Reproductive Endocrinology and Infertility

Center for Advanced Reproductive Medicine (CARM)

The main goal of Center for Advanced Reproductive Medicine is providing the comprehensive fertility service with the state-of- the-art reproductive technology that encompasses both diagnostic and therapeutic services. Our faculty and staff acknowledge the importance of successful infertility treatment, and strive to achieve the highest pregnancy rate utilizing the latest reproductive techniques of ovulation induction, artificial insemination, and in vitro fertilization. The Fertility Preservation Program and Preimplantation Genetic Diagnosis (PGD) Program are the new programs that only CARM can offer in Kansas City.

1. Ovulation Induction (OI):
   Ovulation induction has been developed to treat patients with ovulatory dysfunction. Nevertheless, ovulation induction or controlled ovarian hyperstimulation (COH) has become an integral part of  most infertility treatment including IUI and IVF. The most frequently using medications for OI are clomiphene (oral) and gonadotropin (injection).
   
   
2. Intrauterine Insemination (IUI):
   IUI has been utilized as a form of infertility treatment for a long time, in particular for male factor infertility. IUI procedure include ultrasound monitoring of follicular development (with or without ovulation induction medications), sperm preparation, and placing washed sperm into the uterine cavity with a thin plastic catheter.
   
   
3. In Vitro Fertilization with Embryo Transfer (IVF- ET):
   Beginning with the first birth in 1978, IVF-ET has become a mainstay of infertility treatment the world over. To date, approximately a million babies were conceived by IVF procedure. The chances for success through IVF-ET have steadily increased over the past decade to the point where fewer embryos are needed in an embryo transfer procedure to give high odds for a pregnancy to occur as a result. In fact the pregnancy rate in patients under 35 years old is over 50%
   
   IVF-ET requires the female partner to receive a series of injections of potent fertility drugs, which cause her ovaries to produce several ripened eggs at the same time as opposed to just one in a normal, unmedicated menstrual cycle. Ripened eggs are retrieved from the ovaries under light sedation by an intravaginal aspiration process under the ultrasound guidance. A semen specimen is obtained from the male partner, and eggs and sperm are combined in the IVF laboratory. In anywhere from 3 - 6 days, embryos developing from this process are evaluated, and some are selected for embryo transfer. Embryo transfer (ET) involves loading selected embryos into a thin, flexible plastic tube, which is gently passed through the opening in the cervix leading to the interior of the uterus. The embryos are expelled into the uterus, and the plastic tube withdrawn. In about 12 days a blood test for pregnancy is performed to see if the procedure was a success.
   
   
4. Preimplantation Genetic Diagnosis (PGD):
   Preimplantation Genetic Diagnosis has been in existence for over 10 years, but only in the last three or four years has it become an increasingly sought-after means to evaluate human embryos in vitro. PGD is designed to evaluate either the genetic or chromosomal status of early stage embryos in vitro. Indications for PGD include recurrent pregnancy loss, known heritable disorders (Duchenne Muscular Dystrophy, Cystic Fibrosis, Tay Sachs Disease, Sickle Cell Disorder, X-linked disorders...), advanced maternal age, prior birth of a child with Down syndrome, determination of the sex of each embryo.

KU Fertility Preservation Program

The Fertility Preservation Program at KU is established to provide the service for cancer patients who desire to preserve fertility before gonadotoxic cancer treatment. This is the first Fertility Preservation Program in the region and perhaps the third in the US.

Aggressive cancer treatment can cause gonadal failure. Where the risk of gonadal failure is high with chemotherapy and radiotherapy, it is wise to attempt to safeguard the fertility before treatment. To date, there are a few options for fertility preservation including sperm banking for men, GnRHa, oophoropexy, freezing of embryos, oocytes, and ovarian tissue for women, but most of theses options except sperm and embryo cryobanking are still experimental.

Cryopreservation of embryos is a well established technique, but it cannot be an option for the patient who cannot delay cancer treatment or who does not have a partner. The technology of oocyte freezing has been improved last 2-3 years, and the live birth rate per transfer after 2005 is above 30% in some centers. A new strategy, involving transplantation of stored ovarian tissue, may be effective for reinstating fertility as well as restoring hormonal function for women facing premature ovarian failure. We are one of the few centers in the world that has expertise and experience in ovarian cryopreservation and transplantation.

Andrology/Endocrine Laboratories

All Andrology laboratory tests are available including semen analysis, strict sperm morphology, viability staining, post vasectomy check, anti-sperm antibodies, semen cryopreservation , semen preparation for Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF), sperm identification and cryopreservation during sperm aspirations, donor sperm storage and processing.

Endocrine laboratory services are also available upon receipt of a physician’s order and a properly labeled serum sample. Available laboratory assays are ß hCG, estradiol, follicle stimulating hormone, luteinizing hormone, progesterone, prolactin, DHEA-S, 17- alpha hydroxy progesterone, testosterone.

Reproductive Surgery

Advanced Reproductive surgery is available including microsurgical tubal reanastomosis (tubal reversal), robotic assisted myomectomy (removal of fibroid tumor), laparoscopic cystectomy, laser surgery of endometriosis, hysteroscopic surgery. In addition, our well trained and experienced surgeons can provide reconstructive surgery for congenital anomalies of genital organ such as uterine septum (wall inside the uterus), bicornuate uterus (uterus with two horns), or vaginal agenesis (absence of vagina).

Reproductive Endocrinology

All endocrine disorders related to reproduction or reproductive organs can be managed by our doctors who have subspecialty training in Reproductive Endocrinology. The common endocrine disorders in the clinic include Polycystic Ovary Syndrome (PCOS), Hirsutism (excessive male pattern hair growth), Amenorrhea (no menstruation for more than 6 months), Dysfunctional Uterine Bleeding, Hyperprolatinemia (elevation of prolactin hormone that is produced from pituitary gland in the brain), Premature Ovarian Failure (early menopause before the age 40).