Infertility is a more common problem than most people realize, affecting more than 6  million Americans or one in six couples. After unsuccessfully trying to get pregnant for just one  year, a couple is considered infertile. If the female partner is thirty-five years or older, an  evaluation after six months of unsuccessful attempts at conceiving is recommended. Some  couples will seek help while others will do nothing, prolonging their agony for years. In many  cases, both men and women contribute to the etiology of their infertility. Unfortunately, many of  those suffering from infertility also do not realize that help from fertility experts is more  effective and readily available than they think. Once they get help from experts, more than half  of patients conceive. In 2005, nearly 49,500 babies were born in the United States with the help  of advanced reproductive technologies such as In Vitro Fertilization. Many more couples were  successful in starting or enlarging their family through less advanced techniques and procedures. 

Every other year, the Centers for Disease Control (CDC) releases the Assisted  Reproductive Technology (ART) report on clinic pregnancy success rates in the U.S. with the  2005 report providing the most current data. When reading this report, anyone seeking a fertility  clinic should not only consider its success rate, but should also consider other factors including  the training and experience of the clinic, the laboratory professionals and the quality of services  they provide. Other factors should include the patients themselves, their age, and the cause of  their infertility. Additionally, some clinics, may only choose patients with a high likelihood of  success in order to ensure that their success rate looks the best.

The Central Georgia Fertility Institute (CGFI), located in Macon, Georgia, is a full service fertility center offering a wide range of fertility-enhancing options for both individuals  and couples in middle Georgia. The Center has been providing fertility services to middle  Georgia since 1999. In April of 2003, the practice moved into it’s present facility with an on-site  embryology laboratory. Prior to that time they were working with an embryology laboratory in  Atlanta for In Vitro Fertilization. With the opening of this state-of-the-art facility, patients no  longer have to travel to Atlanta for any part of the IVF process. Committed to providing the  highest quality of care for their patients, physicians William J. Butler, MD and David E.  Carnovale, MD, are board-certified specialists in infertility and the Center is a member of the  Society of Assisted Reproductive Technologies. CGFI’s state-of-the-art IVF laboratory is under  the direction of board-certified embryologist, Abdelmoneium I. Younis, DVM, MS, PhD,  HCLD, who now performs and analyzes the majority of the Center’s procedures on site and  under strict guidelines. Dedicated to minimizing the emotional pain of infertility, while  maximizing a couple’s chance of having a child, the team of physicians and nurses hold regular  conferences to ensure that the best possible plan is developed and executed to meet a couple’s  needs throughout the conception process. This attention to detail and close communication with  patients are just a few of the reasons Mike and Ashley Scarborough pursued CGFI for counsel  and support. 

Mike and Ashley had begun their lives together and wanted to have a family of their own.  Ashley had already had a child – now a teenager, and Mike had had a vasectomy years earlier.  “When we met to discuss the Scarboroughs, we knew the couple had the possibility of treatment  through our new partnership with local urologist, Dr. Joshua Perkel,” said Dr. Butler, Director of 

CGFI. “We had recently combined efforts with Dr. Perkel to assist our male patients, and knew  that this new technique, the sperm aspiration procedure, might be perfect for Mike.” “This new partnership, and procedure, allow more choices for couples seeking fertility  options,” said Dr. Carnovale, the Scarborough’s treating physician and Director of Assisted  Reproduction at CGFI. 

When the couple initially met with Dr. Perkel to discuss their options, he explained that  male infertility can be the result of factors affecting fertility at three different levels. Pretesticular  factors interfere with the hormone that induces sperm development. Testicular factors interfere  with testicle’s ability to produce sperm. Post-testicular factors prevent the sperm from being  expelled. “In Mike’s case, we knew it was post-testicular – Mike’s vasectomy. Nevertheless,  Mike would still need a complete evaluation, including a fertility history and physical exam, as  well as blood and semen testing,” said Dr. Perkel. 

The Scarborough’s best chance for pregnancy would have been to restore the free flow of  sperm, if possible. “We could try to reverse Mike’s vasectomy, which would have been a  considerable operation. He would have been placed under anesthesia and I would have had to use  a high-powered surgical microscope to reconnect the vas deferens, the tube that carries sperm  through the penis,” explained Dr. Perkel. “Even if I was successful in reconnecting the vas  deferens, there was still the likelihood that it wouldn’t work,” he continued. He then offered the  Scarboroughs a second option often used in failed vasectomy reversals: surgical sperm retrieval,  or sperm aspiration, a minor procedure usually performed under a local or general anesthetic.  The retrieval method is best for men who still produce sperm but have a blockage preventing  sperm from being in their ejaculate (blockage can be caused by a congenital absence of the vas  deference, a previous vasectomy, or failed vasectomy reversal). Even when little or no sperm is found in the epididymal tubules, or when there is no epididymis, fertilization can occur with  testicular sperm that is injected directly into the egg through the In Vitro procedure. The sperm aspiration procedure would be relatively painless and could be done at CGFI’s  onsite lab. Once sedated, they would numb the skin and use a spring-loaded biopsy needle to  extract the sample from the testes. “It required coordinating efforts with CGFI and Dr. Younis,  the CGFI embryologist, because the sperm would immediately have to be inserted in an ovum  for fertilization,” said Dr. Perkel. 

“It seemed that this procedure would be the best thing for Ashley and me. It was not a  difficult choice choosing between a major operation that might not work and a simple office  procedure that would most definitely work,” said Mike. 

While Mike was getting his evaluation, Ashley was undergoing a simultaneous evaluation with Dr. Carnovale. Since this particular fertility treatment required In Vitro Fertilization, Dr. Carnovale drew Ashley’s blood and tested it to determine levels of follicle  stimulating hormone and lutenizing hormone, both key to development and quality of eggs. He  also performed a transvaginal ultrasound exam to assess the lining of the uterus, monitor follicle  development, and assess the condition of the uterus and ovaries. Ashley’s evaluation also  included an examination of her fallopian tubes and ovaries, tests to determine if endometriosis or pelvic adhesions were present and an endometrial biopsy to test for hormone imbalance – something which could prevent her from sustaining a pregnancy. 

Once Ashley’s fertility was confirmed, she began taking a hormone stimulant to produce  the eggs. Dr. Carnovale then harvested ten eggs from Ashley, while she was under anesthesia,  and prepared them for fertilization. When Mike’s procedure was finished, Dr. Younis took the  sample and dissected the tissue to select the best sperm, assuring easier fertilization. Between four and eight hours after egg isolation, individual sperm were injected into Ashley’s eggs. This  reproductive technique is called Intracytoplasmic Sperm Injection (ICSI). “There’s almost no  such thing as male infertility”, says Dr. Younis. Using ICSI, there are people with Kleinfelter’s  Syndrome (men with no sperm in their semen) who are having their own kids. Technology has  caught up with male infertility so that almost all of it is treatable or by-passable.” After ICSI of  Ashley’s eggs, the initial stages of embryo began to form in as little as 12 hours. Then, when the  embryos reached blastocyst stage after five days in the incubator, two embryos were implanted  into Ashley. Two weeks later, she was pregnant with twins. 

After thirty-eight weeks of a text-book pregnancy, Ashley gave vaginal birth to Alexis  and Amelia. These two babies were the first successful pregnancy to term via the sperm retrieval  process conducted at the Central Georgia Fertility Institute. “We are very thankful for Central  Georgia Fertility and what they were able to give us,” said Ashley Scarborough. “We thank God  for them and our beautiful babies everyday.” 

“Central Georgia Fertility Institute is pleased to offer this new procedure for those  seeking fertility assistance,” says Dr. Carnovale. “We are proud that our partnership with Dr.  Perkel offers another ray of hope for patients in Central Georgia.”