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Infertility eNewsletter Fall 2012


Virtual Consults with Cleveland Clinic Infertility Specialists Now in Canfield

Cleveland Clinic’s infertility specialists are now on call via telemedicine in Canfield. For Youngstown-area patients who struggle with infertility, virtual consultation provides convenient, quality care without making the drive to Cleveland.

While an on-site physician assistant facilitates the visit in Canfield, Cleveland Clinic’s infertility expert Julie Tan, MD, consults with the patient via securely connected digital cameras and sophisticated communications technology. The consultation includes a thorough patient history, assessment and review of information before the patient receives a recommendation for further evaluation or treatment.

We help streamline the scheduling of further evaluations or procedures at one of our Fertility Center locations throughout Northeast Ohio, including main campus, and the family health centers in Avon, Beachwood, Solon, Strongsville and Twinsburg. The consultation provides the patient with assistance in finding the appropriate fertility-related care. Cleveland Clinic’s fertility centers offer a complete range of infertility services, including a state-of-the-art In Vitro Fertilization (IVF) Laboratory. Male infertility consultations with Edmund Sabanegh, MD, are available at the Center for Male Infertility at Cleveland Clinic’s main campus and Beachwood Family Health and Surgery Center.

Additionally, Cleveland Clinic Canfield telemedicine patients have streamlined access to a host of other services, including radiologists for imaging, licensed acupuncturists, and mental health professionals trained for stress relief and support.

Cleveland Clinic’s gynecology program is the best in Ohio, and U.S. News & World Report has ranked it No. 3 in the nation for 2013. Medical Economics magazine has also praised the program, naming it one of eight U.S. Clinical Centers of Excellence in Infertility.

If patients are interested in scheduling a telemedicine appointment in Canfield, they can call 216.444.2240. For additional information about Cleveland Clinic in Canfield, patients can call 330.533.8350. Cleveland Clinic’s Canfield facility is at 3736 Boardman Canfield Road.


Andrology Lab at Richard E. Jacobs Health Center in Avon Helps Couples Conceive

According to recent data, the population of men and women of reproductive age is expected to grow. Some of these individuals will experience infertility issues. To address those concerns in the western suburbs of Cleveland, Cleveland Clinic’s Richard E. Jacobs Health Center in Avon now includes an Andrology Laboratory and Reproductive Tissue Bank.

Director Ashok Agarwal, PhD, says the state-of-the-art facility has performed more than 150 tests since it opened on June 1. The male fertility lab offers testing including microscopy, sperm processing, semen biochemistry and sperm function tests.

“We conduct a large number of tests, mostly by semen analysis, to discover whether there are abnormalities in the semen,” says Dr. Agarwal. “Based on those results, the physician can decide on further advanced testing or treatment for the patient. Certain advanced tests allow us to detect functional defects in spermatozoa that are associated with specific conditions, genital tract infection, idiopathic infertility or unexplained recurrent failure of in vitro fertilization.”

Among several microscopy tests, the facility offers computerized semen analysis, the leukocytospermia quantitation/Endtz test and strict criteria morphology classification. Sperm processing tests include density-gradient sperm washing. Sperm function tests include semen oxidative stress profile, reactive oxygen species, the total antioxidant capacity test and DNA damage testing.

The facility also offers sperm banking and long-term storage by cryopreservation.

Patients who undergo testing at the Andrology Laboratory and Reproductive Tissue Bank can consult with Milton Lakin, MD, an internist with specialty interest in male fertility, or main campus urologist Edmund Sabanegh, Jr., MD, for male fertility issues. For female fertility issues, Julie Tan, MD, offers consultations, treatment and intrauterine insemination.

A multidisciplinary teamwork approach and collaborative efforts help to resolve infertility and achieve pregnancy. “Not many places in the country have been able to form the very close partnership that we have at Cleveland Clinic,” says Dr. Sabanegh. “Our success is realized through a seamless collaboration that puts our patients first.”

For more information or to refer a patient to Cleveland Clinic's Andrology Laboratory, call 216.444.8182.


Cleveland Clinic’s Harboring HopeSM Fund Gives Prospective Parents a Second Chance

The reality of In Vitro Fertilization (IVF) is both hopeful and discouraging for many patients. Although the process often successfully brings joyful couples the family they’ve hoped for, it is also expensive for many patients. This is especially true for couples whose first round of IVF has failed.

The cost of IVF, usually greater than $15,000, is often too high for prospective parents, especially because only 20 percent of patients have insurance coverage for this treatment. For the one in six couples who require medical intervention to conceive a child, the costs related to IVF can be prohibitive and heartbreaking.

But there’s hope.

Cleveland Clinic’s Harboring HopeSM Fund offers qualifying couples grants, based on select financial and clinical criteria, to proceed with a second cycle of IVF. The goal of the fund is to provide as many grants as possible to qualified couples needing a second round of IVF. Couples may also reapply for the grants if they are not selected initially. The fund coordinates with referring obstetricians to provide the best, full-service care.

If you have a patient who would be interested in applying for a grant or wish to learn more about the Cleveland Clinic Harboring HopeSM program, please call 216.839.2929.


Cleveland Clinic’s IVF Lab Has Its Eye on Embryos with New EmbryoScope

Cleveland Clinic’s IVF lab at the Beachwood Family Health and Surgery Center is now one of only 10 labs in the United States and the only lab in Ohio with the EmbryoScope™ (Unisense® FertiliTech) used to continuously monitor embryo development from conception to time of transfer. The device will open up a whole new area in understanding embryo development, allowing staff to identify new grading criteria for embryo selection.

This high-tech device allows the incubation of up to 72 embryos at a time–12 from each of six patients. A built-in camera provides automated and continuous time-lapse imaging of fertilized oocytes without disturbing their environment.

Because data suggest that the timing of variables such as pronuclear formation, syngamy, early cleavage, compaction and cavitation are indicators of an embryo’s developmental potential, this device will provide embryologists the ability to evaluate these variables at many more time points. As the IVF lab and physicians gather more information about the early development of the embryos and the resulting pregnancies, they can add to the grading criteria for selecting embryos with the best implantation potential.

A novel benefit for patients is that they can receive a CD showing the cleavage of all their embryos prior to implantation and witness the development of their baby from the very beginning.

The device has already resulted in several successful pregnancies for Cleveland Clinic patients.


Research Offers New Hope for Preserving Fertility in Cancer Patients

Infertility is a significant complication of cancer treatment because many treatments can substantially damage or destroy a young woman’s reproductive system. Understanding that this is often a major concern, Cleveland Clinic has given considerable attention to the long-term reproductive health of women of childbearing age undergoing cancer treatment.

In an effort to offer new hope for preserving fertility, Nina Desai, PhD, HCLD, Director of IVF and Clinical Research, and colleagues have developed a mouse model for maturing enzymatically isolated preantral follicles suspended three-dimensionally in a tyramine-based hyaluronan (HA) hydrogel culture system.

Whereas a conventional culture system limits the growth of the follicle, forcing granulosa cells to attach to the surface of the culture and abandon the oocyte, the HA culture system more closely mimics the follicles’ natural growth conditions without disrupting the complex interactions between somatic cell components and the oocyte that are necessary for cytoplasmic and nuclear maturation.

Dr. Desai and her team tested several encapsulation methods and HA gel concentrations and examined the ability of HA-embedded follicles to mature in vitro and produce mature metaphase II oocytes.

The investigators were able to develop mature eggs with apparently normal meiotic spindles, suggesting the eggs could go on to normal fertilization and embryonic development, which will be the second stage of the research.

The study was recently published in the journal Reproductive Biology and Endocrinology.