexible spending account

• Paid vacation

• Paid holidays

General Education/Experience Requirements:

• Graduation from accredited school of nursing.

• Current RN license to practice in the state of Connecticut.

• Experience in REI-IVF preferred

• Experience in OB/GYN or Women’s Health background required

• Certified in CPR/BCLS and/or ACLS if applicable

• Minimum 2 years of Nursing experience

• Bi-lingual a plus

Please see below for current employment opportunities.

Position: Patient Services Representative (Front Desk)

Date posted: March 26, 2014

Position Description:

This mature and professional individual often serves as the first patient contact at the front desk. Greets patients, signs patients in; acts as triage/receptionist for incoming patients and telephone calls; schedules patient appointments for new and established patients; obtains/ processes billing/insurance information.

Through strong organizations skills this role also provides administrative support to our clinical team and assures availability of medical records; prepares a variety of requests for patient diagnostic testing; may transport specimens; receives/records tests results, notifies physicians of test results; may stock work areas; may order supplies and manage inventory; works on special projects; may perform secretarial duties; keeps records and files; prepares reports/correspondence; performs other related duties as required.

Knowledge, Skills and Abilities:

●Experience and commitment to outstanding customer services skills

●Knowledge of the principles and practices of physician/clinical office management

●Knowledge of medical terminology

●Insurance pre-certifications

●Charge entry

●Outstanding interpersonal skills as well as strong oral and written communication skills

●Ability to operate standard office equipment

●Ability to multi-task, manage and prioritize workflow

●Strong organizational skills and attention to detail

●Computer experience including electronic medical record

●Date entry

Required Qualifications:

●Demonstrated experience with outstanding customer services skills

●1-2 years physician office experience in welcoming patients, check in/checkout process and overall clinic preparation/support

●Strong administrative experience such as word processing and data base management (ie, Outlook, Microsoft Word, Excel,)

●Education and training experience that could reasonably be expected to provide the knowledge, skills and abilities listed above

Preferred Qualifications:

●Customer service training/experience

●Infertility physician office experience

●ObGyn physician office experience

●Specific computer program knowledge (ie, MISYS GUI, and RESource or other EMR)

●Understanding process of physician office billing (receiving the encounter to the charge entry and ICD9/CPT coding)

Schedule:

Generally the work week would be Monday thru Friday. Hours would be varied according to clinic needs (7:00am to 4:00pm), (7:30am to 4:30pm), (8:00 am to 5:00pm) or (8:30am to 5:30pm). The Center is opened 363 days per year. This position requires weekend and holiday rotation. Employees must be flexible to work in all 3 locations of CARS (Hartford, Farmington, and New London).

Position: Medical Assistant

Date posted: March 26, 2014

Position Description:

Responsibilities include but are not limited to:

●Patient flow activities and assistance with clinical exams and procedures related to all

●Reproductive Endocrinology office activities.

●Prepares and instructs patients as per protocol for basic diagnostic and screening procedures, treatments, specimen collections, etc.

●Performs phlebotomy, and other appropriate procedures, i.e., vital signs, etc. in accordance with protocols.

●Refers patients to appropriate physician/nurse staff when special needs are identified

●Documents activities/data in medical record

●Completes lab test requisitions, labeling, scheduling, and computer entry

●Participates in the implementation of protocol/care plans as appropriate; attends interdisciplinary meetings

●May participate in the collection of data and specimens as per protocols and QA requirements

●Orders supplies

●Equipment checks and follow-ups

●Prepares rooms and work areas for clinical and administrative use including stocking of rooms/carts, etc; inventories/orders/maintains equipment, supplies and patient education materials

●Maintains/performs medical record functions and documentation

●Performs other related clinical and administrative duties as assigned

Required Skills:

●Medical Assistant School Graduate

●Knowledge of medical assisting practices; strong organizational and interpersonal skills

●Strong oral and written communication skills ability to work under pressure in a rapidly changing environment

●Must have ability and skills to perform above duties

Preferred Skills:

●Minimum of 1 year experience in a hospital, medical facility or physician office setting (Ob/Gyn or women’s health setting ideal)

●Demonstrated proficient phlebotomy skills

●Computer skills

●Registered/certified Medical assistant

●CPR certified

●Experience in GUI/Mysis scheduling system

Work schedule:

Flexibility required based upon clinical needs. Hours generally are between 6:45 am to 3:45 pm weekdays; or 7:15 am to 4:15 pm; or 7:30 am to 4:30 pm and 8:30 to 5:30 pm as assigned. Rotational weekends and holidays. Must have the ability to travel easily between Farmington and Hartford offices if needed and other off site locations as requested.

Position: Ultrasonographer

FTE: Part Time/Per diem
Date Posted: 3.13.13

The Center for Advanced Reproductive Services (The Center) is seeking a part time ultrasonographer to meet the needs of its growing program. This is an excellent opportunity for dynamic and motivated individuals to work in a comprehensive state-of-the-art infertility treatment program which includes general clinical, in vitro fertilization (IVF), ambulatory surgery suite and/or third party reproduction.

Position Description:

Provides transvaginal and abdominal ultrasonography scans to reproductive endocrinology and infertility (REI-IVF) patients as well as ultrasound monitoring for patients going thru intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles.

Qualifications:

Requirements include:

● Current ARDMS registration required. ObGyn certification

● Minimum of 2 years OB/GYN or Women’s Health ultrasound experience

● Excellent interpersonal and customer service skills

● Effective written and oral communication skills

● Ability to multitask and focus on details

Preferred requirements include:

● Experience with follicular monitoring during IUI and IVF cycles

Schedule:

Qualified candidates must be available for flexible hours based upon patient care and clinical needs of a growing infertility treatment program. Hours are generally 7:30 am to 9:30 am, Monday-Friday. Rotational weekends and holidays included. Must be able to easily commute to our Farmington and Hartford locations

Position: Clinical Nurse

FTE: Full Time
Date Posted: 2.26.14

The Center for Advanced Reproductive Services (The Center) is seeking full time RN’s to meet the needs of its growing program. This is an excellent opportunity for dynamic and motivated RNs to work in a comprehensive state-of-the-art infertility treatment program which includes general clinical, in vitro fertilization (IVF), ambulatory surgery suite and/or third party reproduction.

Position Description:

Nursing positions at The Center are responsible for the clinical performance and evaluation of nursing care to patients/families seeking advanced reproductive services.Responsibilities include, but are not limited to: patient history intake/ assessment and preparation, medication administration, lab assessment/data collection, IVF and ovulation induction preparation and monitoring, procedure performance &/or assistance,phlebotomy, patient teaching, advanced telephone triage functions and some research functions.

The Center also provides procedure room nursing care including OR and patient recovery. Clinical functions include nursing liaison between patients, families and other health care professionals, maintenance of accurate records/documentation and performance improvement functions and other related duties.

Qualifications:

Requirements include:

● Current CT RN license

● Minimum of 1-2 years OB/GYN or Women’s Health nursing experience

● Excellent interpersonal skills

● Effective written and oral communication skills

● Ability to multitask and focus on details

● Ability to commute easily between Farmington Campus and other satellite/outreach offices as needed

Preferred requirements include:

● Reproductive Endocrinology and Infertility (REI) and/or IVF experience

● Labor and delivery (L&D) experience

● Phlebotomy skill

● IV start

● Care of the anesthetized patient

● Women’s health ambulatory experience

Schedule:

Qualified candidates must be available for flexible hours based upon patient care and clinical needs of a growing infertility treatment program. Hours generally 8:00am to 5:00 pm or 7:30 to 4:30 pm with some flexibility required Monday-Friday. Rotational weekends and holidays included.