We are proud to offer a wide range of fertility treatments to our patients. From the simple monitoring of ovulation and sperm production, to the more detailed studies of the reproductive tract utilizing sonohysterogram, FemVue, hysteroscopy, hysterosalpingography, and laparoscopy, we assist our patients in every step they take towards overcoming the infertility problem. The advanced technologies of sperm and embryo freezing through cryopreservation; intrauterine insemination; ovulation induction; superovulation; egg retrieval; in vitro fertilization (IVF); and embryo transfer are performed here. Our clinic is able to offer donor sperm and donor eggs to infertile patients. We provide an intermediate-level of infertility care. We refer difficult cases that require intra-cytoplasmic sperm injection (ICSI), embryo biopsy (preimplantation genetic screening, PGS), or egg freezing to clinics in Tacoma, Seattle, and Bellevue.
At Olympia Fertility, we try to identify the specific cause for infertility, and correct that problem. A cost effective approach is individually tailored to each patient, after medical history is discussed and reviewed. We may evaluate ovulation and semen production by home monitoring for an LH surge, pre and post-ovulatory ultrasound, a post-coital test, a mid-luteal serum progesterone, and semen analysis. Any abnormalities of these tests are addressed and corrected. If all are normal, we may proceed with evaluation of the uterus and oviducts using an anti-chlamydia antibody test, sonohysterogram, FemVue tubal patency test, hysteroscopy, hysterosalpingogram, or laparoscopy. Fertility is primarily determined by egg production, sperm production, and an open path between them.
Those cases that prove resistant to the usual therapies of ovulation induction and direct intra-uterine insemination often proceed to advanced therapies. Superovulation with intrauterine insemination can be attempted with normal oviducts for mild endometriosis, mild male factor infertility, or infertility of unknown causes. If there is tubal damage, moderate-to-severe endometriosis, severe male factor infertility, or failure of other therapies, we may suggest IVF.
Some patients will become pregnant quickly; others will conceive after some effort and persistence; some will never conceive. We always use our best judgement to recommend appropriate therapies to patients, presenting them with all the information and likeliest productive course of treatment for their needs.
Preconception advice that applies to all patients would be to initiate your care at Olympia Fertility with a screening for rubella (German measles), varicella (chicken pox), and HIV (the AIDS virus). Vaccination against rubella and varicella prevents birth defects by protecting the conceptus from viral infection. The other advice we give to all patients attempting to conceive is to take a prenatal vitamin every day. It should contain at least 0.8 mg folic acid (folate); 4 mg if you or a near relative has had a child with anencephaly, spina bifida, or encephalocele. Daily folic acid supplementation reduces the risk of neural tube defects if taken preconceptually and during early pregnancy.
Finally, try to maintain a near ideal body weight. Being too thin or having inadequate body fat (<18% Body Mass Index) causes ovulatory problems. Being too heavy or having excess body fat also disturbs ovulation. Avoid running more than one mile per day. We recommend walking, swimming, calisthenics, aerobics, or other muscle toning exercises.
What We Do
Infertility treatment is a series of diagnostic tests and interventional therapies, hopefully culminating with the end result of pregnancy and a baby. Our "basic work-up" is to perform a semen analysis and monitor ovulation. A post coital test is then performed to assess how the spermatozoa are being received around the time of ovulation. We may perform ultrasound exams before and after ovulation to visualize follicular development and release of the egg. Adequacy of the luteal phase is assessed with a midluteal serum progesterone test. All other tests and interventions are based upon this "basic work-up".
If there is an obvious problem with ovulation, it is treated with ovulation induction. Clomiphene fertility pills are usually tried first. Luteal phase defects may simply be supplemented with luteal progesterone. If ovulation and an adequate luteal phase are not achieved, letrozole tablets or low dose human menopausal gonadotropin (HMG) injections may be utilized.
An impaired semen analysis or poor post coital test may result in a suggestion of intrauterine insemination as the treatment of choice. Severe male factor infertility may require IVF or donor sperm. A urology consultation at the University of Washington or at Oregon Health Sciences University is recommended for those hoping to improve semen quality.
Intrauterine insemination (IUI) is sometimes used to bypass the cervix. It delivers more motile sperm into the uterus and and tubes than intercourse alone. Intrauterine insemination is appropriate for inadequate cervical mucus, moderately decreased sperm counts, and low volume ejaculates
Sperm freezing preserves live spermatozoa indefinitely. Individuals vary in the percentage of spermatozoa that survive freezing and thawing. We have utilized this technique to create a small sperm bank. It allows us to perform inseminations or IVF when a husband or partner is out of town, or when donor sperm that has been purchased is not yet ready to use. We have also provided this service to men with cancer before they undergo chemotherapy.
Donor sperm is often utilized for severe male factor infertility. We suggest picking a donor who physically resembles your husband or partner. We have a limited supply of sperm available at our office; usually, these are extra samples purchased by patients who no longer need them. Our embryologist, Dr. Cai, can provide patients with extensive and current lists from several sperm banks. These specimens are shipped frozen to us, and stored in liquid nitrogen tanks in our laboratory.
The Path Between
A history of pelvic inflammatory disease, or long-standing infertility with normal ovulation, normal semen analysis, and normal post coital test may require early evaluation of tubal patency with an anti-chlamydia antibody test, the FemVue tubal patency test, hysterosalpingogram, or laparoscopy. Endometriosis is suggested by painful periods, or pain during intercourse. Laparoscopy is required to evaluate endometriosis and plan appropriate care.
The anti-chlamydia antibody test is a blood test for immunoglobulin (IgG) against Chlamydia trachomatis. It suggests "significant" past exposure to a venereal disease that scars the oviducts internally and externally. A negative test result is reassuring that the tubes have not been damaged by infection.
Sonohysterogram is an ultrasound technique that places a balloon-catheter inside the uterus, and instills saltwater. The water assists in visualizations of endometrial polyps and endometrial fibroids. Endometrial polyps and fibroids are thought to increase miscarriages, and are removed prior to further fertility treatments.
FemVue is a saline-air device, which can test tubal patency using ultrasound. The FemVue syringe creates bubbles in saltwater, and with ultrasound the bubbles can be seen passing through normal tubes.
Hysterosalpingogram (HSG) is an X-ray procedure performed in the hospital. Radio-opaque dye is pushed through the cervix via catheter. HSG helps to delineate abnormalities of the uterine cavity and the tubal lumen. It is useful for the diagnosis of blocked tubes and hydrosalpinx.
Hysteroscopy is an in-office procedure, where a flexible telescope is inserted through the cervix to view the endometrial cavity. This diagnostic approach is used to confirm endometrial abnormalities seen during a pelvic ultrasound, sonohysterogram, or hysterosalpingogram. Endometrial polyps and intracavitary fibroids are usually removed at St. Peter's Hospital using general anesthesia and operative hysteroscopy.
Laparoscopy visualizes the pelvic organs with a telescope through the umbilicus. It requires a hospital operating room and an anesthesiologist. The abdomen is first filled with carbon dioxide gas to create an open space in which to work. A tubal dye test can be performed during laparoscopy, and each tube inspected for free flow of tinctured saline. Adhesions and endometriosis, which impair tubal pickup of eggs from the ovary, are best diagnosed and treated with laparoscopy.
Advanced Reproductive Technology (ART)
Superovulation with intrauterine insemination is appropriate for couples with open tubes, who have been unable to get pregnant by simpler treatment. Typically, mild endometriosis and infertility of unknown cause respond well. We utilize a microdose-Lupron protocol with human menopausal gonadotropin (HMG) and recombinant FSH (r-FSH). The microdose-Lupron provides an initial release of FSH from the pituitary and later prevents the occurrence of a premature LH surge. Two intrauterine inseminations are usually performed on these cycles; one before and one after the expected time of egg release. Progesterone is supplemented at 25 mg intramuscularly each day from luteal day 3 until the pregnancy test. The pregnancy rate of this therapy has been 20% in women under 35 years of age.
In vitro fertilization (IVF) is used when tubes are not patent, or the patient has not gotten pregnant by other therapies.
Natural cycle IVF has the advantage of not requiring expensive drugs for ovary stimulation. When pregnant by natural cycle, there is little risk of multiple births because only one embryo is transferred. The downside of this approach is that it requires nearly as much work to obtain and grow one embryo as it would to obtain and grow multiple embryos. In about 15% of natural IVF cycles we do not even get an egg. Only half of fertilized eggs will develop into healthy blastocysts. When one blastocyst is transferred, the pregnancy rate is about 40% in young women. The overall pregnancy rate from natural cycle IVF is about 15% per initiated cycle. This procedure is restricted to women who are under 35 years of age.
Stimulated cycle IVF is more reliable than natural cycle IVF. We almost always obtain multiple eggs and transfer multiple embryos. The pregnancy rate per each cycle attempted is about 30-50%, depending on the patient's age. These cycles are more expensive because of medication, ultrasound, and laboratory costs. There is also a higher chance of twins or triplets.
Freezing embryos may be necessary to preserve extra embryos from a stimulated IVF cycle. These embryos can be transferred at a later date, after hormonal preparation of the uterus.
Donor eggs may be obtained from willing donors on natural or stimulated cycles. The recipient's uterus needs to be prepared hormonally, so as to be receptive when the embryos become available. When possible, friends and family make good egg donors. We also maintain a list of individuals willing to share or donate eggs at a low cost. For an index of available egg donors, please ask to see the list of egg donors at our office.
The Use of Foreign Gonadotropin for Infertility Treatment
Our clinic does not endorse nor condemn the use of gonadotropin hormones from overseas for use in infertility care. Foreign supplies of gonadotropin have traditionally been less expensive than domestic sources. Our goal is to simply clarify terms and synonyms related to gonadotropins for our patients.
There is basically one activating gonadotropin; it is called follicle stimulating hormone (FSH). FSH is available in a variety of purities.
Human menopausal gonadotropin (HMG) is actually a 50:50 mixture of FSH and luteinizing hormone (LH). It is usually purified from the urine of post-menopausal women.
Urinary FSH (u-FSH) is a purification of HMG that uses an antibody extraction to remove almost all LH.
Recombinant FSH (r-FSH) is a follicle stimulating hormone produced in tissue culture by special cells. It is entirely free of LH.
Different manufacturers give these preparations different names in different countries. The following list provides many of these different "trade names".
HMG: Pergonal, Humergon, Repronex, HMG-Lepori, Menogon, Menopur
u-FSH: Metrodin, Fertinex, Fertinorm, Fertiform, Bravelle
r-FSH: Gonal-F, Follistim, Puregon
It is technically illegal to obtain equivalent medications from overseas because the overseas versions have not obtained Food and Drug Administration (FDA) approval. Clinically, overseas medications perform well for infertility treatment. Currently, there has been no report of any unusual side effects that have been attributed to foreign equivalents. The FDA has been lax in the confiscation of medications carried by travelers for their personal use. This is likely to avoid ugly border scenes and bad press. Periodically, the FDA has enforced a ban upon the mail-order importation of these medications, but is currently permitting these shipments.
Our patients must weigh the ethics, costs, and risks in choosing to buy foreign or domestic gonadotropins. We have simply chosen to help our patients, regardless of the origin of their medications.
The tools that assist Dr. Moruzzi to diagnose and treat infertility include ancillary services such as ultrasound, blood chemistry, and an embryology laboratory. All of these services are located within Olympia Fertility for the convenience and efficient care of our patients. All services are intended to be affordable, because our patients are usually paying out-of-pocket.
Some patients may elect to utilize outside ancillary services. That is, they may choose to obtain ultrasound, blood chemistry, or embryology tests elsewhere. If patients choose to do so, the results must be reported to Dr. Moruzzi in a timely manner, and a small interpretation fee may apply. The use of outside ancillary services will not prejudice the medical care given to a patient. You will generally find that our fees for ancillary services are lower than or equal to those charged elsewhere for infertility patients.
Additional medical services are available on a cash-pay basis by Olympia Fertility. Any reimbursement we receive from a patient's insurance company for these medical services will be applied to their account, but insurance write-offs will not be accepted by Olympia Fertility, since we have no contractual agreement with any insurance provider.
Vaccinations: The price for vaccinations will include the cost of the vaccine and an administration fee of $15. (If you donate the cost of a vaccination to an indigent patient, we will administer that vaccine to her for free, i.e. no administration fee.)
Annual Examination: These exams include a review of past medical records, a thorough review of current health, a complete physical exam, usually a pelvic ultrasound, a summation conference, prescriptions and referrals, as needed, for outside testing or consultation. The fee for these services is $220.
Our pricing of procedures is close to cost. Usually, infertility care is not covered by insurance, or is poorly reimbursed. Any insurance payments we receive will be applied to your bill, but the balance will be transferred over to you. Olympia Fertility is not contracted with any insurance provider, and does not accept insurance write-offs.
Services will be terminated when there is an outstanding balance of over $1,000, and will not resume until the balance has been paid to under $500. Advanced payment is required for in vitro fertilization (IVF).
Provisions may be considered for low income patients on a case-by-case basis, but monthly payments will still be required.
If your medical condition requires IVF, but you cannot afford the cost of this procedure, we may be able to arrange egg sharing. By this arrangement, half of your eggs would be sold to another couple that desires pregnancy, and they will pay for your gonadotropins and lab work. If you are interested in sharing eggs, you will need to fill out a medical questionnaire.