Published in UAB Insight, Summer 2007
Comprehensive approach, latest technology, decades of experience
The UAB Division of Reproductive Endocrinology and Infertility (REI), an internationally recognized referral center for complex reproductive problems, offers a full spectrum of diagnostic tools and innovative treatments for infertility, says Division Director Cynthia K. Sites, MD.
UAB’s REI infertility services use the latest, most innovative reproductive endocrinology technologies. These include evaluation of female and male factor infertility; treatments, such as ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF) and donor egg IVF; and infertility surgery (laparoscopy, hysteroscopy, and laparotomy). UAB infertility experts also can offer additional procedures to increase the likelihood of an IVF pregnancy: assisted hatching, surgical sperm aspiration, intracytoplasmic sperm injection (ICSI), blastocyst stage embryo transfer, preimplantation genetic diagnosis (PGD), and ovarian tissue cryopreservation.
“UAB REI specialists assess patient’s needs comprehensively to determine the best treatment for each individual or couple,” says reproductive endocrinologist John A. Lucas, MD, director of UAB’s IVF program. “Infertility can be a complex puzzle to solve, and we can address every issue in-house. Patients benefit from convenience, physician consultations, and the combined experience of outstanding endocrinologists, urologists, geneticists, fetal maternal specialists, and the most experienced embryologist in the region.”
All of UAB’s REI clinicians are board-certified in obstetrics and gynecology and reproductive endocrinology, and the division participates in National Institutes of Health-funded research to advance the field. In addition to Sites and Lucas, Richard E. Blackwell, PhD, MD, specializes in women’s medicine and menopause.
UAB IVF: Longstanding Success
Infertility affects more than 6 million US women and their partners — about 10% to 15% of women of childbearing age. The condition is treated most often with conventional therapies such as medication or surgical procedures. Only a small number of couples need advanced fertility treatment such as IVF, but for some it offers the only hope for pregnancy. “IVF is the most successful offering for infertile couples based on its chances for pregnancy in any single cycle,” says Sites.
UAB’s IVF program is the oldest in the state and one of the most successful programs in the Southeast with an excellent success rate. The first IVF birth in Alabama occurred at UAB. “A woman younger than 35 has a 52% chance of live birth in one IVF cycle at UAB (2006 statistics), Sites says. “At age 42 years or more success rates are less than 5% nationally with the woman’s own eggs.” UAB offers a donor egg program, and couples can use a family member’s egg or an egg from an anonymous donor located by UAB.
UAB embryologist Phillip A. Kretzer, ELD, has more than 20 years experience. He helped pioneer the first successful IVF pregnancy and the first ICSI pregnancy in Alabama. “His ability to identify viable eggs and healthy mature sperm from the testes and epididymis in difficult infertility cases cannot be matched,” Sites says. “We maintain a very respectable success rate while accepting extremely challenging cases,” Kretzer says.
Many couples’ first step is intrauterine insemination. Kretzer and colleagues designed a specialized sperm processing media with customized components that results in impressive IUI outcomes.
For couples with more challenging issues, Kretzer’s experience paired with cutting-edge technology can make a difference. “Imaging technology few programs in the United States have enables us to noninvasively assess a living oocyte at the chromosomal molecular level. We can determine the location of the meiotic spindle and perform ICSI without damaging it, which is vital to proper chromosome alignment and division within the oocyte and developing embryo. Our Zilos laser can ablate the zona pellucida to facilitate embryo biopsy, identify defects in the zona without compromising the egg or embryo, and assist hatching. It is one step toward helping patients isolate and overcome their fertility barriers,” Kretzer says.
UAB also offers blastocyst stage embryo transfer, in which a 5-day-old embryo is placed in the uterus. Using the more developed embryo results in a better chance of pregnancy for some patients than a typical transfer and reduces the possibility of multiple pregnancies.
In addition, UAB has the most comprehensive male factor infertility program for IVF in Birmingham. The most common correctable abnormality is a varicocele, which UAB surgeons treat with microsurgical varicocele ligation.
Some causes of male infertility will require advanced reproductive technologies. UAB’s success rates in cases of azoospermia and oligospermia, the most common male infertility factors, are at or above the national average. The most significant advance in treating severe male infertility is IVF with ICSI. (For more on male infertility, see Insight Summer 2007 issue story "Evaluation and Treatment of Male Factor Infertility")
Reducing Risk of Genetic Disease
For couples at risk for specific genetic disorders caused by mutations of a single gene, the option of selecting unaffected embryos prior to IVF is more acceptable than alternatives. “Our PGD program can reduce risk of many genetic abnormalities, including life-threatening single-gene disorders and chromosomal translocations for patients at known risk for genetic disease,” Lucas says.
Ovarian Tissue Cryopreservation
In 2006 UAB started Alabama’s only Institutional Review Board-approved ovarian tissue cryopreservation program for girls and women at risk of premature ovarian failure as a result of cancer treatment. Clinicians laparoscopically collect ovarian cortical tissue, which may contain hundreds of primordial follicles, screen it for cancer to eliminate any risk of reintroduction, and freeze it. Once the patient is cancer free, the tissue is transplanted to the outer surface of the remaining ovary. This technology, still in its infancy, has succeeded in restoring hormone production, as well as pregnancies in cancer survivors (N Engl J Med. 2005;353[3]:318-321) and (Lancet. 2004;364[9443]:1405-1410).
For more information
Dr. Cynthia Sites
Dr. John Lucas
Dr. Richard Blackwell
Phillip Kretzer, ELD
1.800.UAB.MIST
mist@uabmc.edu
Montgomery UAB Obstetrics and Gynecology
UAB’s Obstetrics and Gynecology physicians’ office in Montgomery offers fertility consults, monitoring and follow-up, high-risk pregnancy consults, first trimester screening, and gynecological oncologic consults. Nurse practitioner Della Fuller, CRNP, is in the office full-time. On Mondays a reproductive endocrinologist and fertility specialist consults on fertility and reproductive issues as well as menopausal, hormonal, and other endocrine system problems. On Thursdays a maternal-fetal medicine subspecialist is available to consult on high-risk pregnancies and perform first trimester screening for genetic defects for private patients. A gynecological oncologist is available on Fridays. Office hours are Monday-Friday, 8 AM-5 PM. To make an appointment or for more information, call 334.288.2727 or 877.314.2727.