Your Fertility Forum

You are ready to consider becoming a parent, but need help. Every story is unique and every fertility journey is yours alone. Maybe you need help because you have been actively trying to become pregnant or have had pregnancies which ended in pregnancy loss. Maybe you need help because you are currently unpartnered and ready to be a parent or in a same sex relationship. Maybe you need help because you have low ovarian reserve and want to preserve your fertility. Maybe you need help because you have endometriosis or polycystic ovarian syndrome (PCOS). Maybe you need help because you need donor eggs or a gestational carrier. Whatever your story, at FORA we are here for you.

At Fora, we believe in tailored education and personalized care. After a complete fertility assessment and consultation, we will customize a treatment plan that is right for you and your family goals. Fertility treatments provided at FORA include ovulation induction, intrauterine insemination (IUI), INVOcell, In vitro fertilization (IVF), preimplantation genetic testing (PGT), donor egg IVF, gestational surrogacy, reproductive surgery, and more. Your fertility, your family, your way. At FORA, our goal is to help you achieve the family of your dreams in your forum, on your terms.

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Ovarian Reserve

Women are born with all of the eggs (oocytes) we will ever have. Over time, women spend these eggs, and when we reach a certain critical threshold, that’s when we undergo the menopause.  Reproductive lifespan, or the time remaining to complete a genetic family, is therefore dependent in part upon the number of eggs a woman has remaining (also called ovarian reserve).

There are two main ways to assess ovarian reserve: AMH (Anti-Mullerian Hormone) and AFC (Antral Follicle Count). AMH is a blood test of the hormone that comes from the remaining eggs, and results do not vary widely with menstrual cycle. AMH decreases over the lifespan as the number of eggs decreases. AFC (Antral follicle Count) can be done in office as part of an ultrasound at the new patient visit. Although the egg itself is microscopic, the follicle that houses the egg is visible on ultrasound. Counting these antral follicles gives an estimation of ovarian reserve. AFC also decreases over the lifespan as the number of eggs decreases.

At FORA we will provide AMH and AFC as a part of your fertility assessment and discuss these results with you to tailor a treatment plan.

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Ovarian Reserve

While women are all born with a similar number of eggs, some reproductive age women have fewer eggs than would be expected by age alone. This is called diminished ovarian reserve (DOR). Reasons for DOR can include genetics, autoimmune disease, prior surgical and medical treatments (e.g, ovarian surgery to remove cysts for endometriosis, chemotherapy for cancer) and environmental toxins (such as smoking).

Having DOR is not a cause of infertility. However, DOR can limit the amount of time a woman has to complete a genetic family. DOR can also limit expectations in any given treatment cycle since ovarian reserve correlates with the number of available eggs for a cycle. Unfortunately, women are often told that having low ovarian reserve means that they are not candidates for using their own eggs for fertility preservation or fertility treatment. While expectations on a per cycle basis may be lower, and while it may take more than one cycle to achieve goals, having DOR does not preclude a woman from pursuing fertility treatments with her own eggs.

Dr Skillern has a special interest in diminished ovarian reserve, and has been involved in basic science research to better understand the underlying genetic reasons for DOR.  She has helped many patients grow their genetic families who had previously been told that their DOR made that impossible.

At FORA, we will discuss your ovarian reserve parameters and realistic expectations with you. Taking into account age, family goals, and other factors, we will make a decision along with you about your best course of action in the setting of DOR.

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Induction and IUI

Ovulation Induction (OI) is when medications (pills such as clomid or letrozole) are taken to help a woman develop one or more eggs for ovulation. All OI cycles include ultrasound monitoring to evaluate ovarian response to optimally time ovulation with intercourse. OI can help women with anovulation (such as those with PCOS, polycystic ovarian syndrome) ovulate in a predictable and regular fashion in order to time intercourse. 

Ovulation induction can also be combined with intrauterine insemination (IUI) to help treat mild male infertility or for unexplained infertility. With OI/IUI, a sperm sample is collected at the time of ovulation and processed into a highly concentrated specimen. The IUI procedure is simple involving passage of a small guide through the cervix, and placing sperm directly into the uterine cavity.

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AT FORA, our physicians were involved in some of the initial trials of INVOcell in the United States and we are thrilled to offer this option to our patients.

INVOcell is a lower cost, lower complexity version of IVF. INVOcell is also called “in vivo fertilization” since this technology allows sperm and eggs to meet inside the female body rather than inside the laboratory. INVOcell involves ovarian stimulation with a minimal stimulation medication protocol, limiting potential side effects from medications. Ultrasound monitoring helps to determine when eggs (oocytes) are ready for collection. These mature eggs are then mixed with sperm and placed in the INVOcell device which is inserted into the vagina for incubation so that the sperm and egg can meet and form embryos. After vaginal incubation for 5 days, the INVOcell device is removed and the best embryo is selected for transfer into the uterus. Any remaining embryos will be frozen for future embryo transfers.

Patients are now benefiting from INVOcell technology over the traditional approach of intrauterine insemination. INVOCELL often results in achieving pregnancy in a shorter period of time for an overall lower treatment cost.  However, INVOcell is not perfect for all people, and a complete fertility consultation and evaluation will help identify couples who could benefit from treatment with INVOcell.

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IVF (in vitro fertilization) has the highest success rate of any available fertility treatment. During IVF, a woman takes hormone injections over the course of approximately 2 weeks, while being monitored with blood work and ultrasound in the office to evaluate egg (oocyte) growth. Once eggs are at a mature size, they are collected and fertilized with sperm in the lab to create embryos (future babies). The goal is then to grow (culture) embryos in the lab until they reach the potential implantation stage, called the blastocyst stage. At the blastocyst stage, most often embryos are sampled for genetic rearrangements which would make them unable to form a baby, and thus, unsuitable for embryo transfer. This testing technology is called PGT-A or preimplantation genetic testing for aneuploidy. Embryos found to have the correct chromosomal complement with PGT-A (called euploid embryos) have the highest chance of becoming a baby upon embryo transfer. Under certain circumstances, embryos may also be transferred to the uterus without such testing or frozen for later transfer to the uterus.

PGT-A has also revolutionized options for those looking to plan for a future family. This process, called embryo banking, allows patients to create and preserve euploid embryos as part of a family building strategy. Patients who are embarking on their fertility journeys but who desire more than one child can benefit from creating, testing, and preserving embryos for the future. IVF is also the process by which we fertilize donor eggs to create embryos We also use this technology to create embryos for patients which require a gestational carrier to complete their families.

At FORA, we understand that IVF can seem like a challenging process, so we are here for you every step of the way. Dr. Skillern’s experience as an IVF Director means that your IVF protocol and journey will be specifically tailed to your body and your goals. At FORA, we also provide the option of our concierge injection service to make your IVF journey easier.

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Egg Donation

Sometimes women have a combination of DOR and age related aneuploidy (percentage of abnormal eggs which increases with age) or have failed prior treatment cycles using their own eggs. In these cases, egg donation (ovum donation) can become an alternative family building strategy. Egg donation is the process of obtaining eggs from egg donors, who are healthy women between the ages of 21-30, and thus have higher numbers of eggs and lower percentages of abnormal eggs. These eggs are then fertilized, and a resulting embryo transferred to a woman’s uterus to affect a pregnancy.

Family building with donor eggs can sometimes seem like a daunting task. That is why we at FORA have partnered with Simplify Egg Bank to simplify this process for our patients. A multi-ethnic donor population, concierge patient care, and guaranteed PGT-A chromosomally normal (euploid) embryo for transfer are only some of the reasons FORA celebrates this collaboration.

Dr Skillern also has a special interest in egg (oocyte) donation as a family building option She has authored peer reviewed articles on the ethics of eggdonation and has presented at numerous invited speaking engagements in support of her interest.. With her guidance, FORA has composed a world class team to assist you through the egg donation experience. At FORA, we know there are many pathways to a family, and egg donation is one option that we are poised to discuss further should the need arise

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