1. James S. Heiner, MD Reproductive Endocrinologist Reproductive Care Center Sandy, Utah Exploring Family Building Options 801-878-8888

2. Topics to Discuss Exploring Exploring Family Building Options - help is available!

3. Exploring The Goal The Plan The Experience  Discovery– so much to learn  Surprises – so much can happen The End Result

4. Exploring Family Building It can be daunting  Overwhelming Where do you start?  Frightening Will it work?  Exciting Maybe it will work!

5. Exploring Family Building It can be challenging  Time  Money  Emotions  Learning  Uncertainty  Persistence

6. Exploring Family Building A good guide can help in the journey  Board Certified Reproductive Endocrinologist  Three years of formal training in infertility after 4 years of OB/GYN training  Two years to gain experience and pass examinations

7. Exploring Family Building As you begin or continue your exploration, remember:  Be optimistic  Be realistic  Be together and unified  Be determined and persistent  Be satisfied that you have done your best

8. Exploring Family Building Examples of two couples who had the experience of exploring family building.  Couple 1-unsuccessful but kept a positive attitude and had a good experience  Couple 2-persistent and succeeded in an unexpected way

9. Exploring Family Building Learning from others can help make your own exploration easier and more enjoyable, even though the journey is different for every couple.

10. Options Sex Fertility pills Injections Inseminations In vitro fertilization Other advanced techniques

11. Options-Sex SEX  You should keep having sex!  Many couples seem to forget this one while they’re so busy looking at other options. Worse yet, they learn to dread it!  Sex is good for fertility, for togetherness, for unity, and for fun!  Good therapy after a hard day at the clinic (or after a good day at the clinic!)

12. Options-Fertility Pills Pills to help the woman ovulate  Clomid  Femara Injections to help the woman ovulate more  FSH to stimulate more egg development  hCG to trigger ovulation

13. Options-Injections Injections to help stimulate ovulation  FSH is a natural hormone  FSH requires close monitoring  FSH is expensive  FSH can be used with or without ovulation induction pills  hCG can be used will pills or injections to help assure and time ovulation

14. Options IUI - Intra Unterine Insemation IVF - In Vitro Fertilization ICSI - Intracytoplasm Sperm Injection TESE -Testicular Sperm Extraction AH - Assisted Hatching PGD - Pre Implantation Genetic Dx.

15. Options- IUI IUI- Intrauternine Uterine Insemination  Minimal increase in the chance of pregnancy, but cost effective Increases the chance of conception from 8% to 11% per cycle, in a typical couple with unexplained infertility  It can be used with or without medications for ovulation induction

16. Options- IUI  IUI Takes of couple of hours to prepare the sperm for the IUI Usually costs a few hundred dollars Simple and relatively painless

18. Options- IVF IVF-- In Vitro Fertilization  More expensive than basic treatments but also much more likely to result in a pregnancy in each cycle attempted Pregnancy rate typically >50% in young women in good centers

19. Options- IVF IVF  Eggs are stimulated with FSH, and retrieved under sedation using a transvaginal, ultrasound guided needle  Eggs are fertilized with sperm and the resultant embryos are incubated for 2-6 days then transferred into the uterus

23. Options- ICSI ICSI- Intra cytoplasmic Sperm Injection  Revolutionized the ability to fertilize eggs using sperm with problems  Greatly increases chance of pregnancy when moderate to severe sperm problems exist

24. Options- Assisted Hatching AH- Assisted Hatching  Laser is used to put a small slit in zona pelucida (egg shell)  This makes it easier for the embryo to hatch out later on  Used primarily when the zona is thicker than normal, after embryo freezing, in cases of advanced maternal age, or when prior IVF cycles have failed

26. Options- TESE TESE- Testicular Epididymal Sperm Extraction  Used in cases where no sperm come out in the ejaculated semen  Male hormones and other tests done to be sure TESE is appropriate

27. Options- PGD PGD- Pre implantation Genetic Diagnosis  Used primarily to prevent the transmission of genetic diseases to the next generation Cystic fibrosis, Sex potential of embryo, Help gender balancing in a family

28. Options- Third Party Third party options for building your family  Donor Sperm  Donor Eggs  Donor Embryos  Gestational Surrogates  Traditional Adoption

29. It usually works– but what if it doesn’t? Was it still worth the journey? Can you still keep exploring? Can you still be happy?

30. Conlusions slide Mountain view with name, phone number of clinic Reproductive Care Center 801-878-8888 Sandy, Utah