SIU’s Fertility and IVF Center celebrates five years of helping couples
Written by Rebecca Budde • Photography by Jason Johnson
In 2009, the large, empty bulletin board in SIU’s new Fertility and IVF Center begged to be filled. SIU had always had an interest in reproduction and infertility (read article), but had never had an official Center. Now, five years later, the board is a tapestry of holiday greetings, thank-you notes and birth announcements of hundreds of babies born to couples who sought the assistance of the fertility experts at the Center.
This spring, the Center celebrated five years of helping couples start their families. In that time, the Center has maintained and been recognized for superior quality patient care and a state-of-the-art embryology laboratory. These make SIU’s Fertility and IVF Center the preferred option for couples dealing with infertility. Since its opening, the patient population has tripled and patients travel from the nearby states of Missouri, Indiana, Tennessee and Ohio and from as far as Europe, Mexico and South America to have a chance at having a baby.
Jay and Ann Gemberling of Springfield became patients in 2011 after trying to conceive on their own for a year. "Everyone in the Center is just what patients need - they’re so reassuring," Ann says. "Dr. Loret de Mola talked to me about every detail. He said he wanted me to know how much my body was going to go through and he’d be with me all the way."
Collaboration among all members of the Center’s team - physicians, nurses, embryologists, counselors and nutritionists - is stronger than ever. They meet together for an hour at noon every day to review, discuss and plan for each patient in their care. The comprehensive, multidisciplinary team approach to patient care provides each patient - mother, father and fetus - with the best possible individualized attention.
All nurses working in the Center are certified reproductive endocrinology and infertility nurses. The American Society for Reproductive Medicine has designated the Center as a Nursing Center of Excellence, an achievement only a handful of fertility centers in the country can claim, according to J. Ricardo Loret de Mola, MD, medical director of the Fertility & IVF Center and professor and chair of the Division of Ob/Gyn. "Instead of two sets of eyes, our patients get twenty sets of eyes looking over every detail," he says.
Consideration of the smallest detail in the lab makes the IVF Center the perfect environment to produce the healthiest embryos for each couple. Directed by Mary McAsey, PhD, associate professor of ob/gyn, the Center’s embryology laboratory is accredited by the College of American Pathologists (CAP), which was begin in the early 1960s. The US federal government recognizes the CAP Laboratory Accreditation Program as being equal-to or more-stringent-than the government’s own inspection program. Achieving these levels of recognition takes continual effort. "We are constantly monitoring ourselves to maintain the highest quality in our lab," Dr. McAsey says.
Hard work and dedication keep these beneficial pieces of the Center unchanged, while advanced technologies and an expanded list of available procedures provide patients with a better continuum of care. Physicians can now perform diagnostic procedures at the Center that once had to be done at a hospital. "Our continuum of care - work up, diagnosis, treatment - means the patient doesn’t have to repeat herself three or four times because here she sees the same people each time for her care," Dr. Loret de Mola says.
For those who do not benefit from surgery or other treatments, the Center offers in vitro fertilization (IVF). "The goal of any good IVF practice is to have a single, healthy pregnancy," says Jim Kontio, senior embryologist. "It’s an extreme amount of stress on the mother and fetus to go through a multiple pregnancy and birth." Pregnancies and births of multiples also lead to more prenatal and pre-term labor costs, as most of the babies spend their first days in the neonatal intensive care unit. In addition, studies show that children who are born pre-term have more medical problems throughout childhood.
"The state-of-the-art tools we have allow us to make better choices to transfer a single embryo and have a healthy baby at the end of the process," Kontio says.
The Gemberlings had a successful IVF with the transfer of one embryo, and Ann gave birth to a daughter, Maycee, in November 2012. The Gemberlings froze the remaining three embryos and plan to add to their family in the coming months.
Read about the beginning of SIU’s Fertility and IVF Center in the article “Families in the Making” from aspects, volume 32-2.
UNDER THE MICROSCOPE
Though it’s common knowledge that it takes two to have a baby, many wrongly assume that fertility issues stem from reproductive problems with the woman. Many women undergo fertility treatments only to find out, after many unsuccessful attempts, that the issues result from problems with their partner. Approximately one-third of infertility is attributed to the female, one-third to the male and one-third by a combination of issues in both or is unexplained, according to the American Society for Reproductive Medicine. For the men who need fertility treatment, Tobias Köhler, MD, associate professor of urology, specializes in male infertility at the Center.
For men in question, the IVF lab technicians use a computer-assisted semen analysis microscope. Using the microscope and computer software, the lab team can produce a more objective analysis of the motility, size, shape and number of sperm. This provides a more standardized approach for determining the quantity and quality of the sperm, allowing physicians and lab technicians to choose the healthiest sperm to fertilize the eggs.
Once an egg is fertilized, patients must wait a few days before the embryo is transferred. Another emerging technology soon to be implemented at the Center is time-lapse imaging of the embrysos. As the embryos develop for three to five days in an environmentally controlled incubator, fiber optics capture its growth and development. An innovative software system then applies an algorithm to the digital data regarding timing and changes captured by the imaging of the embryos. "Using this technology as the new standard of care will help us know more about the possibility of the embryo establishing a healthy pregnancy and baby outcome through IVF," Kontio says.
THE GENETICS OF INFERTILITY
The pieces that put us together, our DNA, can play a large role in fertility. Women age 35 or older comprise a large sector of those seeking fertility treatments. Their advancing years not only decrease their chances of getting pregnant, but also increase their chances of chromosomal abnormalities resulting in miscarriage(s) or birth defects. Sometimes younger patients experience miscarriages and seek out genetic testing for answers. They may learn that they carry or have a family history of certain genetic conditions that they could pass on to their children. Genetic screening of the mother, father and/or tissue from miscarriages can sometimes help determine the cause.
In addition to offering genetic testing to patients, the Center soon will be able to offer pre-implantation genetic diagnosis (PGD) to help put future parents’ minds at ease while helping them have a successful pregnancy.
PGD tests embryos for specific genetic differences. "If we know a couple is at high risk to have a child with a chromosome abnormality, we can use PGD to find embryos that have healthy chromosomes and implant those," SIU genetic counselor Heather Glessner says. "If both members of a couple are carriers of a recessive disease, they have a 25 percent chance of each baby having the condition. Again, we can use PGD to test the embryos and determine which ones are unaffected."
Glessner is a certified genetic counselor offering counseling for prenatal and reproductive risks and also counseling for personal or family history of known genetic conditions. She is one of a team of three genetic counselors at the School - the only board-certified genetic counselors in the region. In the future, the team hopes to begin a preconception consultative practice for all patients interested in having genetic testing prior to becoming pregnant.
After the embryologist safely takes a sample from the embryo, it is sent to a lab for analysis. While awaiting the results, the embryos are frozen. Results indicate which embryos carry the mutation and which ones do not and are therefore more likely to produce a successful pregnancy and healthy birth.
Sometimes, however, all the embryos are affected. "Though it’s difficult for the patients, it can bring closure and allow them to move on to the next step," Dr. Loret de Mola says. In these cases, Glessner helps the couple weigh their options of continuing with in vitro fertilization with PGD, finding a sperm or egg donor or adopting.
The Gemberlings feel lucky to have the IVF Center so close to home. "I remember after the embryo transfer they wheeled me past that bulletin board with all the pictures of the babies, and it gave me such hope," Ann says. "I send a Christmas card every year; and soon, I hope our card will have a picture with two children."