A Note From Doctors Chandler and Fogarty

Dear Infertility Patient:

We have put together the information below to help you understand infertility, the tests involved, the cost, and what you can expect throughout this process. Before looking through this material, you must understand two basic aspects of infertility. First, have patience. Things rarely happen as fast as you would like. Second, timing and instructions are crucial.

Most infertility patients will have 2-3 appointments a month while actively trying to achieve pregnancy. All infertility patients will have help with ovulation timing and serial ultrasounds to follow their egg development and endometrial lining progression.

A series of tests will help identify your source of infertility. Evaluation begins with a blood test and semen analysis. These may be followed by office tests, and surgery if necessary. If you have questions about medications or procedures, please ask. Taking medicine incorrectly often leads to a delay in achieving pregnancy.

We hope you find your experience with our office to be satisfactory. Our staff has your best interest at heart. Some
couples may need advanced methods that are not provided in Joplin. We work with excellent clinics in Tulsa and Kansas City, and we will assist you in that endeavor; if necessary.

Together, the staff of OB/Gyn Associates of Joplin would like to be an integral part of achieving the family you desire.

Sincerely,
Drs. Chandler and Fogarty

ROUTINE COSTS OF INFERTILITY CARE

Doctor Visits
Doctor visits are billed like a gynecologic visit. At first your insurance will often cover this service. If not, you will be responsible for the costs. On days when you have an ultrasound for follicular development, we do not charge to see the doctor.

Ultrasound - $150.00

Lab Tests
Most insurance companies cover many of the lab tests but not all of them. You may receive a bill from the lab for some of these tests, but this varies by insurance carrier.

Semen Analysis - $105.00
Some insurance companies cover the cost of this test, but some do not. Forty percent of infertile couples have male factor infertility, which is identified by semen analysis.

Hysterosalpingogram (HSG)
HSG is a radiographic test that determines if your tubes are open.

Hysteroscopy/Laparoscopy
This test can be very expensive, and we make every effort to have it covered by your insurance company. Usually these tests are justified for reasons like pelvic pain, abnormal bleeding, and abnormal ultrasound results. This allows us to bill your insurance company if it does not cover infertility.

Post-Coital Test
This test is only performed once.

Intrauterine Insemination (IUI) - $150.00 IUI - $150.00 Sperm Washing
If this route is chosen, the procedure will be performed for three consecutive cycles or until pregnancy is achieved.

Phone Consultation - Free
The nursing staff does phone consultations. The nurses are knowledgeable in infertility and will answer your questions. Phone consultations are encouraged if questions arise. Delays in pregnancy are common when the patient does not understand the process.

To learn more about these procedures, log on to www.freemanhealth.com.

Prices are subject to change.

MEDICATIONS

Clomiphene (Serophene or Clomid)
Clomiphene is an oral, tablet used to improve ovulation. The medication helps your body produce more of its own follicle stimulating hormone (FSH) for the ovulation process. FHS stimulates the ovaries to produce more follicles with the eggs eventually released through ovulation.

Many ovulation disorders are successfully treated with Clomiphene. About one third of patients will become pregnant with Clomiphene. The majority of these patients will become pregnant within the first three to four ovulatory cycles.

There is not an increased risk of genetically abnormal infants or congenital abnormalities in infants conceived with Clomiphene.

Gonadotropin Therapy
Gonadotropins (Gonal-F, Pergonal, Repronex, Humagon) are fertility medications containing FSH and/or luteunizing hormone (LH). Gonadotropins stimulate egg development within the ovaries. These medications must be administered through the skin or into the muscle.

You may undergo Gonadotropin therapy if you fail to ovulate or fail to achieve pregnancy with Clomiphene. These medications are potent and require careful monitoring by ultrasound and blood work to evaluate egg development.

There is not an increased risk of genetically abnormal infants or congenital abnormalities in infants conceived with help from these medications.

To learn more about these medications, log on to www.freemanhealth.com.

PROCEDURES

Intrauterine Insemination (IUI) - Sperm Wash
This procedure involves injecting sperm from the donor into the uterine cavity at the time of ovulation. Pregnancy rates are generally better when IUI is done in conjunction with oral or injected ovulation induction techniques.

IUI is commonly used with male factor, cervical factor, and unexplained infertility.

During IUI, a thin, flexible, sterile catheter is placed into the uterus through the cervical opening. The prepared sperm is then placed close to the ovulated eggs.

There are no restrictions on activity or intercourse after IUI. Intercourse is actually encouraged the evening of or the morning after insemination. Cramping and bleeding are minimal after this procedure.

Hysterosalpingogram (HSG)
The Hysterosalpingogram is an X-ray procedure used to study the uterine cavity and fallopian tubes. The test can diagnose abnormalities such as uterine polyps, fibroids, intra-uterine scarring, and malformations of shape and size. HSG can also detect blocked or dilated fallopian tubes.

Your physician or radiologist will perform the procedure. Radio-opaque contrast is injected into the uterine cavity and fallopian tubes and observed under X-ray. The procedure is done after menstrual flow has ended but before ovulation has begun. Cramps are common after the procedure along with slight vaginal bleeding.

To learn more about these procedures, log on to www.freemanhealth.com.

DONOR SPERM AND SPERM BANKS

There are many resources for donor sperm. Most sperm banks allow you to see detailed statistics on the donor and select sperm with physical, ethnic, and religious similarities to your families. Good infertility information is also available on the Internet.

Sperm banks we think are the best and have used with success in the past:
 
Fairfax Cryobank

California Cryobank

The following site contains helpful infertility information and provides numerous links to other useful sites:
Infertility Resources