How do I become an egg donor?

Egg donation is an excellent, medically appropriate therapy to help women achieve pregnancy. Who is a Qualified Candidate?

Egg donors give a couple the opportunity to experience pregnancy, childbirth, and most importantly, the chance to build a family. Criteria to be an egg donor candidate include:

• Healthy female
• Normal ovarian reserve and no indication of impaired fertility
• Between the ages of 21 and 30

Egg Donation
Before becoming an egg donor, a candidate receives a complete health evaluation by a fertility specialist. Penn Fertility Care’s team of specialists offer a full range of egg donation services all in one convenient location. Egg donors receive generous compensation.  Please note that donors will remain anonymous throughout the process.


How to Become an Egg Donor
A woman interested in becoming an egg donor candidate can make a confidential inquiry by visiting PennMedicine.org/donor-egg to complete a screening form, or contact Penn Fertility Care at 800.789.PENN or 215.615.4218.

What do I do with Unwanted Hair?

Laser hair removal has become a common cosmetic procedure performed for women, as well as men, who have unwanted facial and body hair. Laser hair removal is commonly done on the upper lip, chin, ear lobe, shoulders, back, underarms, abdomen, buttocks, pubic area, bikini area, thighs, face, neck, chest, arms, legs, hands, and toes.

The process involves using a focused beam of light of a specific wavelength designed to selectively target the pigment in the hair follicle. When the laser beam is absorbed by the pigment (melanin) in the hair follicle heat is generated, and the ability of the follicle to produce a hair is disrupted. Because these lasers target pigment, traditionally, light skin and dark, coarse hair have been the ideal combination. Newer lasers are available for patients with skin of color. Its safety and effectiveness is highly dependent upon the skill and experience of the person operating the laser, along with the choice and availability of the appropriate laser equipment at the center, which is performing the procedure.

Tips for Healthful Dining

There are many ways to watch calories. Here are a few that may work for you.

1. If you are going to dine at a restaurant or attending a party, have a healthful snack, such as a cup of light yogurt or a piece of fruit, before leaving home. If you are less hungry when you arrive at the restaurant/party, you are more likely to make careful choices. 
2. Eat your calories, don't drink them. Choose low calorie beverages, such as sparkling water, diet soda, or sugar-free iced tea, rather than beer or mixed drinks with alcohol, which can have hundreds of calories per serving.
3. If there is a buffet, look over the entire buffet table. Consider all of your choices before making your selection.
4. Try the plate method of meal planning: half a plate of low calorie vegetables; one-fourth plate of lean protein foods (about the size of a deck of cards); and one-fourth plate of starchy foods (a cup--about the size of a woman's fist).
5. Eat mindfully. Enjoy your food slowly; savor the aromas, flavors, and textures of special treats.
6. If you are attending a party, rather than staying near the food, take a seat across the room and focus on the guests and the conversation.
7. When you are the hostess, provide a selection of healthful choices for your guests: vegetables, fruits, and lean protein foods. When you are the guest, ask the hostess if you can bring a healthy dish to share with the other guests.

Roasted Veggies

Ingredients:

4 to 6 small zucchini, cut into ¾ inch chunks
1 large or 2 small (3/4 pound total) sweet onion(s), cut into ¾ inch chunks
2 large yellow and/or orange bell pepper, stemmed, seeded, and cut into ¾ inch pieces
3 tablespoons olive oil
¼ teaspoon kosher salt
Freshly ground black pepper
Six 5- or 6- inch sprigs fresh rosemary or 2 Tbsp dried rosemary

Directions:
Preheat the oven to 375
degrees. Have a large roasting pan ready for use. Combine the zucchini, onions and bell pepper pieces in the pan. Add 2
tablespoons of the oil; season with salt and pepper to taste, then toss to coat them. Add the remaining tbsp. of oil as
needed. Place the sprigs of rosemary on the vegetables then continue to roast foranother 20-25 minutes,
or until vegetables are tender and lightly browned. Discard the rosemary sprigs and any loose rosemary
leaves. Transfer to a large bowl, serve warm or at room temperature.
Recipe serves 6

Low Fat Chicken Caesar Salad

Ingredients:

1 Large head of Romaine Lettuce, torn
2 cups chopped,cooked, skinless chicken-breast
1 cup fat-free or low fat croutons
¼ cup freshly grated parmesan cheese

Dressing:

1/3 cup plain non-fat yogurt, drained (or fat-2 free mayonnaise)
2 tsbp fresh lemon juice
1 tsp olive oil
1 tsp white wine vinegar
1 tsp anchovy paste (optional)
1 tsp Worcestershire sauce
1 garlic clove,crushed

Preparation:

Arrange torn Romaine lettuce in a big serving bowl. Top with chicken, croutons and sprinkle with cheese.
Whisk dressing ingredients together and drizzle over salad. Gently toss until combined. Add freshlyground black pepper to taste. Serves 4

Per Serving: Calories 188,
Calories from Fat 39, Total Fat
4.5g (Sat 1.5 g), Cholesterol
54mg, Sodium 328 mg,
Carbohydrates 11.3g, Fiber
2.3g, Protein 25.9g

Depression in women with PCOS

Depression is a common mood disorder with significant impact on daily life. Approximately 5% of the general population is dealing with depression at any given time. Women are twice as likely to suffer from depression as men, although men are less likely to get help. Depression may be related to experiencing a major life event such as a loved one’s death, or not situational and may recur over the course of an individual’s life.Major depressive disorder causes many symptoms that result in an inability to function in daily life in contrast with feeling “sad,” or “down in the dumps.” People experiencing major depression cannot simply “lift themselves out of it,” and usually require psychotherapy and/ or medication to feel better.

Depression and Women

As many as one in four women will suffer from depression throughout their lifetime,and often will experience it during the childbearing years, during pregnancy and within the first year after delivery.Deborah Kim, MD, a Psychiatrist at Penn Center for Women’s Behavioral Wellness and Assistant Professor of Psychiatry in the Perelman School of Medicine states, “If a woman is experiencing prolonged sadness guilty feelings, hopelessness or low self esteem,she may be suffering from depression or an anxiety disorder.”

Depression and PCOS

Depression, anxiety and eating disorders often occur in women with PCOS. A 2005 research study of 206 women conducted by Anuja Dokras, MD, PhD and Elizabeth Hollinrake, MD found that 35% of women with PCOS had depression. The study found that women with PCOS are more likely to develop depression or depressive symptoms. Dr. Dokras noted that depression in PCOS patients is significantly associated with both high body mass index (BMI) and insulin resistance. This may have some correlation with the psychological and metabolic effects of obesity. Women with PCOS often have abnormal levels male
hormones such as testosterone but there is no clear evidence to link these to depressive symptoms.

Another possible contributing factor to depression is that women with PCOS often struggle with the physical symptoms of the disorder such as weight gain, acne, increased facial hair and hair loss. These symptoms can often lead to feelings of frustration, lack of control over one’s appearance and isolation. Whatever the cause, both Drs Kim and Dokras believe that PCOS women should be treated with a holistic approach. Women with depression and anxiety disorders show improvement when treated with psychiatric medications and to some extent, with a healthy diet and exercise program, nutritional supplements and stress management. Weight loss also helps reduce insulin resistance.

Women with PCOS should be screened regularly for depression and anxiety. According to Dr. Dokras, "Between 50 and 70 percent of women who are treated for depression recover completely, so this is an important target population that we should be both screening and treating." If you are experiencing some of the physical signs of depression (depressed mood, loss of motivation, insomnia, overeating, sleeping
too much and not eating) and feel that you are very overwhelmed with PCOS, you may benefit from seeing a therapist with experience in reproductive issues, infertility or women’s health.

The Penn Center for Women's Behavioral Wellness is a collaboration between the Departments of Psychiatry and Obstetrics/Gynecology in the Perelman School of Medicine at the University of Pennsylvania. The center provides clinical consultation and treatment, as well as opportunities to participate in research focusing on conditions related to women’s behavioral health across the lifespan.

When is it Time to See a Fertility Specialist?

Many women wonder what the right amount of time is to wait before seeing a fertility specialist.
 

At a glance, follow these general guidelines to determine when the time is right:

• Women under age 35 unable to conceive after a year of unprotected intercourse.
• Women age 35 and over and unable to conceive after  six months of unprotected intercourse.
• Women who have lost two or more pregnancies to miscarriage.
• Women with a history of irregular ovulation/menstrual cycles.
• Men with a low sperm count, poor motility (movement), or poor morphology (structure).
• Men, women or both who have health conditions affecting reproduction or when other infertility treatments  have not been successful.
 
One in seven couples experience infertility, but today there are more options to conceive than ever before, and Penn Fertility Care is ready to help you get started. 

Fitness Tips during the Summer

From Kristen Dowell, Fitness Instructor and Personal Trainer

The long days and warm weather is a welcome change for those of you who rely on walking as your main source of exercise. You can  safely navigate the streets without fear of slipping on ice, and without  the extra prep time needed to arm yourself with the endless layers of clothing, and of course, tissues! Walking is an easily accessible (and free!) form of exercise, and it can be an effective tool for increasing your level of fitness. However, at some  point during your walking career you are bound to hit a plateau when you no longer see the results you once enjoyed. When this happens, there are 3 categories of adjustments you  can make to your routine, each one of them having the ability to rev up your results:

1. Adjust the frequency. This one is a no-brainer. If you typically walk twice a week,
add a third session. To prevent boredom, research other routes. Visit local parks outside of your neighborhood, if you’re used to walking at a track, switch things up and try the town.

2. Adjust the duration. If your legs have been traveling the same
distance walk after walk they are begging for change! Sneak in an extra 10 minutes each day,
or challenge yourself once a week and double your mileage.

3. Adjust the intensity. This is the category in which you can get the most
creative. If you don’t have the extra time in your week to tackle #1 or #2 above,
then you must work smarter during the time you have.

Here are a few ways to spice up the jaunts:

• Grab a stopwatch and prepare to break up your walk into timed sections:Let’s say you typically walk for 30 minutes. This time walk at your normal pace for 40 seconds,and then speed up your pace for 20 seconds. Repeat this over the course of the entire trip.

• Get inclined! Adjust your route so that the same 30 minutes contains more hills than usual.
• If you’re feeling brave, center the entire session at the base of one large hill or staircase.

• Count how many times you can go up and down the hill in those 30 minutes. Try the same route in a month to see if you have improved.

•      Play! When was the last time you skipped down the street? If it’s been a few decades, you’re missing out! This activity might be best done at a walking/jogging track or park where uneven sidewalks aren’t a safety hazard. Substitute your regular gait with measured bouts of skipping, galloping, side shuffles or backward walking. These fun substitutions will wake your muscles from their boredom and burn more calories in the same amount of time.

Even with the implementation of the above changes, you will eventually hit another plateau.
Never fear! Refer back to the above list and make another tweak to the frequency,
duration, or intensity.

No matter your strategy, be sure to include a warm up period in the beginning of the walk.
Here you travel at a slower pace and allow the muscles to prep for the workout ahead.
And whatever you do, be sure to allow time at the end to adequately stretch the lower body.
Lengthening the muscles after they’ve been working will help prevent soreness, and the
increased flexibility will make your next walk that much more enjoyable!

Happy Exercising!

Kristin Dowell

We are interested in IVF and the gestational carrier program, but have many questions. Can you help?

Piero asks: Hi we are an Italian couple, I'm 45 and my wife is 39. We already have a 9-year-old daughter and we wish to have one more child, but due to asherman syndrome (endometrium adhesions that partially close the uterus cavity) my wife cannot carry the baby. We have good gametes from several test results and so we want to use our eggs and sperm, excluding any donors. We are interested in IVF and the gestational carrier program. Is there list of fees and costs? What is included and what is not (for ex. medicines, ultrasound, etc)? Our interest, obviously, is to keep down costs, still looking at quality of services and success rate, is there any chance? How many oocytes do you normally obtain with stimulation and how many embryos with IVF? Also, how many embryos do you transfer to the carrier per time? Waiting for your answer, ciao.

Samantha M. Pfeifer, MD responds: Success of IVF is dependent on the age of the woman. The number of eggs obtained depends on the woman's age and her ovarian reserve. We like to have more than 5 follicles present after stimulation to go through the egg retrieval process. The average 39 year old woman will get approximately 5-10 eggs, unless there is a decreased ovarian reserve. Our program follows the American Society for Reproductive Medicine Guidelines for the number of embryos to transfer - on average 2-4 in this age group depending on fertility/reproductive history, quality of embryos, and stage of embryos (example: day 3 or 5 after retrieval).

Financial costs vary depending on your insurance coverage. Some insurances cover diagnostic services, ultrasound and blood work, while others may cover diagnostic services and procedures. The same applies for medications. Some insurance benefits cover medications and others do not. The cost is determined by the medication and the dose that is prescribed. At Penn Fertility Care we have financial counselors that will meet with you to review your insurance benefits and answer any questions related to your financial concerns.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Creating a Modern Family through Third-Party Reproduction

Fertility treatments have evolved considerably throughout the last 40 years. These advances are evident in the development of third-party reproduction options.

“Third-party reproduction, also called assisted reproduction, is a process where a person provides eggs, sperm or embryos to another person so that they may become pregnant,” says Anuja Dokras, MD, PhD, medical director of Penn Fertility Care’s in vitro fertilization program. “Another scenario includes surrogacy, where a woman provides her uterus to carry another woman’s baby to term. In vitro fertilization (IVF) is the most common treatment used to initiate this third-party pregnancy and involves implanting an embryo into a woman’s womb.”

“The third party’s assistance is limited to the reproductive process and does not involve raising the child,” explains Dokras. “This may not be a traditional method to have a baby, but these services have helped to build families around the world.”

When to Consider Third-Party Reproduction - Learn more...

Herb Dip with Raw Veggies

Makes six servings. Each with: 70 calories, 2 grams fat,
225mg sodium, 11 grams carbohydrate
1/2 cup plain nonfat yogurt
1/3 cup reduced fat mayonnaise
2 tsp dried dill weed
1 tbsp lemon juice
1 tsp dijon mustard
1 tsp honey
1/2 tsp garlic powder
6 cups raw carrots, bell peppers,
broccoli or cauliflower florets,
celery, cherry tomatoes, etc.

Whisk together all ingredients except veggies. Chill several hours to blend
flavors.

PCOS Summer 2010 Newsletter recipe

Fitness for Life

Fitting fitness into your life will reward you in many ways. Weight loss, increased energy,strength and endurance and a decrease in risk for diabetes, hypertension and heart disease are just a few of the great benefits of taking the time to  EXERCISE. There are 3 parts to every complete exercise program:

• Cardiovascular training
• Resistance training and 
• Flexibility exercises. 

It is recommended that cardiovascular training be done for 30 minutes most daysof the week. Walking is
one of the easiest ways to get regular cardiovascular exercise. Just dress in layers and head out of the door!
Start with 15 minutes and work your way up to 30 minutes. Maintain a pace that allows you to complete
the time, and use the Talk Test to determine your intensity. If you can sing asong then you will need
to work harder. If you cannot hold a conversation, then decrease your intensity.

• Resistance training may be done 2-3 times per week and exercises should cover all of the major muscle groups. Shallow squats over a chair, push ups on a kitchen counter, and some abdominal exercises on the floor or a plyo-ball will get you started and can be done in just a few minutes. 

• Flexibility exercises may be done daily and will help increase range of motion and decrease joint pain. Hold each stretch for 30 seconds or more. Put it all together by heading out for a walk, run through 1-2 sets of 10-15 repetitions of each resistance exercise then reward yourself with some relaxing stretching at the end. Getting started can be tough but with a little knowledge and patience you will be successful! 

Set realistic expectations and create a plan to keep progressing at an appropriate pace. Start slowly and work your way up to longer workouts with increased intensity. You’ll feel better first and the results will soon follow.  Enlist the help of a personal trainer or find a friend to partner up with and before you know it you will find yourself in the new habit of exercising regularly!

Vicki Amon is a degreed and nationally certified personal trainer with over 15 years of experience. She is the owner of Fit 4 You, Inc. Personal Training and strives to help her clients feel comfortable with their own individualized workouts while achieving great results!

www.fit-4-you.org
info@fit4youtraining.com

*PCOS NEWSLETTER SUMMER 2010

How can you get pregnant with low FSH?

Mary asks:How can you get pregnant with low FSH?

Penn Medicine responds:
We suspect you mean FSH (follicle stimulating hormone). Each person is different. To advise you properly, we would have to review your health history to get a complete picture of what is going on — i.e. other hormone values, weight loss, etc.

If you would like to have an evaluation, we would be happy to help. To schedule a consultation, please call 1-800-789-PENN (7366) or request an appointment online.

Treating Infertility Resulting from PCOS

Polycystic ovary syndrome, or PCOS, can be a cause of infertility, but there are treatments available to help women with PCOS become pregnant. PCOS occurs when the follicle, a small sac in the ovaries filled with eggs, doesn’t mature correctly and release an egg each month during ovulation. Irregular ovulation is a common cause of fertility issues.

Anuja Dokras, MD, PhD, director of the Penn Polycystic Ovary Syndrome Center, talks with FertilityAuthority.com about treatment options for women with PCOS who are trying to become pregnant, including:

• Medication management
• Minimally invasive surgery
• Weight management

Read the full article on treating PCOS.

Learn more about The Penn Polycystic Ovary Syndrome Center or request an appointment by calling 800-789-PENN (7366).

Do You Know the Symptoms of PCOS?

PCOS, or polycystic ovary syndrome, can be difficult to diagnose. It is not a disease but more a collection of symptoms that point to a common disorder. The symptoms vary in type and severity from one woman to another, but early diagnosis and treatment are important to control the symptoms that include:

• Irregular menstrual cycles
• Hypertension
• Infertility
• Insulin resistance/diabetes
• Obesity

Anuja Dokras, MD, PhD, director of the Penn Polycystic Ovary Syndrome Center, talks with FertilityAuthority.com about criteria for diagnosing PCOS and explains what the “cysts” really are.

Read the full article on diagnosing PCOS.

The Importance of Staying Fit When You Have PCOS

Women with polycystic ovary syndrome (PCOS) often have trouble maintaining a healthy weight. Obesity can worsen the symptoms of PCOS, so is important for you to eat a healthy diet, exercise regularly and keep your weight in check.

Anuja Dokras, MD, PhD, director of the Penn Polycystic Ovary Syndrome Center, discusses recent research findings about PCOS with FertilityAuthority.com and offers PCOS sufferers tips on what types of food to eat and suggestions for successful exercise routines.

Read the full article with Dr. Dokras http://www.fertilityauthority.com/articles/pcos-studies-highlight-diet-and-exercise

Financial Assistance for Fertility Treatments

Penn Fertility Care understands that some patients may have difficulty affording fertility treatment. The center offers full-time financial counselors to provide guidance on payment for services at any stage during the treatment process. Penn Fertility Care is a member of the Advanced Reproductive Care, Inc. (ARC) network.
Learn more...

Elizabeth's Story

"My name is Elizabeth and I gave birth at the age of 41 via in vitro fertilization (IVF) to a healthy baby girl at Penn Fertility Care at the Hospital of the University of Pennsylvania! I had two retrievals and four transfers. Multiple eggs were transferred the first three times and I had one egg left for the last one—it was a success! I remember asking the doctor if it was worth transferring just one egg, and she said of course!

I look at my daughter every day and still can't believe she is mine. I went through so much to have her and it was worth every bit of it. Never, never, give up!"

Are you a participating provider with United Healthcare?

Tina asks: Are you a participating provider with United Healthcare?

Penn Fertility Care responds: Yes, we do participate with United Healthcare and a variety of other insurance programs. Learn more about financial options at Penn Fertility Care:

To schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366) or request an appointment online.

If I donate will I still be able to have my own child?

Kriskat11 asks: If I donate will I still be able to have my own child?

Penn Fertility Care responds: Yes, even if you donate some of your eggs you can still have children of your own later in life. Penn Fertility Care has a donor egg program for those who are interested in donating. Learn more at pennmedicine.org/fertility/patient/clinical-services/donor-egg-program/.

To schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366) or request an appointment online.

At my age, is it possible to consider using an egg donor?

Kelly asks: I will be 45 this year and would like to have a baby with my new husband. I have a 14 year old and he has 2 children. Because of my age I am considering using an egg donor. Is that possible at my age? Thank you.

Monica A. Mainigi, MD responds: Many women in their 40's have children using in vitro fertilization with an egg donor. Whether at 45 this is a reasonable option for you depends on your health, your ability to carry a preganacy, and your partner's semen analysis. A fertility specialist could help assess whether egg donation is a reasonable option for you and help you with the process of selecting an egg donor and the egg donation process.

To schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366) or request an appointment online.

Is there a waiting list for embryo donation?

Deb asks: Is there a waiting list for embryo donation and if so how long?

Penn Fertility Care responds: Yes, currently there is a waiting list for the Donor Embryo Program at Penn Fertility Care. The list size varies so please contact us to determine if you are a candidate and what the current wait may be.

To schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366) or request an appointment online.

Is there an age cap for donor egg receipients?

Anna asks: Do you set an age cap for donor egg receipients? I have 3 biological children and another from embryo donation. However, I have suffered 7 miscarriages and want to use donor eggs.

Steven Sondheimer, MD responds: For most individuals, deciding to undergo fertility treatment is a difficult decision. This is especially true as one gets older. As each person is different, we meet with patients desiring fertility treatment and do a complete evaluation. This may include directing them to a counselor to help decide on a medical fertility treatment, meeting with a maternal fetal medicine specialist or meeting with a geneticist to help with the decision making process.

To schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366) or request an appointment online.

I have not received my information packet in the mail. Can you email me instead?

Marvin asks: I called about your Donor Embryo Program and was supposed to receive a packet of information in the mail. It has been three weeks and I have not received anything yet. Is there an information packet that can be emailed to me instead?

Penn Fertility Care responds: We are researching your request and would like to reach out to you directly. Please give us a call at (215) 662-6100 as this public forum does not provide us with your email address and contact information. You may also generate a new request for information by calling 1-800-789-PENN (7366).

To schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Are there any fertility treatments available over-the-counter?

Jennifer asks: I have been trying to get pregnant for almost a year now with no success. One person told me to start taking prenatal vitamins because it increases fertility in a woman, but I still have not become pregnant. I am afraid I am infertile. Are there any fertility treatments available over-the-counter? Is there anything I can do to become pregnant?

Samantha Butts, MD MSCE responds: I would advise that after one year of trying to become pregnant you should be seen by a doctor who specializes in the treatment of patients who are having difficulty achieving a pregnancy. In many cases, explanations can be found during a thorough evaluation of you and your partner that provide the doctor with options to treat you and increase your chances of becoming pregnant. Many options exist that help many couples achieve a pregnancy.

Prenatal vitamins do not increase the chances of becoming pregnant but you should still take them every day. They are important for the health of a baby and can prevent specific birth defects in babies.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I am 20 years old, can I still be an egg donor?

Tashianna asks: I am 20 years old, can I still be an egg donor?

Penn Fertility Care responds: To start the screening process to become an egg donor you must be 21-years-old.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Is it possible for me to be a surrogate for my girlfriend?

Skipper asks: Is it possible for me to be a surrogate for my girlfriend - meaning I carry her biological baby? Can I do this if I have never carried a child before?

Samantha Butts, MD MSCE responds: In order to determine if you could carry a child for your girlfriend, you would both have to be evaluated by a fertility specialist. At a meeting like this, the doctor would obtain a medical history on you both to understand what your reproductive needs are and will provide you with information about what treatment options are available and what they require from you both.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

What occurs at the first appointment at the fertility center? Does the couple attend the first appointment together?

Selena asks: What occurs at the first appointment at the fertility center? Does the couple attend the first appointment together?

Samantha F. Butts, MD , MSCE responds: At the first visit, your doctor will ask you questions about your health, your general medical history and your history of any gynecologic problems. This information is important because it adds to an understanding of risk factors for infertility. If you have had important studies related to infertility treatments or testing from another doctor you should arrange to have those sent to the new doctor's office ahead of time (and call ahead of time to verify that they have been received) or bring the records with you. If your doctor does not get your records ahead of time, you should expect that he or she will have to dedicate time after the appointment to do a thorough review of these studies.

You may be examined during this visit and possibly be offered a pelvic ultrasound (typically done vaginally) to examine your uterus and ovaries. This is an important part of the evaluation.

Your doctor will also order lab tests for you, many of which will look at hormone levels that are important for understanding your fertility. Some of these tests can be done at anytime, but some can only be done at certain time during your menstrual cycle so be prepared to possibly need to get your blood drawn more than once during this process. You will most likely have some additional studies ordered (x-ray or ultrasound) that are designed to look at your uterus, fallopian tubes and ovaries.

If you have a male partner (as opposed to needing/requesting sperm from a sperm bank for instance) he will be asked to collect a sample of sperm to perform a semen analysis. Specific instructions will be provided for this process.

Finally, your doctor will want to know if your routine medical care is up to date. You should have seen your gynecologist and your primary care doctor (and of course any specialists you see) within the last year and gotten a clean bill of health from them. It is very difficult to move forward with infertility treatments if you have medical problems that are not controlled or monitored - we worry that these problems could become worse in pregnancy and jeopardize your health and the health of your baby.

Don’t be surprised if it takes between 4 to 6 weeks for a complete evaluation. Some of the results can take more than a week to come back. We typically recommend that you schedule a follow-up appointment at least one month after your initial visit to review all your test results and make treatment recommendations. Also, your doctor may ask you to repeat some tests that have already been performed, especially if the initial result was not normal.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I was wondering how much a tubal reversal will set a family back?

Wendy asks: I was wondering how much a tubal reversal will set a family back?

Penn Fertility Care responds: The cost of a tubal reversal procedure varies according to practice location, hospital, and health insurance coverage. An option that is, on average, less expensive is in vitro fertilization (IVF). IVF involves stimulating your ovaries with medication and using a needled to obtain the eggs from your ovaries. These can be fertilized with your husband’s sperm in the laboratory (in vitro) and the resulting embryo(s) can be transferred back into your uterus: bypassing your tubes altogether. The best option is to schedule a consultation with a specialist in reproductive endocrinology who can discuss both IVF and tubal reversal.

If you would like to schedule an appointment with Penn Fertility Care, call 800-789-PENN (7366) or request an appointment online.

Will you take a patient at age 43? Also, Where can my male partner go to receive tests?

Lynn67 asks: I am 43 years old and was diagnosed with infertility in 1995 due to crushed/twisted fallopian tubes. I went through IVF in 1996 but it did not result in pregnancy. I would like to try again but would also like my partner’s sperm to be tested for count and mobility. Will you take a patient at my age? Also, where would my partner have to go to receive his test?

Steven Sondheimer, MD responds: I think you should arrange a meeting with an infertility specialist. I would be glad to meet with you and your partner to review your history and records.

Each person and couple is different and I cannot give you specific answers without all the information. Your partner should schedule a semen analysis and the two of you should schedule a consultation. Obtain as much of your records before hand so that the visit can be most productive. Also write down questions even before you arrive.

In general, as a women gets older the interventions we use to help make pregnancy possible such as IVF are less likely to be successful. If blocked fallopian tubes are your cause of infertility we can evaluate the number of eggs remaining in your ovary and give you a better idea of the chances of success with your eggs and IVF.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Does Penn reimburse the cost of IVF if it is not successful?

Boss asks: Does Penn reimburse the cost of IVF if it is not successful?

Penn Fertility Care responds: Penn Fertility Care does not reimburse for unsuccessful IVF cycles. However, we do have a partnership with Advanced Reproductive Care (ARC). ARC provides affordable and convenient financing as well as a Refund Guarantee program. For more information you can contact one of our Financial Counselors or visit ARC’s website.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I had a tubal ligation in 2003 and got married. I can’t afford to get my tubes untied. What is my best plan for me and my husband to have a baby?

Lisa asks: I had a tubal ligation in 2003 and got married. I can’t afford to get my tubes untied. What is my best plan for me and my husband to have a baby?

Scott E. Edwards, MD responds: The two options available are in vitro fertilization (IVF) and a tubal reversal procedure. IVF involves stimulating your ovaries with medication and using a needled to obtain the eggs from your ovaries. These can be fertilized with your husband’s sperm in the laboratory (in vitro) and the resulting embryo(s) can be transferred back into your uterus: bypassing your tubes altogether. The cost of both procedures will vary according to insurance coverage, although on average IVF may be less expensive since it doesn’t require hospitalization and as much care in the operating room. However, costs will vary according to practice location, hospital, and health insurance coverage. Both procedures have a good chance for success but, of course, will vary according to a person’s age and particular health issues. The best option is to schedule a consultation with a specialist in reproductive endocrinology who can discuss both IVF and tubal reversal.

If you would like to schedule an appointment with Penn Fertility Care, call 800-789-PENN (7366) or request an appointment online.

How often can I donate eggs?

Jen asks: How often can I donate eggs?

Anuja Dokras, MD, PhD responds: The American Society for Reproductive Medicine states that there are no clearly documented long term risks associated with oocyte donation; therefore, there are no definite data on which to base absolute recommendations. However, due to potential health risks it seems prudent to consider limiting the number of stimulated cycles in a given donor to approximately six. Donors should wait a minimum of two months between cycles.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I have one child and would like another but I am having trouble. What could we be doing wrong?

Angie asks: I've had one child and that was 3 yrs ago. Now we would like another but have been unsuccessful. I don't think it has to do with my weight because 4 yrs ago I weighed 230 lbs and now I weigh 185 lbs. What could we be doing wrong?

Clarisa R. Gracia, MD, MSCE responds: There are a variety of reasons why you might be having trouble getting pregnant. If your menstrual cycles are irregular, you could have an ovulation problem (not be releasing an egg). There could be a blockage in your fallopian tubes, or your husband may have a low sperm count. Other factors may also be playing a role such as your age. I recommend that you see a physician who treats women for infertility to find out what might be going wrong. Best of luck!

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

IVF did not work for us. What services can Penn Fertility Care offer to give us hope of becoming parents?

Ana asks: I just turned 36 and my husband is 39. We have been trying to get pregnant for past 10 years; two years ago our third IVF attempt failed. None of our embryos lived more than a week (each retrieval we had several spares) and our doctor at another fertility clinic was unable to give us any explanation as to why it did not work for us, why embryos stopped growing, or what to do next. He suggested trying donors. Do you have any advice? What services can Penn Fertility Care offer to give us hope of becoming parents?

Kurt Barnhart, MD, MSCE responds: Penn Fertility care provides a full range of services for couples trying to become parents. We offer comprehensive evaluation of men and women as well as treatment options ranging from ovulation induction, intrauterine insemination, IVF, ICSI, egg donation, embryo donation and pre-implantation genetics. To best determine the specific treatment to help your situation a full consultation is recommended. We look forward to assisting you in your desire to be a parent.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Do you offer cryopreservation of embryos?

Andrea asks: Do you offer cryopreservation of embryos?

Clarisa Gracia, MD, MSCE responds: Penn Fertility Care does offer embryo cryopreservation. We also offer a full range of services for couples trying to become parents. If you would like to learn more about our program you please feel free to schedule a consult with one of our physicians.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

A urologist prescribed my partner clomid. Is it time for us to see a fertility specialist or should we wait to see if the clomid works?

Monk asks: My cycle is irregular, but that issue is being helped by medroxyprogesterone. All of my hormone levels are fine. My significant other has had a semen analysis and blood work. The blood work revealed low testosterone levels and the semen analysis revealed low motility. The urologist prescribed him clomid. I have been seeing my gynecologist and he has been to the urologist. Is it time for us to see a fertility specialist or should we wait to see if the clomid works?

Monica A. Mainigi, MD responds: It sounds as if your doctor(s) have already identified possible causes of your infertility and started treatment, which is great. Treatment with clomid may improve your husband’s testosterone and in turn, improve his semen parameters. He should have another semen analysis after 3 months of treatment to determine if the treatment is working and if his motility has returned to normal. If his count or motility is still low, a fertility specialist can discuss other treatments that may increase you chance of pregnancy.

Even if his semen analysis returns to normal on clomid, with your irregular cycles it is difficult to know if you are ovulating (releasing an egg) every month. Even if you do ovulate, with irregular cycles it can be difficult to time intercourse to maximize your chance of pregnancy. A fertility specialist can help determine if/when you ovulate and if not, discuss what options are available.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Can my husband's anti-seizure meds affect our fertility?

J asks: Can my husband's anti-seizure meds affect our fertility? It took us over 2 years to get pregnant (resulted in a miscarriage at 19 weeks). We have been trying for the past 6 months and still not pregnant. We are both 32 years old and all other test results are normal.

Samantha Butts, MD, MSCE responds: If your husband has a normal semen analysis (normal concentration of sperm, normal amount moving and normal shapes of the sperm) it is unlikely that his anti-seizure medication is a problem. If the medicine were effecting his fertility in a substantive way, this would be detected on the semen analysis.

That being said, there is clinical evidence that some medications used to treat epilepsy (such as valproic acid, oxcarbazepine, and carbamazepine) might negatively impact hormonal levels in a way that increases sperm morphologic defects. Again, in anyone with a normal semen analysis, I would find it difficult to explain a couple's infertility by exposure to anti-seizure medications.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I had a miscarriage and haven't been able to get pregnant since. When should I see a Reproductive Endocrinologist?

Hemi ask: I have been pregnant 3 times (2 were terminations and 1 was a 2 trimester miscarriage). I was 15 years old with the first pregnancy and 20 years old with the second. It took almost 3 years of unprotected sex to get pregnant the 3rd time. It's been 6 months since my miscarriage and I still have not been able to get pregnant again. I have very regular cycles (every 27-28 days). When should I see a Reproductive Endocrinologist?

Scott Edwards, MD responds: In general, an evaluation should be undertaken after 12 months of unprotected intercourse in women under the age of 35. Because fertility begins to decline after the age of 35, it is reasonable to begin an evaluation after 6 months of unsuccessful attempts. However, given that it took you 3 years in the past it would be reasonable to undergo an evaluation at this time. An initial evaluation would include an evaluation of the uterine cavity and fallopian tubes, a semen analysis, and usually some measure of the health of the eggs within the ovaries.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I have been having a hard time conceiving and I don’t know why I’m not able to have a baby. Can you help?

Rasheeda asks: I have been having a hard time conceiving and I don’t know why I’m not able to have a baby. Can you help?

Penn Fertility Care responds: There are multiple reasons why you may be having trouble getting pregnant. It is recommended that women under age 35 who have been unable to conceive after a year of trying to get pregnant or women age 35 and over who have been unable to conceive after six months of trying to get pregnant, see a fertility specialist for a fertility evaluation to help determine the cause of infertility. In addition the male partner needs to be evaluated as well since approximately 40 percent of fertility issues stem from the male. We would be happy to meet with you for a fertility consultation.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I had a tubal ligation and I regret this decision. Am I able to have the procedure reversed?

Tina asks: I had a tubal ligation and I regret this decision. Am I able to have the procedure reversed?

Penn Fertility Care responds: Yes, we do perform this type of reversal surgery at Penn Fertility care, however; it is not always successful as tubal ligation is meant to be permanent.

One option to consider is in vitro fertilization. It does not involve major surgery and has a success rate of up to 50 percent per cycle for women less than 35 years of age.

We suggest obtaining records of your tubal ligation and setting up a consultation with a fertility specialist. Bring your records with you to your consultation so you and the specialist can discuss the issue at hand.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

How do I contact Penn Fertility Care?

Allison asks: How do I contact Penn Fertility Care?

Penn Fertility Care responds: To contact Penn Fertility Care please call 800-789-PENN (7366). If you would like to schedule an appointment, you can do so over the phone or you can request an appointment online. Penn Fertility Care is located at:

3701 Market Street

8th floor

Philadelphia, PA 19104

Pennsylvania Hospital

Spruce Building, 7th Floor

801 Spruce Street

Philadelphia, PA 19107

Penn Medicine Radnor

250 King of Prussia Road

Radnor, PA 19087

I am a 35 year old female that has been trying to get pregnant for 1 year. What could be the problem?

Reka asks: I am a 35 year old female that has been trying to get pregnant for 1 year. What could be the problem?

Penn Fertility Care responds: It is recommended that women under age 35 who have been unable to conceive after a year of trying to get pregnant or women age 35 and over who have been unable to conceive after six months of trying to get pregnant, see a fertility specialist for a fertility evaluation to help determine the cause of infertility. In addition the male partner needs to be evaluated as well since approximately 40 percent of fertility issues stem from the male. We would be happy to meet with you for a fertility consultation.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

I have aspermia. Is there any hope for me to be a father?

W asks: I have aspermia. A biopsy showed results of low cellularity on rt testis and few sperms on lt, most of abnormal shape. Is there any hope for me to be a father?

Monica Mainigi, MD responds: Low sperm count is often associated with difficulty conceiving. However, with the technology today men with low sperm count can often still have children, depending on the severity of their condition. Using in vitro fertilization, or IVF, we often need only a few sperm to fertilize your partner’s eggs. You should meet with a fertility specialist who can review the results of your biopsy and determine what your best options are. You should also see a urologist to determine the cause of your low sperm count, as some of these conditions can be treated or passed on to your children.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Penn Ovarian Cancer Research Center Grateful to the Philadelphia Antiques Show

This week, The Philadelphia Antiques Show wrapped up another amazing display of fine furniture, folk art and decorative arts.  The 2011 show marked it’s 50th year as the major fundraiser for Penn Medicine in support of innovative programs that directly impact patient care.

The Penn Ovarian Cancer Research Center (OCRC) would like to express it's sincere thanks to the Philadelphia Antiques Show as this year’s proceeds benefit the program. The center aims to make innovative immunotherapeutic ovarian cancer treatment available to more women in the Philadelphia region. Immunotherapy uses T-cells from patients' own tumors to develop vaccines that help fight the disease. This personalized therapy improves survival rates and offers women affected by ovarian cancer a better quality of life.

I am 41 and have been diagnosed with unexplained infertility. Am I able to get pregnant without ARC?

Karen asks: I am 41 and have been diagnosed with unexplained infertility. My husband and I have been trying to conceive for the past 2 years. Am I able to get pregnant without ARC?

Kurt Barnhart, MD, MSCE responds: Thank you for your question. There are a number of treatments available for someone with unexplained infertility. They can be very conservative using oral medications, can involve inseminations, or can progress to the use of IVF. The specialists at Penn Fertility Care would be happy to discuss your fertility options with you to best fit your needs and goals. You also inquired about ARC, this is a fertility financing resource with whom our practice participates. One of our financial counselors would be happy to review this program with you if you are interested.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Can you tell me if Pre-implantation Genetic Diagnosis can test for dilated cardiomyopathy?

Cuteshoes asks: Could you tell me if Pre-implantation Genetic Diagnosis can test for dilated cardiomyopathy? I was diagnosed with dilated cardiomyopathy about a year ago, of course while my husband and I were trying to start a family. I was told that it would be risky to get pregnant with this condition. So now my husband and I are left with starting a family in a different way. We are leaning toward using a surrogate, and I understand that I would have to have eggs retrieved. Would that be able to be done with my IUD in place? Or would it have to be removed first? I don't think a lot of people have this problem!

Anuja Dokras, MD, PhD responds: Pre-implantation genetic diagnosis can be used for most conditions where the specific gene defect associated with that condition is known. Some cases of cardiomyopathy are associated with a known mutation and pre-implantation genetic diagnosis can then be performed.

Also, it is possible to stimulate your ovaries without removing the IUD. We do see patients with a number of different health problems and with a multi-disciplinary team approach make recommendations that are safe and successful.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

If you have had 5 surgeries to remove endometriosis and scar tissue and it keeps coming back, will it keep coming back and getting worse?

Eileen asks: If you have had 5 surgeries to remove endometriosis and scar tissue and it keeps coming back, will it keep coming back and getting worse?

Steven J. Sondheimer, MD responds: I do not have enough information to answer your question. It is unusual to have 5 or more surgeries in the treatment of endometriosis. Endometriosis is a chronic recurrent condition in which women suffer from various combinations of severe menstrual pain, pain on intercourse and chronic pelvic pain. Endometriosis may also cause infertility but it is unusual to recommend surgery to improve fertility, since it has little benefit. Endometriosis is usually found inside the peritoneal cavity at the top of the vagina, other locations are also common and cysts filled with thick, deep brown fluid called endometriomas, or chocolate cysts, can be located in the ovary. Scar tissue can also form as a result of irritation and inflammation from the endometriosis. I would suggest you see a reproductive endocrinologist who cares for women with endometriosis, and is an expert minimally invasive surgeon. The decision on what combination of medication and surgery to treat your symptoms will require an in depth review of how you are feeling and how you have responded to treatment in the past. Occasionally a cause other than endometriosis may be found for your symptoms even if you have endometriosis. The decision to proceed with surgery requires a careful review of the benefits that might occur versus the risks of additional surgery. If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

How much are the egg donors paid?

K asks: How much are the egg donors paid?

Penn Fertility Care responds: Generous compensation is offered to donors for their time and travel. Compensation is reviewed during the applicant process.

For more information, visit PennMedicine.org

How would my wife and I go about having a child with both of us being the biological parents?

Desire asks: How would my wife and I go about having a child with both of us being the biological parents?

Penn Fertility Care responds: There are various options available for you and your wife to become biological parents of a child. Without knowing your medical history it is difficult to give a specific answer. The best place to start would be making an appointment with a Reproductive Endocrinologist. If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Elisabeth's Story

I had been diagnosed with polysytic ovary syndrome (PCOS) several years ago and knew conceiving might be difficult. We tried, but to no avail. I researched doctors on the internet and came across Samantha M. Pfeifer, MD. I immediately made an appointment to see her. After taking Metformin, Clomid and doing injections, we were still unsuccessful. Dr. Pfeifer took a chance and performed ovarian drilling on me back in December of 2007. To make a long story short, with the help of the surgery and one more round of Clomid, I gave birth to my beautiful son, Justin, the following December. Much to my surprise, I then became pregnant again the following July and gave birth to my sweetiepie, Jacqueline, this past April. Thank you so much, Dr. Pfeifer and Penn Health for Women! I owe you so much!

Can a husband's stress cause miscarriages?

Lynn Asks:
I have had three consecutive miscarriages this past year. My husband has been under a lot of stress. Can a husband's stress cause miscarriages? P.S. I had a healthy pregnancy before these three.

Moderator Responds:
Your husband's stress cannot cause a miscarriage but it may add to your stress, which could adversely affect your health. Penn Fertility Care advises women to seek a fertility specialist if they have lost two or more pregnancies due to miscarriage, have been trying to conceive for over a year (under age 35), have been trying to conceive for over six months (age 35 and over) or if you have any other underlying gynecologic issues (ie. endometriosis or PCOS). We wish you luck. Feel free to contact us if you decide to be evaluated by a fertility specialist.

If I am turning 21 in October is it possible for me to donate my eggs now?

Patient asks:
If I am turning 21 in October is it possible for me to donate my eggs now?

Penn Fertility Care responds:
To start the screening process to become an egg donor you must be 21-years-old.

For more information or to talk to a Penn Fertility Care specialist please call 1-800-789-PENN (7366) or request an appointment online

Jennifer's Story

My husband and I are both 34. We tried for almost two years to get pregnant. Finally, we went to the fertility doctor. After what seemed like 100 different tests, I was diagnosed with endometriosis. After a couple of months of Clomid treatments, the doctor decided to do surgery. For two months after the surgery, I was taking Follistim shots.

We were pregnant within two months. Our son is now 16 months old. Our only concern throughout the process was why the doctor waited five months to do the surgery. I was told about the endrometriosis in November, and the surgery was not done until March. We feel that five months was wasted on Clomid treatments. If they knew I needed surgery, that should have been on the top of the list.

For anyone with a similar situation, I suggest you ask every question about every treatment, and do not let the doctor delay anything. When dealing with infertility, time is of the essence. We are now trying to conceive a second child, however, we are trying the old-fashioned way this time.

Good luck to all who are trying, and do not give up. We were ready to look in to adoption (which we still might). Congratulations to all who have the little one they were waiting so long for. I thank God everyday for my son.

Nai's Story

When I was younger I always thought that when I turned 25 years old I would start a family. My sister and cousin both started their families very young and I vowed that would not be me. I was going to do things right - like get a job, find a good husband, get a big house... then comes the family. Well everything took place but the children.

I spent so much time ignoring my body calling for help, I wish I could go back and change things but I know I can't. I found out that I had scared tubes that where clubbed at the ends and were blocked. When I heard this I felt dead inside. All that I could think is that my husband isn't going to want to be with me now and that I'm cheating him out of his life. We both wanted children and I knew he wanted to be with someone that could give him a child.

Before I found out that my tubes were blocked, we had tried for over a year and someone from my job told me about her fertility doctor. The fertility specialist did a laparoscopy and he said that he removed the adhesions and that my tubes where closed and damaged and I need to have IVF done to conceive. I thought ok when can I do it? I didn't know what IVF was. I just wanted a baby so when I found out how much it can cost I was disheartened since I couldn't afford the procedure.

My friend told me that she had the same thing. I was shocked and I didn't believe it because she has three kids. So I asked her what she did and she got a second opinion (since all of the doctors are different). The second doctor she saw had another course of treatment for her. I took her one year to conceive her first child, six months for the second child and two years for her third child. She said you have to have a doctor that really care about you.

So I went to see her doctor and gave him my past surgery pictures and info and he looked at me and said "who the heck told me that this isn't repairable?" I was shocked from his reaction and felt like this is the doctor for me. He told me he can fix my problem with another laparoscopy. I remember being put under sedation for the procedure and he was telling me that I'm not going wake up unless my problem was fixed.

When I woke up he had this sad look on his face and I wanted to just cry because I believed him when he said he was going to help me. He looked at me and said well your tubes are opened but it might take you a while to conceive. Well it didn't...I'm now four months pregnant with a healthy baby. I just want to say that some treatments are good for infertility they are not for everyone. A second opinion helped instead of me hiding from my problem. Good luck to everyone.

Tanya's Story

Well like any other young woman I got married and wanted to start a family. I found out after I got married that I had polycystic ovary syndrome (PCOS). Fast forward about two years and my son was born. Now I'm 29 soon to be 30 the end of this month and the baby bug bit again. I so want to have another child. I came to Penn Fertility Care in hopes of good news.

Today I got a mix. Yesterday I had a HSG test and just received the results, both of my tubes are open and everything else looks good with the exception of a little scar tissue in my left tube. I will go for an insemination in the next few weeks and I'm currently taking clomid.

Hopefully this will work because my insurance won't cover IVF. No need to say that my spirits in spite of the good side of things are very low. But in the mean time I've been doing a lot of praying.

Nicole's Story

Well my story is long, true and still hurtful to this day, but I'll make it short. My mission is on a good track now so hopefully my story will help someone out in some way. I always thought I could have a baby. When I was younger I got an rude awakening when I thought I had the man of my dreams. When I was 18 or 19 years old, I thought we were going to leave each other so I planned to get pregnant. I tried and tried and nothing happened. I was confused so I stopped at that age. I didn't know anything about a fertility doctor. Anyway he wasn't "the one" and I'm glad I didn't get pregnant then.

I met another man and before we got married he made it clear that he wanted children as did I. We decided to stop using contraception but I wasn't getting pregnant. I started asking my gyn about this and she told me to see a fertility specialist. I had blood work and a laparoscopy and I found out from him that my tubes were blocked. In his opinion, I needed IVF. I found that was too expensive. I showed my ob/gyn the pictures and told her what the specialist said. My ob/gyn looked at the pictures and said the fertility doctor was wrong and to get a second opinion. She referred me to a doctor she went to and she was right. The new doctor fixed on of my tubes and the other is opened a little.

I didn't take no for an answer and even though IVF is a good treatment, I just couldn't afford it. Now, one month after my second laparoscopy, I am pregnant but they are checking to see if it is tubal or normal. I will find out in two days so please pray for me.

The problem I see with a lot of women is that they accept what they are told without fighting, they do not do research on the doctors or success rates, they don't know that there are other treatments than IVF. Trust your heart and know that your husband may act tough be he wants the same thing that you do, a baby. Talk about things and relax and determine the best plan for you. I wish you all well and I'm praying for you all.

Sam's Story

My husband and I have been trying to conceive for two years. My ob/gyn kept telling us to have intercourse on days 12-14 of my cycle, but it was not working. In September of 2006, I left work, sat at the dining room table and cried. I told my husband I did not want to try anymore, and that the stress and disappointment were too much. We cried together.

Then, in October, I had a blood spot a week before my period. I remember thinking, "This is odd," because that had never happened before. The next week, I bought a pregnancy test and tested. We had two lines! I ran into our bedroom shouting, "We have two lines! We have two lines!" We celebrated and our families were ecstatic!

Three weeks later, we miscarried. The worst part was the dilation and curettage (D and C). We had to be in the maternity ward, with all of the healthy babies and healthy moms. My appointment was for 11:00, but I did not get into the operating room until 1:30. There were two emergency C-sections ahead of me. Those babies were more important to the hospital because those babies were alive. I was fine that night and the next night. But, the third day was horrible. The anesthetic wore off and I was in a lot of pain – physical and emotional.

I cried the whole month of November. I cried all the way to work and all the way home. December was good; I had been given the go-ahead to try again in January. When January came, so did the tears. I was terrified that we wouldn't be able to conceive or that we would miscarry again. As luck would have it, we got pregnant in January. At the end of the month, I began spotting again. On Super Bowl Sunday, as we were leaving church, I felt the baby come out. I saved her, and took her to my doctor's office on Monday. The tests revealed nothing conclusive – just a spontaneous abortion. (I hate that term. Why use abortion?) I cried and was angry.

At the same time, I was taking a grief counseling class for my degree. I shared my experience with my class. During a break, a woman who was a pediatric nurse came up to me and said, "I know someone who can help you. There is a doctor I work with who is a fertility specialist." She gave me his name, and I went home and looked him up on the internet. I made an appointment the following week. I consulted my ob/gyn, and she was angry with me. She said, "I do not recommend this until you have had three miscarriages." I asked her why she would want to put me through that again, and she did not have an answer.

She and my specialist began working together. She ordered 22 blood tests (all negative) and then did a hysterosalpingogram (HSG) – also fine. She faxed all of the results to my specialist and he analyzed them. He determined that all I needed was a shot, gonal-f, to keep my ovaries from releasing an egg until the follicles were mature. I had been ovualting at day ten, and he wanted my body to hold off until day twelve. I took gonal-f injections for five days.

When I returned for an ultrasound, the follicles were not quite ready, so I continued for two more days. This time, the follicles were mature, and my luteinizing hormone (LH) blood count was rising, so I was instructed to take 500 mg of ovidrel that night with intercouse and 250 mg of ovidrel the next night with intercourse. The timed intercourse was very difficult for me. I was worried that something might go wrong, and I could not relax. All that I could think about was, "We paid a lot of money. We have to do it." The second night was much better, and I was able to relax.

I am still waiting for the results of this cycle. I am concerned that because my LH was already rising, we might have missed the egg. I will not know for another week. I am excited that I have a doctor who is skilled and who knows what he is doing, but I am disappointed that I have to go through all of this.

Karen's Story

I am 26 years-old and have a 5-year-old son. I started trying to conceive for our second child at the end of June 2008. I got a [positive result] BFP on 7/17/08, but 8/4/08 an ultrasound showed it was ectopic. I’ve been trying to conceive since and nothing.

I used over the counter ovulation predictor kits, regularly took my temperature, and used a microscope all at the same time to detect ovulation, and only detected it once in December 2008. I can’t find any doctors who want to really help me quicker.

In October of 2009 I will be getting laparoscopy done if I’m not pregnant by then. I really feel I should get a hysterosalpingogram (HSG) done first because of the ectopic pregnancy. It’s one of those instinct feelings. So I’m currently looking for an HSG to be done. I have three sources I have to call yet and if they won’t help I’m done trying to conceive until the summer is over. This makes me very sad.

Dana's Story

My husband and I got pregnant after four months of being off of the pill. I was 22 at the time. At eight weeks I lost the pregnancy and was very upset, understandably.

The very next month we got pregnant again. I spent the first three months of the pregnancy just waiting for "it" to happen again. I felt unable to get excited because I was afraid it would all be over. We ended up having a healthy baby boy and we were told by the ob/gyn that a miscarrage is normal.

When our son was two we decided to try again. We got pregnant after six months of trying and unfortunately, I had another miscarrage. It has been over a year now of trying and nothing, no pregnancies. I am 26 now and feeling like this is the prime time to have a baby and disappointed that it's not happening!

Now I am worried that I will never have another baby and I don't want them to be too far apart in age (my son is 3). We are on a limited budget for infertility treatment and right now I am feeling helpless.

Susan's Story

I am 35 and my husband is 38. I am currently pregnant with our first child following infertility treatment. I had intrauterine insemination performed at Penn Fertility Care. I was so unhappy with my former doctor and really believe that I/we would still be suffering if I had not contacted Penn Fertility last spring. You are entitled to good care and must seek it out, especially if you are older (like me).

While we were trying, I found a lot of solace and support online. Many of the infertility blogs (deadbug, barrenmare) I came across made me cry very hard, but they also made me laugh, gave me hope, and reassured me that I wasn't alone. I wasted a lot of time (1.5 years) with my OB-GYN and then the reproductive endocrinologist I was seeing before.

I had endured tons of blood tests and an HSG (all normal) but was told I wasn't ovulating (even though some home urine tests indicated that I was). When I was given a prescription for a high dose of Clomid last spring & told, in response to a question about what that recommended course of treatment was based on, that it was "based on 15 years of clinical experience", I decided it was time to find a new doctor.

A friend from work told me about Penn Fertility. Shortly after my first visit, they did PCT (which the other doctor had never done) and suggested, based on the results, that we try a few cycles of IUI. The first attempt didn't work, but the second one did. Less than 3 months after my first appointment I was finally pregnant!

We are expecting a baby girl in the spring and we are thrilled. My advice to others suffering through infertility is to be proactive: switch doctors if you don't like yours/don't feel he/she is taking you seriously/giving you good care--and above all, do not lose hope! You WILL have the family you are dreaming of, even if it doesn't happen as fast as you would like.

Janelle's Story

We had been trying unofficially for about 2+ years, when I knew that something was wrong. I was 27 when I was referred to Penn Fertility Care by my ob/gyn. After being evaluated and tested - they discovered that both of my tubes were blocked. I took it quite hard, but I had faith in science.

So after much thinking I decided to try to have my tubes repaired — after surgery they told me that there was a lot of damage and that my chances of conceiving was about 20% — to me that was alot better then 0%. So we had fun trying, until I realized that maybe things weren't going to well in there. Test confirmed that scar tissue had blocked one of the tubes completely and about 3/4 of the other. So back to the operating room I went to have both tubes removed (an option that I was given the first time but I chose to try to have them repaired first).

After surgery I was having surgery remorse — like why didn't I get a second opinion, why didn't I ask if there was any other alternatives? But I got my self together, after I enjoyed my summer and took my mind of "babies" we decided I was up for a dance with IVF (we waited until September).

After having my case reviewed the clinic also decided that I was a good candidate and off to the consultation and drugs I went — early October. The drugs threw me for a loop I was so darn moody, and anxious that I could not get myself together. However, after a while I adjusted to the "needle schedule" and before I new it I was getting the blood draws and ultrasounds every other day.

It was time for the egg retrieval and I had produced 24 eggs. Out of the 24 eggs, 22 fertilized. Out of the 22 that fertilized, 20 went to "blast" — I waited five days instead of three days. They informed me I had all quality "blast", so they would put the one in that had matured first. So, on December 21st, I was closer to pregnancy then I had ever been. I continued my meds and then the dreaded 2 week-wait begin, which was to end on Jan 2.

I was extremely anxious. I was so edgy and snappy - I believed in my heart that it had worked, but I was also scared to get my hopes up. Happy New Year! We rang in the New Year together and I did not drink "just in case." On the way home I begged him to stop at Walgreen's so I could get a test...I could not bare to wait!

We arrived home and after I said a little prayer, to give me strength, I ran up to the bathroom. Seconds past and I saw the faintest second pink line appear. However, I thought I had willed my brain into seeing something that was not there. I screamed for Hubby to check the results. "What do you see?" I asked frantically. "Is that another line?" I waited as he carefully examined the test. He looked over and said to me with a smile, "Congratulations!"

I did not know if I should, scream or what... I waited until Jan. 2 and it was confirmed through blood work that I was pregnant, I continued the progesterone. We could not be happier; my due date is September 8th. If it were not for the many wonderful people in the office that helped us create life, I do not think this would have been possible on my own. We sincerely thank each and everyone I have had the pleasure of meeting.

Heather's Story

I am 38 years old. My husband and I tried to get pregnant since 2003, on an off with my ob/gyn's help. In fall of 2006, my hubby had his sperm checked, and they were fine. In March of 2007, I had an HSG with my ob/gyn, and my tubes were fine. I finally went to a fertility specialist in April of 2007.

My doctor was affiliated with Dr. Maureen Kelly (now a doctor with this practice). My doctor was on vacation when my IUI's were done May 30, 2007 and June 1, 2007. Dr. Kelly did both of my procedures, and I became pregnant. I delivered a healthy baby boy named Daniel on February 20, 2008. My husband and I have never been happier. We are now going back to Dr. Kelly at this practice because she conceived my son, and we want to give our son a sibling. I will be 39 in September. Just keep up hope that it will happen for you.

Dani's Story

I was diagnosed with PCOS about six years ago. My husband and I have been trying for a family for about eight months now. Dr. Pfiefer is absolutely amazing and after three rounds of clomid we are pregnant! She and her nurses are just so supportive and wonderful. We couldn't have asked for better treatment. Here's hoping all goes well over the next nine months!

Jessica's Story

I am a 26 year-old woman who has PCOS. I started infertility treatments when I was 23. I felt like I would never get pregnant after trying several times. I became very depressed and made the relationship between me and my husband very strained. I finally became pregnant one year later. I was so excited. Then I lost the baby.

I had a blighted ovum and had to have a D&C. I was so stressed and depressed & I obsessed over getting pregnant again. Well the obsession must have worked because 6 months passed and I was pregnant again. I was so amazed because I thought the treatments I was taking would not work. So at my last appointment my physician advised me that I had an egg growing. I was so excited....I had this gut feeling that "It's going to work this time."

And I am happy to report that I am now the proud mother of a one year little girl named Allyana. She is the best. I delivered her after 48 hours of long painful labor, but it was all worth it. I just want to thank Penn Fertility Care for all of their support.