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The Jones Institute for Reproductive Medicine,
Virginia Fertility Clinic Services

The Jones Institute offers the full spectrum of infertility services ranging from diagnosis and first level treatments, such as Intrauterine Insemination ( IUI ) and Ovulation Induction ( OI ), to advanced assisted reproductive technologies ( ART ). These advanced technologies include in vitro fertilization ( IVF ), intracytoplasmic sperm injection ( ICSI ), preimplantation genetic diagnosis ( PGD ), donor egg ( DE ), correctivereproductive surgery, and others.

Our fertility services are highly individualized to meet the needs of each couple. We will always recommend the treatments most likely to result in pregnancy while considering patient desires and cost.

It has been our experience that patients sometimes delay consulting a reproductive endocrinologist because of concerns over cost, lack of insurance coverage or feelings that assisted reproductive procedures may not be effective. Some patients also believe that a referral from their primary care physician is necessary; however, in many infertility centers, more than half of the patients are self - referred. Often times the totalcost of infertility therapy is less when a specialist is consulted early in treatment.

We strongly believe that patient education is essential to seeking treatment for infertility, and we encourage you to review all of the information available on this Web site. Also, we would suggest that you contact your insurance carrier to determine your level of infertility coverage, if any. Patients can greatly reduce the stress and apprehension that often accompanies the process of seeking treatment if they have the facts beforehand.

The links below explain in detail some of the many services that we offer, as well as providing some general information about infertility.

 
  • Endocrine Laboratory
  • Fertility Preservation
  • Reproductive Surgery
  • Intracytoplasmic Sperm Injection (ICSI)
  • Preimplantation Genetic Diagnosis (PGD)
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    In Vitro Fertilization (IVF)

    IVF, in vitro fertilization, was first performed successfully in the United States at the Jones Institute for Reproductive Medicine, Eastern Virginia Medical School. Our specialized IVF team includes reproductive endocrinologists, IVF nurse coordinators, IVF laboratory specialists, and andrologists. The combined efforts of these individuals are responsible for our superior pregnancy IVF success rates.

    In vitro fertilization ( IVF ) is a process that involves the use of medications ( FSH ), to stimulate the development, growth, and maturation of eggs located within follicles on the ovaries. FSH dosages are individualized for each patient; responses are carefully monitored using ultrasound and estradiol measurements.

    IVF bypasses the fallopian tubes and is therefore the treatment of first choice for most patients with damaged or absent fallopian tubes. IVF also has been instrumental in helping patients with endometriosis, moderate to severe male factor infertility, infertility of unknown causes, and many other infertility disorders.

     

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    The Donor Egg Program
    The Donor Egg Program is designed for women who have difficulty getting pregnant for a variety of reasons, or are concerned they might transmit a serious genetic disease to the baby.

    Our staff at the Jones Institute manages each couple's donor egg process including recruitment, screening, matching, and implantation.  This ensures that all donors meet our strict medical and psychological standards, as well as comply with FDA regulations.  Unless the couple has chosen the donor (such as a friend or family member), all donors remain anonymous.

    For more information on becoming a donor or recipient of donated eggs, please call 757.446.7446.  The Jones Institute offers a risk share program for donor egg services.  Please contact our business office staff for more information by calling 757.446.8944.   

     

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    Intrauterine Insemination (IUI)

     

    Intrauterine insemination ( IUI ) using the partner's or donor sperm is often a viable option for couples experiencing infertility. IUI requires that the female produce and ovulate viable eggs that travel unimpeded through the fallopian tubes and are capable of being fertilized by sperm. IUI is sometimes used as a "first line" infertility treatment in combination with ovulation inducing medications such as clomiphene citrate ( Clomid ) or FSH ( Gonal - F or Follistim ).
    Indications for IUI include:

    IUI is a painless procedure that requires only a few minutes to perform. If the partner's count is low, his sperm can be collected, specially prepared, washed, concentrated, and placed into the uterine cavity. ( Unwashed sperm should never be placed directly into the uterus as fatal allergic reactions can occur. )

    In cases of moderate to severe male factor infertility, in vitro fertilization (IVF )) is the treatment of first choice. Per cycle, success rates with IVF are usually higher than IUI, and many patients opt for IVF as the first line treatment. IUI is less expensive per cycle than IVF, meaning some patients can afford more attempts; however, statistically the chance of conception from two IVF attempts is significantly higher than three to four IUI cycles.

     

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    Andrology Laboratory

    Male factor infertility is a contributing factor in approximately 45% of infertility cases. Therefore, the male partner should receive a thorough evaluation by a laboratory experienced in diagnosing male factor infertility.

    The Jones Institute Andrology Laboratory, established in 1980, is one of the premier laboratories in the United States designed exclusively for clinical laboratory evaluations of male infertility. It was one of the first reproductive laboratories in the nation to achieve certification by the Health Care Financing Administration mandated by the Clinical Laboratory Improvement Amendments of 1988 ( CLIA - 88 ).

    We continuously research new methods of evaluating male infertility, are familiar with the most recent discoveries in the specialty, and use the most updated methods / techniques of evaluation and performing laboratory tests. Many methods currently utilized in other laboratories were discovered in our Jones Institute laboratories.

    Our program is one of the few in the country employing a full - time PhD andrologist devoted solely to semen analysis, sperm cryopreservation, and male factor infertility research. Since 1980, we have performed thousands of semen evaluations for Jones Institute patients and others throughout the world.

    We consider every evaluation as unique as the patient being evaluated. We use our experience and expertise to insure that our methods and results are as updated, accurate, comprehensive, and informative as possible. Our reports are accompanied by an interpretation useful for clinicians and patients, as well.

    Our laboratory director, Mahmood Morshedi, PhD, HCLD, CTBS, has been with the Institute since 1989. He has published numerous studies in scientific journals and is an authority on male infertility and laboratory evaluations for male infertility.

    Additional services provided by the cryopreservation laboratory include sperm cryopreservation, providing donor sperm, cryopreservation of various other tissues, and long term storage of tissues ( including sperm ) cryopreserved elsewhere.

    Cryopreservation

    The Andrology Laboratory operates a separate comprehensive sperm / tissue cryopreservation laboratory as well as a donor sperm program to assist couples who desire to have children through artificial insemination using a male donor ( AID ).

    Our donor program began in 1985 as one of the first cryopreservation laboratories in the United States to achieve CLIA certification. We offer sperm cryopreservation services:

    These services offer couples the hope of having children in the future even if the male partner's ability to produce viable sperm is impaired. We also provide services for the long term storage of various samples cryopreserved elsewhere. Our special vapor phase storage facility is the best system available for preventing cross contamination of various samples that may be positive for infectious diseases.

     

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    Ovulation Induction (OI)

    Ovulation induction refers to the administration of medications to stimulate ovulation. These medications range from oral Clomid to FSH ( gonadotropins ) or combinations of the two. Gonadotropins are injected ovulation stimulating hormones ( FSH ) that are replicas of the hormones produced by the body.

    Many medications are utilized for ovulation induction. They include Clomid, Metformin, Parlodel, and FSH ( Gonal - F, Follistim, Bravelle and Repronex ). FSH is used in IVF cycles when many eggs are required for assisted reproductive technology ( ART ) procedures. The most commonly used gonadotropin at the Jones Institute is produced from recombinant DNA technology and is identical to the hormone secreted by the pituitary gland.

    The purpose of ovarian stimulation with FSH is to yield multiple healthy fertilizable oocytes for ART. Transfer of multiple embryos significantly improves the pregnancy rate over single embryo transfers. Excess embryos also can be cryopreserved for future transfers.

    At our institute, ovarian stimulation is individualized to meet patient needs based on age, prior IVF attempts, and cycle day - 3 levels of FSH, LH, and E2. We do not have a "universal" protocol for all patients, but rather individualize the protocol and the dosage of hormones based on the individual patient.

     

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    Embryology Laboratory

    The Assisted Reproductive Technology ( ART ) Laboratories of the Jones Institute are dedicated to the application of the highest quality of patient care in the treatment of male and female reproductive problems, the prevention of inheritable birth defects, and the scholarly pursuit, dissemination, and application of new knowledge in the reproductive sciences.

    Under the directorship of Jacob F. Mayer, PhD, HCLD, an internationally known authority on embryology procedures, our laboratories are designed and staffed to assure the highest standards of excellence. We utilize a team approach which allows us to use our combined experience in conducting ART procedures.

    Estella Jones, MS, laboratory supervisor, has experience in a wide variety of laboratory procedures including radio - immune assay, molecular biology, and male reproductive biology. She was awarded the "1998 LIFE Award for Original Research" from Serono Laboratories.

    Our staff collectively has more than 35 years of hands - on experience in clinical ART procedures. Among these are the first experience in the United States with intracytoplasmic sperm injection ( ICSI ) in 1987, fifteen years of experience in embryo cryopreservation, and the first successful birth in the United States using preimplantation genetic diagnosis ( PGD ), a procedure that removes a few cells from the embryo for genetic testing. We are noted for our "breakthrough" research on the use of ultra pure air filters in the embryology laboratory.

    We offer state - of - the - art fertility treatments, including but not limited to in vitro fertilization ( IVF ), embryo cryopreservation, intracytoplasmic sperm injection ( ICSI ), assisted hatching, testicular or epididymal sperm aspiration, and preimplantation genetic diagnosis. We have the latest equipment available including a computerized semen analyzer, two cell freezers, and two CO2 incubator chambers. We have a separate specialized laboratory dedicated to micromanipulation procedures, such as ICSI.

    Laboratory conditions are strictly controlled with meticulous attention to detail. Extensive water filtration systems remove both organic and inorganic substances from water before utilized for embryo development. Our laboratory was the first to prospectively evaluate high purity air filtration systems ( Coda Filtration System ) specifically designed for incubators. Our research study demonstrated significant increases in pregnancy rates when the filtration system was utilized.

    The Jones Institute has a separate full service andrology laboratory which offers detailed semen analysis and preparation for IVF, IUI, and storage using the most current and accurate procedures. We also maintain a donor semen bank.

     

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    Endocrine Laboratory
     

    Patients arrive at the Jones Institute every morning to have their blood drawn for testing. The Reproductive Endocrinology Laboratory is located on the second floor of the Jones Institute. We accommodate physicians and nurses who require a quick turnaround report of blood results to make timely decisions concerning IVF patients' care. We utilize both estradiol serum levels and follicular ultrasound measurements to individualize each patient's treatment protocol.

    For more than 20 years, our laboratory has offered seven - day service to in - house physicians and our colleagues in the community who utilize our services as a reference laboratory. The laboratory is CLIA certified and performs hormone assays for men and women, which include estradiol, leutinizing hormone, and follicle stimulating hormone, progesterone, 17·0H progesterone, testosterone, quantitative pregnancy test, prolactin, thyroid stimulating hormone, and DHEAS assays.

    We provide physicians with results for both clinical and research use in reproductive endocrinology. These quality controlled tests are used to monitor IVF, ovulation induction, donor egg recipients, and donors' cycles; to diagnose male and female infertility; to monitor increased or decreased hormone levels present in abnormal situations; for pregnancy follow - up; or to treat patients who habitually miscarry. We also work with researchers conducting clinical trials in several therapeutic areas.

     

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    Fertility Preservation

    Preserving Fertility Before Cancer Treatment

    Cancer will affect approximately 1 in 50 women and 1 in 70 men by the time they reach their 39th birthday. Similarly, 1 in 500 children will be diagnosed with a form of childhood cancer. Fortunately, advances in cancer treatment have increased survival in all of these patients.

    Who is a Candidate for Fertility Preservation?

    The Jones Institute treats all patients (children, adolescents, adult men and women) who are faced with the use of chemotherapy or radiation therapy, trauma (spinal cord injury), chronic diseases (multiple sclerosis, diabetes, etc.), surgery (vasectomy, ovarian removal for benign diseases such as endometriosis and ovarian cysts) that may alter their fertility, whether they have a diagnosis of cancer or other life-altering disease, and to fulfill a patient’s desire to preserve/extend reproductive life.

    Download this page in PDF format


    What are the Techniques to Preserve Fertility?

    For Females:

    For Males:

    Fertility preservation should be considered along with your cancer treatment and your overall health. We recommend you make an appointment with us and your primary care physician to discuss pre-treatment and post-treatment options.

    Together we may be able to make a difference in your life ... and in your future fertility.

     

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    Fertility and Reproductive Surgery
    View images of the daVinci robot
    and photos from the microscope ( PDF )

    Surgery remains an important step in the treatment of infertility, particularly when the uterus is abnormally shaped, fibroids or polyps are present, or there is internal scarring.

    Robotically Assisted Reproductive Surgery

    Jones Institute doctors are the first in the Tidewater area to perform gynecologic laparoscopies with the assistance of the "da Vinci" robot at Sentara Norfolk General Hospital. Over the last two decades, minimally invasive surgery has become increasingly popular and has been demanded by both surgeons and patients.

    Its benefits lie predominantly in reducing pain and providing a more rapid recovery for patients compared to traditional surgery. In addition to providing magnification, laparoscopy avoids tissue dying, foreign body contamination, tissue abrasion from packs and bleeding from an incision.

    These factors improve healing and decrease postoperative complications. The use of a controlled robot has the potential to enhance surgical precision. Robot - assisted procedures do not differ from the standard laparoscopy, but they have a superior three - dimensional view of tissue as well as better maneuverability of surgical instruments.

    Surgery can also be effective in reversing tubal ligation ( reopening "tied" tubes ). Whether or not tubal

    reversal is possible depends upon many factors including patient age and how the tubes were " tied. " Not every surgery is reversible, but many are and acceptable pregnancy rates can occur. Tubal reversals in females over 37 years of age are rarely effective; therefore, IVF is usually recommended.

    IVF has replaced many surgical treatments for infertility. For instance, although elaborate surgeries were devised to repair fallopian tubes damaged by infection, they are rarely done today. This is because the chance for pregnancy with one IVF cycle is higher than the chances after tubal surgery.

    Endometriosis is another condition where IVF may be a better choice than surgery. Endometriosis is a common condition in which the type of tissue that lines the inside of the uterus implants outside the uterus in the pelvic area. It can cause pain and always seems to lower fertility.

    Surgery may alleviate pain caused by endometriosis, but surgery for endometriosis rarely improves fertility. Women with the mildest degree of endometriosis can remain infertile when all the visible implants ( endometrial tissue ) have been removed. This fact is not widely accepted by many obstetrician / gynecologists and patients with endometriosis; consequently, patients should see a reproductive specialist as soon as diagnosed with endometriosis.

    Surgery usually improves the chances for pregnancy if the uterus is deformed or if fibroids or polyps are present. Most surgeries can be performed laparoscopically, reducing the potential for scarring and decreasing recovery time. When the uterus is severely diseased or absent, a surrogate can carry the pregnancy to term.

     

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    Intracytoplasmic Sperm Injection (ICSI)

    Although cases presenting with mild sperm abnormalities can be successfully treated by "classical" IVF, today intracytoplasmic sperm injection ( ICSI ) offers a new dimension of therapy for all the moderate and more severe forms of male infertility. Indications for ICSI include:

    The Jones Institute was the first to perform pre - clinical and clinical trials with ICSI. This followed extensive animal experimentation and approval of ethical guidelines dictated by the Institutional Review Board of Eastern Virginia Medical School. Because of the high incidence of male infertility and the outstanding success of the technique, currently we perform ICSI in 40% of all IVF cases. For this technique, success has to be assessed both in terms of fertilization and pregnancy outcome.

    For all patients considered in the past year, the overall fertilization rate ( number of eggs fertilized following ICSI / number of eggs micromanipulated ) was 77%; 94% of patients from ICSI cycles reach the transfer step, and 32% of cycles had excess embryos that were cryopreserved. Fertilization and pregnancy outcome after ICSI were unaffected by the type or degree of sperm abnormality; we also have obtained similar results with sperm derived from the ejaculate, epididymis, or testicular tissue. Review our IVF success rates with ICSI.

    There are probably several thousand babies born worldwide through ICSI. Worldwide registries note that in 97% or more of the times that ICSI results in delivery of normal healthy babies. These numbers are probably very close to the results achieved in standard IVF therapy and probably not far from natural reproduction.

    However, we are learning more and more about incidences of chromosomal / genetic problems in the infertile man. New techniques are being developed; statistics quote approximately 10% incidence of genetic or chromosomal abnormalities in men with either severely low sperm counts ( oligospermia ) or lack of sperm in the semen ( azoospermia ). For this reason, and in addition to performing a chromosomal evaluation of the fetus ( baby in the uterus ) in early pregnancy either by chorionic villus sampling or amniocentesis, the Jones Institute recommends a genetic consultation.

    Intracytoplasmic sperm injection ( ICSI ) research has focused on the impact of ICSI on the meiotic spindle. The spindle is a "web like" intracellular structure that is crucial for normal chromosome alignment and separation during fertilization. We now use a highly specialized imaging system for ICSI procedures, which allows us to visualize and avoid damaging the meiotic spindle. Extensive research indicates that overall there is no increase in the rate of birth defects or other abnormalities after the ICSI procedure.

    However, there is some concern that ICSI could increase the incidence of male infertility in offspring and that it could enhance the occurrence of rare sexual chromosomal abnormalities. In nature, the most viable sperm reaches and fertilizes the egg; however, in ICSI, sperm are manually selected thus bypassing this natural selection process. Clinical data are not yet available to conclusively rule out this possibility. We recommend that men with severe oligospermia or non - obstructive azoospermic undergo a baryotype ( blood chromosomal analysis ) and an examination of presence / absence of microdeletions of a Y - chromosome. Genetic counseling is offered as appropriate.

     

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    Preimplantation Genetic Diagnosis (PGD)

    Preimplantation genetic diagnosis ( PGD ) allows screening of embryos for specific genetic diseases / chromosomes before the embryos are placed in the uterus. PGD is primarily used to evaluate known carriers of specific single - gene defects, such as cystic fibrosis, or for specific chromosomal abnormalities such as trisomy 21 / Down's Syndrome, Turner's Syndrome, and specific unbalanced translocations. Transferring "screened embryos" lacking the genetic defect makes it extremely unlikely that the disease could be passed to the child.

    PGD is possible because of the advances made in IVF. The eggs are retrieved and fertilized with the partner's sperm, often utilizing intracytoplasmic sperm injection ( ICSI ). Once the embryo reaches the six to eight cell stage, one or two cells are removed ( biopsied ). For single gene defects, the DNA is analyzed by making multiple copies of the suspected gene by a technique known as the polymerase chain reaction ( PCR ). Unaffected embryos are selected to be transferred to the uterus.

    PGD also is used to evaluate the embryo cells for abnormal numbers of specific chromosomes ( aneuploidy ). A normal embryonic cell has 23 chromosomes from the mother and 23 chromosomes from the father yielding 46. Sometimes the dividing cells do not equally distribute their chromosomal complement. This occurs more often as the age of the mother increases and is one of the reasons why fertility declines with increasing female age.

    Chromosomes most commonly involved in miscarriages or live birth abnormalities ( such as chromosomes 13, 21, 18, X and Y ) can be counted. In the photomicrograph shown, you can see the nucleus of a biopsied cell ( blue "globe" ) with the fluorescent red, green, and yellow spots within the nucleus demonstrating chromosomes 13 / 21 ( red ), 18 ( aqua ), X ( green ) and or & Y ( yellow ).

    The technique utilized in this example and process is fluorescent in situ hybridization or FISH. FISH can be used to screen up to nine chromosomes in a cell from the developing embryo; this encompasses approximately 85% of the chromosomal abnormalities seen. Currently, technology makes it difficult to screen all the chromosomes in a cell removed from the embryo, but the Jones Institute has and will continue to investigate other methods that will make complete chromosome screening possible in the future.

    The FISH technique also can be used to evaluate specific chromosome structural rearrangements known as translocations. When a person carries a balanced translocation, the offspring are at risk of having an unbalanced translocation resulting in either extra or missing pieces of the involved chromosomes. Many times, this could result in multiple implantation failures, miscarriages, or severe abnormalities at birth.

    One of our first PGD successes was Brittany Abshire, who was the first child in the world born after PGD to rule out Tay - Sachs disease. This procedure was performed at the Jones Institute.

    Patients who might benefit from PGD include:

    A partial list of the genetic diseases presently evaluated at the Jones Institute includes:

    We test for many additional diseases not listed here. For more information and to discuss your situation, please contact Sue Gitlin, PhD, at ( 757 ) 446-7168.

     

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    In Vitro Fertilization - IVF - Success Rates
     



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