The NJ Center for Fertility and Reproductive Medicine, LLC offers full range of State of the Art reproductive services. Patients have come from all walks of life and from many different states within the USA. An occasional patient will also come from as far away as Europe. Couples anywhere in the USA or Europe are able to call the office to set up a one-hour telephone consultation with Dr. Daiter for a second opinion or to see whether a visit and follow-up in New Jersey would be useful.

For additional information on any of the services that we offer, links to The NJ Center for Fertility and Reproductive Medicine's educational website www.infertilitytutorials.com are provided.

Specific procedures include:

· Bloodwork for hormone evaluation. more information

After obtaining a detailed gynecological and medical history, ovulation problems can further be assessed by bloodwork. The specific hormones evaluated are generally determined by the history and physical examination.

· Semen analysis  more information

A semen analysis is currently the best test to evaluate sperm. The three parameters of greatest value are sperm concentration (how many sperm), sperm morphology (the shape and appearance of sperm), and sperm motility (the percentage moving and sometimes with a characterization of the quality of motion).

· Hysterosalpingogram  more information

The hysterosalpingogram (HSG) is a radiologic test performed under fluoroscopic guidance by either a radiologist or an infertility doctor. The HSG requires a radioopaque distending media so that the cavity and fallopian tubes can be seen using xray. I offer to perform all of the HSG tests for my patients since it is not usually uncomfortable if done "properly." Alternatively, a sonohysterogram can be performed but these tests provide less information about the fallopian tubes.

· Postcoital test  more information

Reproductive Endocrinologists generally agree that sperm must be able to comfortably survive within the female partner's cervical mucus for ideal fertility rates during natural cycles and intercourse. The goal of the postcoital test is to assess the interaction between sperm and cervical mucus, and if a hostile relationship is discovered then intrauterine inseminations are usually suggested.

· Endometrial biopsy  more information

What is endometriosis? In endometriosis, cells that normally grow inside the uterus (womb), instead grow outside the uterus.
I usually suggest an endometrial biopsy of the uterine cavity if there is a strong suggestion of a luteal phase (progesterone) insufficiency problem after obtaining a menstrual history and examining other test results.

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Intrauterine inseminations can be suggested to treat mild male factor infertility or an abnormal postcoital test (abnormal sperm and cervical mucus interaction). The washed sperm sample is placed directly into the uterine cavity near the fallopian tubes so that the sperm has less barriers to cross and they may have a greater chance of fertilizing an egg within the fallopian tube.

· Sperm washing  more information

Sperm must be "washed" from the semen prior to intrauterine insemination because the semen contains molecules (called prostaglandins) that can cause the uterus to contract painfully and the semen also may have bacteria that could cause an infection.

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Irregular menstrual cycles (irregular periods) or no menstrual cycles (absent menses) are often due to ovulation dysfunctions and are a common cause of female infertility. Ovulation induction occurs when a woman takes medication to enable her to ovulate (release a fully mature egg). Ovulation enhancement attempts to produce multiple mature eggs within one given menstrual cycle.

· Clomiphene citrate (clomid)  more information

Clomid is a common "entry level" fertility medication, which induces ovulation in about 85% of women with an ovulation dysfunction. Compared to menotropins, clomid is much less expensive, it requires less monitoring with ultrasounds or bloodwork, and complications are far less severe.

· Menotropins more information

Menotropins can induce or enhance ovulation, and indications for use include ovulation induction when clomiphene citrate fails, mild male factor infertility, mild pelvic factor infertility, and unexplained infertility. Menotropin fertility medications tend to be very expensive, require frequent monitoring for safety, and have some significant complications.

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Hysteroscopy is a wonderful surgical technique that allows the operator to visualize the uterine cavity directly and then to introduce working instruments under direct view to accomplish surgical repair.

· Endometrial (uterine) polyps more information

Endometrium is the total collection of normal lining cells of the uterine cavity and when these cells overgrow into organized masses of tissue with their own independent blood supply these growths are endometrial polyps. These polyps usually can easily be removed at hysteroscopy and then sent out for pathologic diagnosis.

· Submucosal (uterine cavity) leiomyomata (fibroids) more information

Fibroids are overgrowths of smooth muscle cells that compose the muscular uterine wall. If a fibroid is bulging into the uterine cavity (submucosal), then it may become a barrier to embryo implantation. If a fibroid grows throughout the entire uterine wall, then it may interfere with blood supply within the uterus or to a developing embryo. Many fibroids do not seem to interfere with fertility so they should not be removed unless a reproductive problem has been identified and all other treatable causes for the problem have been assessed.

· Intrauterine adhesions (scar tissue) more information

Asherman's syndrome is the presence of scar tissue that has replaced normal endometrium inside the uterine cavity. Embryo implantation can be reduced or eliminated with this condition. Repair of the uterine cavity can most easily and most safely be accomplished with operative hysteroscopy, using either operating scissors or a resectoscope.

· Uterine septum more information

A wedge shaped defect at the top of the uterine cavity (fundus) is the result of incomplete resorption of this poorly vascularized tissue during development within the mother's womb (uterus). Embryo implantation in a septate uterus is usually thought to have a significantly higher chance of spontaneous loss (miscarriage), preterm labor or delivery, and abnormal fetal lie or presentation (such as breech). Repair with operative hysteroscopy is generally straightforward and usually very effective.

· Endometrial sampling more information

Sampling the endometrium to obtain a pathological diagnosis is sometimes necessary, and operative hysteroscopy is ideal if visualization of the sampled region is helpful in selecting the site to biopsy.

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Laparoscopy is another tremendous surgical technique that allows a surgeon to directly view the abdominal and pelvic cavities while introducing working instruments or laser energy to accomplish pelvic reconstruction or repair.

· Endometriosis more information

Endometriosis is the presence of endometrial tissue (glands and stroma that normally lines the uterine cavity) outside the body of the uterus. Endometriosis may be completely asymptomatic, but it frequently causes either infertility or pelvic pain (classically pain during the menstrual flow that becomes progressively more severe over time). Endometriosis can be effectively treated with improvement of fertility and reduction of pain using operative laparoscopy

· Pelvic adhesions more information

The abdominal and pelvic cavities are lined with a thin layer of tissue called peritoneum. When the peritoneum is damaged and cannot heal properly (possibly if there is an active infection, the blood supply has been compromised, or irritants such as char, foreign bodies or blood are present), this delicate tissue is replaced by a tough dense scar tissue. The pelvic scar tissue (adhesions) can disrupt the normal relationships between tissues in the pelvis and reduce fertility. These adhesions may be treated laparoscopically.

· Foreign bodies more information

Foreign bodies can be introduced into the pelvis through trauma or prior surgery. If they are causing a fertility problem or need to be removed, then they may often be removed laparoscopically.

· Ovarian cysts more information

Functional ovarian cysts are the structures in which eggs normally develop during the reproductive years. Abnormal nonfunctional or persistent ovarian cysts can cause chronic irritation to the pelvis, adhesions may form, and fertility may be reduced. These cysts can often be removed laparoscopically.

· Bleeding in the pelvis more information

The pelvis is an uncommon site for spontaneous bleeding, but hemorrhagic ovarian cysts and torn or torsed adnexal structures can bleed, sometimes significantly. If the woman is completely stable (hemodynamically), then laparoscopy may be considered to treat the bleeding sites.

· Peritoneal cysts more information

Peritoneal cysts (usually clear vesicles or blistered regions) may be encountered during laparoscopy. These cysts are thought to be a tissue response to chronic irritation within the pelvis. These cysts can easily be vaporized using a laser.

· Uterine leiomyomata (fibroids) more information

If a fibroid grows predominantly on the outside of the uterus and projects into the abdominal cavity, then it may outgrow its own blood supply causing degeneration or infection and possibly resulting in pain or uterine irritability. In pregnancy, fibroids tend to grow rapidly and may cause preterm labor or excessive pelvic pain.

· Blocked or damaged fallopian tubes more information

The fallopian tubes are the site of fertilization, the union of the sperm and the egg, in humans. Damage to these important structures can result in destruction of the delicate folds that line the inside of the tubes, occlusion (blockage) of the ends of the fallopian tubes, dilatation or distension of the tube with the presence of an inflammatory fluid within the tube, and adhesions or scar tissue around the tubes. Many of these problems can be repaired laparoscopically.

Ectopic pregnancy more information

A pregnancy that grows outside the body of the uterus is called "ectopic" or "out of place." Most of these ectopic pregnancies are located in the fallopian tubes and most of these tubal ectopic pregnancies can be treated laparoscopically when surgical treatment is required.

Treatment Options: In Vitro Fertilization
Indications for IVF

In Vitro Fertilization (IVF) is a set of procedures that involves the maturation and retrieval of multiple mature eggs from the ovaries, fertilization and embryo culture of these eggs within the laboratory, and a subsequent transfer of the embryos into the uterine cavity (womb). Overall, the success rates of IVF have dramatically increased over the past several years.

· Oocyte (egg) retrieval more information

Egg retrieval is a surgical procedure that is almost always performed using a transvaginal approach under ultrasound guidance. This approach allows eggs to be aspirated under direct ultrasound visualization, allows a very high percentage of the mature eggs to be successfully retrieved, is well tolerated by patients using only minimal anesthesia, and has very few complications.

· Embryology more information

The ongoing pregnancy rates with IVF have been rapidly and steadily increasing since the initial birth of Louise Brown (conceived during the first successful IVF cycle). Advances in cell culture technology and embryology lab procedures have contributed significantly to this newfound success that we all enjoy.

º Intracytoplasmic Sperm Injection (ICSI)
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Assisted fertilization using Intracytoplasmic Sperm Injection (ICSI) has allowed a high percentage of mature eggs to be fertilized with sperm that is alive but may otherwise not be able to accomplish fertilization. With ICSI, sperm is placed directly into the egg's cytoplasm to fertilize the egg (initiate egg activation and the formation of the male and female pronuclei).

º Preimplantation genetic diagnosis (PGD)

Preimplantation genetic diagnosis is a powerful laboratory technique that allows embryos to be screened (checked) for specific diseases, major chromosomal abnormalities, or male versus female chromosomes prior to replacing the embryo into the uterus. PGD requires the removal of a cell from the developing embryo and the subsequent analysis of this cell's genetic material (its DNA).

º Culture of embryos up to blastocyst stage

We are pleased whenever the embryo's quality allows laboratory culture up to the blastocyst stage, which usually occurs about five days after egg retrieval, since blastocysts are more likely to result in a pregnancy. The reason for this increased pregnancy rate is not clear, but may be due to natural selection of the best quality embryos (only the top embryos are able to survive to the blastocyst stage in the laboratory). It is also true that in natural spontaneous pregnancy cycles fertilized eggs remain in the fallopian tubes for several days and then normally enter the uterus at the blastocyst stage, so blastocyst transfer at IVF is closest to what happens naturally.

· Embryo transfer more information

An embryo transfer procedure is the use of a sterile embryo catheter to place fertilized eggs into the uterine cavity so as to allow for subsequent implantation and the development of a normal pregnancy.

· Cryopreservation of embryos

Supernumerary (extra) embryos are able to be snap (instantly) frozen in liquid nitrogen (an extremely cold fluid), where they are essentially preserved indefinitely. When desired, the frozen embryos can then be thawed and transferred into a uterine cavity to allow for another attempt at conception.

These brave "real life" stories present examples of the kind of care that Dr. Daiter provides for his patients.