Helping Small Miracles Happen

Small helping

happen

World-class medicine,

sensitive care How IVF

works

On the road to

parenthood ‘he’s our special gift’

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Reproductive Science Center of NJ 8/11/11 11:47 AM

WE’RE HERE

for you

W E L C O M E to the reproductive science center of new Jersey (rscnJ). as a father, i recognize the strong desire to bear children, guide their growth and dream of their accomplishments. that is why every morning, there is no greater professional joy for me than to come here and share my patients’ excitement as they hear their baby’s heartbeat for the very first time. reproductive endocrinology and infertility medicine is a field that is ever evolving, which is why dr. Bromer, dr. salas mann and i find it so exciting and rewarding. our entire team of fertility treatment specialists brings years of experience, expertise and research innovations to each patient/couple’s unique circumstances. our mission is to provide our patients with compassion and respect, plus offer them the services they need to become parents. at rscnJ, our philosophy of care is to create a partnership with our patients—to give them all the information they need to make the treatment decisions that are best for their individual needs, values and timeframes. of course, our ultimate goal is always the same: a healthy baby.

Within these pages, you will learn more about our comprehensive medical, financial and psychosocial services and hear the stories of couples who have made their dreams come true at rscnJ. We welcome your calls and invite you to learn more about us by visiting www.fertilitynj.com.

Best regards, William Ziegler, d.o., medical director reproductive science center of nJ WILLIAM ZIEGLER, D.O.

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OUR

financial SERVICES

AT R S C N J , our financial specialists can help you work within your health insurance coverage and personal budget to obtain infertility treatment. even before you come for your first appointment, we will consult with you on the phone to verify your insurance information. Within a few days, we will call you back to inform you of your benefits, any co-pays and out-of-pocket expenses you can expect, and any referrals you may need. We will obtain any authorizations or pre-certification for your first visit. there will be no financial surprises when you come here for the first time.

“Patients have so many medical issues on their minds that we make every effort to take the financial stress off them,” says rscnJ practice manager donna a. riggio. rscnJ also offers self-pay options and medical financing through advanced reproductive care ® and can work within your employer’s flexible spending account.

You can rely on us to help you navigate the financial complexities of infertility treatment. We encourage you to keep in touch with our Billing department at 732-918-2500 at every step of your journey.

HELPING SMALL MIRACLES HAPPEN is PUBlisHed

BY Wainscot media, montVale, nJ. © 2011. all riGHts reserVed.

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FERTILITY SPECIALISTS HAVE SEVERAL WAYS TO FIGURE OUT HOW TO HELP YOU CONCEIVE a patient has left. these hormones include I F Y O U A R E having trouble getting follicle-stimulating hormone (FsH), which is pregnant, the physicians at the reproductive produced by the brain and is menstrual-cycle science center of new Jersey (rscnJ) can specific, and anti-mullerian hormone (amH), determine your best treatment option. First, which is produced by the ovaries and is not you’ll meet with one of our board-certified cycle specific. other endocrinopathies such reproductive endocrinologists. You can expect as thyroid and prolactin disorders as well as to spend 30 minutes to an hour discussing preconception blood work are your menstrual cycle and pregnancy performed to better guide history, plus you and your patient-specific treatment. partner’s medical and surgical an imaging test called a histories, exposure to toxins, hysterosalpingogram—during environmental influences and which a radio-opaque dye is any chronic illnesses you may be injected through a woman’s experiencing. cervix, uterus and fallopian a physical examination tubes so they can be viewed and a transvaginal ultrasound on moving X-rays—helps exam may be performed next. physicians determine if there this non-invasive test can are fibroids, polyps, scar tissue, help a woman’s physician JESSICA SALAS MANN, M.D. tubal blockages or any other see the shape, anatomy and abnormalities that would endometrial lining of her uterus. impede a fertilized egg’s journey from the one can also see ovarian cysts, uterine tubes to the uterine lining for implantation. fibroids and polyps, as well as determine the male partner’s evaluation consists the number of “resting” follicles within her of a discussion of prior vasectomy, hernia ovaries. the latter is called the antral follicle repair, diabetes or other chronic count (aFc), which gives the reproductive illnesses, toxic exposure, smoking, endocrinologist an idea of how many eggs a ejaculatory dysfunction and any woman has left that can be fertilized. other factors that might affect “as a woman ages, the approximately 1 fertility. a semen analysis to 2 million eggs she is born with decreases, will be performed by one of either because the eggs do not ripen for rscnJ’s andrologists. this will ovulation and are absorbed into the body, or indicate the quality and motility because they are not fertilized after ovulation,” (movement) of the sperm, as well says rscnJ reproductive endocrinologist as how many sperm are produced.

Jessica salas mann, m.d. “too few eggs may if a man does not produce sperm indicate advanced age or a history of radiation or produces a very low number of or chemotherapy, and can represent a sign of sperm, he may be referred poor ovarian reserve. too many eggs to a urologist for further testing could indicate that a patient may or treatment. not ovulate.”

A PRE-APPOINTMENT once all tests are in addition to the PHONE CONSULTATION completed, the patient aFc, specific blood WITH ONE OF OUR REPRODUCTIVE or couple usually tests can be performed ENDOCRINOLOGISTS CAN ANSWER schedules a visit with in order to get a MANY OF OUR PATIENTS’ MOST COMMON PRELIMINARY QUESTIONS BEFORE their reproductive sense of a patient’s THEIR FIRST VISIT. endocrinologist to “ovarian reserve,” or PLEASE CALL US AT review all options. the number of eggs that 732-918-2500.

FIRST STEPS

WHAT TO expect BEFORE YOU’RE expecting

IN COUPLES EXPERIENCING INFERTILITY, PROBLEMS ARE TYPICALLY DUE TO: • FEMALE ISSUES 40% OF THE TIME • MALE ISSUES 30% OF THE TIME • COMBINED MALE AND FEMALE FACTORS 10% OF THE TIME • PROBLEM CANNOT BE DETERMINED 20% OF THE TIME

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released, the greater chance of fertilization. if conception does not occur after three or four cycles using these oral medications, injectable medications are usually next. these medications, called gonadotropins, bypass the woman’s pituitary gland and send a signal directly to the ovaries to produce more eggs. With frequent ultrasound exams of the ovaries, ovulation can be predicted to within almost an hour.

• Intrauterine insemination (IUI): With this treatment, the sperm is washed and prepared in the rscnJ andrology laboratory, drawn up into a thin catheter and then placed through the woman’s cervix and into the uterus. iUi brings the sperm closer to an egg, thus providing a greater chance of fertilization. the doctors at rscnJ may recommend iUi alone or in combination with super-ovulation medications.

O U R C U T T I N G - E D G E P R O C E D U R E S H AV E HELPED THOUSANDS CONCEIVE ONE IN SIX —that’s the number of couples who have difficulty conceiving. But with state-of-the-art methods utilized by highly skilled reproductive endocrinologists, such as those at the reproductive science center of new Jersey (rscnJ), 90 percent of all cases of infertility can be treated. Here are some of the advanced diagnostic and treatment options our board-certified reproductive endocrinologists currently offer.

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FIRST-LINE TREATMENTS doctors often begin your fertility plan with one of these popular procedures.

• “Super-ovulation”: almost 50 percent of patients facing infertility may be assisted by this treatment, which uses oral and injectable medications to enhance ovulation and conception. to begin, the couple’s diagnostic testing must indicate that the man’s sperm is healthy and mobile. in addition, testing must show that the woman has an adequate number of good-quality eggs in her ovaries, and that her reproductive organs are structurally normal and do not contain any uterine fibroids, ovarian cysts, endometriosis of the fallopian tubes, or other abnormalities. most couples start with oral medications, called clomiphene citrate or clomid, which signal the woman’s pituitary gland to produce more folliclestimulating hormone (FsH). this hormone causes the ovaries to ripen and release more than one egg about 10 days into the woman’s monthly cycle. the couple then plans intercourse to coincide with ovulation. the more eggs

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NON-INVASIVE/MINIMALLY INVASIVE PROCEDURES if the first-line methods don’t result in a pregnancy, further insight into the structure and function of a woman’s reproductive organs may be needed.

• Hysteroscopy: during this outpatient procedure, the physician uses a lighted scope placed through the cervix to view the uterine cavity and check for abnormalities.

• Laparoscopic surgery: this minimally invasive procedure, which is performed through several small incisions above the navel, is another way to diagnose and treat abnormalities of the reproductive tract that can impede conception, fertilization or implantation.

• daVinci™ Surgical System: this robotic system takes laparoscopic surgery a step further by giving physicians greater precision and dexterity in diagnosing and treating endometriosis, blocked fallopian tubes and uterine fibroids, and in reversing tubal ligation sterilization surgeries. rscnJ’s medical director, William Ziegler, d.o., and medical associate Jason Bromer, m.d., performed the first robot-assisted tubal reversal surgeries in monmouth and ocean counties. “the robot, with its high-definition fiberoptics, superb magnification of the surgical site and flexible ‘arms’ that we manipulate through tiny abdominal incisions, helps us perform intricate microsurgical techniques that minimize tissue trauma and decrease the body’s inflammatory response during pelvic surgery,” says dr. Ziegler. “this gives us the ability to treat endometriosis and unblock tubes without causing further pelvic adhesions. We can also use the robot to remove up to 10 uterine fibroids during one outpatient surgery or to reconnect the fallopian tubes’ tiny blood vessels that were tied off during tubal ligation.” robot-assisted laparoscopic surgery holds many advantages over traditional “open” surgery. small centimeter-sized incisions, instead of a large incision, mean patients experience less pain, blood loss and surgical complications. the incisions may be covered by a simple bandage or closed with a surgical adhesive. most robot-assisted

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LOOKING AHEAD

WILLIAM ZIEGLER, D.O., JESSICA SALAS MANN, M.D., AND JASON BROMER, M.D.

surgeries do not require an overnight hospital stay, and patients usually return to their regular activities within a week.

ASSISTED REPRODUCTIVE TECHNOLOGIES For many couples who are experiencing infertility or same-sex couples who wish to build a family, an assisted reproductive technology may be the best option.

• In vitro fertilization (IVF): With this treatment, fertilization of the egg by the sperm takes place outside the woman’s body in rscnJ’s state-of-the-art embryology lab at the eatontown facility. the three major steps of iVF include: 1. Giving follicle-stimulating hormones to the woman to help her ovaries produce extra eggs. medications are also given to suppress ovulation until the timing is right. Just before ovulation, the woman’s reproductive endocrinologist retrieves the eggs from her ovaries.

2. taking the eggs to the embryology lab, where they are fertilized with a partner’s or donor’s sperm. there they grow in special cultures for three to five days.

3. transferring one or several of the fertilized embryos (the number depends on the woman’s age and medical history) back into the woman’s uterus on day three or five, where, if successful, they will implant and grow into a baby. if there are additional embryos remaining after the transfer, the patient/couple can choose to have them frozen and stored for future use. several other assisted reproductive technologies may be used at rscnJ in combination with iVF. these include: • intracytoplasmic sperm injection (icsi), which involves injecting one single sperm into an egg. icsi can assist men who have a low sperm count and women who have a low number of viable eggs.

• microepididymal sperm aspiration (mesa) or testicular excisional sperm extraction (tese), during which a urologist obtains sperm directly from the man’s reproductive tract • assisted hatching, which involves opening the shell of the embryo to improve implantation • donor sperm, either fresh or frozen • donor eggs and embryos • Gestational carriers • Pre-implantation genetic diagnosis (PGd) to screen embryos for genetic disorders using comparative genomic hybridization (cGH), the latest advance in PGd • Fertility preservation and postponement with frozen eggs and embryos (see sidebar)

PRESERVING

fertility R S C N J C A N S AV E Y O U R E G G S FOR FUTURE PREGNANCIES WOMEN WITH A FAMILY history of early menopause or who are undergoing medical care that may be toxic to their eggs or reproductive organs, such as chemotherapy and/or radiation for cancer, may choose to freeze their eggs.

While embryos have long been cryopreserved (frozen in liquid JASON BROMER, M.D. nitrogen) and then successfully thawed and used in iVF treatments, the freezing and future use of unfertilized eggs is now gaining momentum as new fast-freezing techniques (called vitrification) are able to protect delicate eggs from the formation of damaging ice crystals. cryopreserving eggs also gives healthy women who wish to delay childbearing the ability to freeze their eggs for future use. research, including that of rscnJ’s Jason Bromer, m.d., reveals that pregnancy rates are rising with the use of both cryopreserved eggs and embryos, but frozen eggs provide several advantages over frozen embryos, particularly for women who want to delay childbearing.

“Freezing eggs does not require sperm, which can make this an attractive option for a single woman,” says dr. Bromer. “in addition, it gives women the chance to use healthy, young eggs later in life when the eggs in their ovaries may be older and not viable. lastly, while there are many who are uncomfortable 00 25 . with discarding frozen embryos, there are very few 8 .91 people who have moral or ethical issues 732 • with discarding frozen eggs.”

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SUCCESS STORIES

FEELING RIGHT

‘at home’

RSCNJ’S CARING AND WELCOMING STAFF WAS JUST WHAT THE DOCTOR ORDERED What makes a couple choose a fertility center? although there are several reproductive treatment facilities in the metropolitan area, sometimes the decision comes down to a feeling. such was the case for christie and amanda Beyer of West allenhurst. “We had gone to another center and did not feel a connection,” says christie. “But when we came to the reproductive science center of new Jersey (rscnJ) on the advice of friends, we instantly felt at home with dr. Bromer and knew that he could help us build a family. We liked the fact that being a same-sex couple was not an issue at this center; everyone treated us respectfully.” christie, 33, and amanda, 27, had been a couple for five years and had been joined in a civil union for one year when they chose to pursue motherhood in January 2010. they decided that christie, who had a strong desire to bear children, would be the one to become pregnant and carry the baby. “as a nurse, i was in favor of starting with conservative ovulation medication treatments combined with insemination using donor sperm,” recalls christie. “neither one of us had tried to conceive before, and we thought it would be relatively easy.”

THANKS TO AGGRESSIVE FERTILITY TREATMENTS, A TOMS RIVER COUPLE WELCOMES A BOUNCING BABY BOY

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Unfortunately, two rounds of oral medications followed by two rounds of medication injections failed to produce a baby. diagnostic tests indicated that christie’s eggs were of poor quality, and she was probably experiencing premature ovarian failure syndrome. this condition, marked by the ovaries’ decreasing ability to produce viable eggs, can begin when a woman is in her 20s. dr. Bromer recommended iVF, but there were health insurance hurdles to overcome. “dr. Bromer and his staff took all the insurance pressure off of us so we could focus on becoming mothers,” says amanda. christie also credits the nurses at rscnJ for making her feel safe and comfortable during her fertility treatments and helping both she and amanda handle the stress that accompanied the three treatment cycles they underwent until christie became pregnant.

Finally, in august 2010, christie and amanda received the happy news that they were expecting twins. on march 11, 2011, after 34 ½ weeks of pregnancy, christie’s water broke. a boy, Jace, was delivered at 5 pounds, 2 ounces. next came a girl, Julia, weighing 5 pounds, 3 ounces. christie and amanda are eager to one day have more children. When they feel the time is right to add to their family, they say they’ll go “home” to dr. Bromer and the rest of the rscnJ staff.

elizabeth and robert Holligan of toms river don’t mind the sleepless nights that come along with caring for their baby son, Justin. “after years of trying to conceive, all that matters are Justin’s smiles,” says elizabeth.

Justin was born on november 29, 2010, thanks to fertility treatments elizabeth received at the reproductive science center of new Jersey (rscnJ). the couple first sought help from rscnJ in 2007 when elizabeth was 30. “everyone kept saying, ‘Just relax, you’re young, you’ll get pregnant,’” recalls elizabeth. “But we were concerned because we had been trying for a year.” despite extensive diagnostic testing, it was unclear why the Holligans couldn’t conceive. no matter: that didn’t mean there wasn’t a solution. “my best friend had just become pregnant with iVF administered by dr. Ziegler of the center, so i was completely familiar and comfortable with this treatment and wanted to try it.” the couple happily learned that their insurance policy covered four iVF cycles.

But the road to parenthood was a bumpy one for the couple. the hormone medications and injections necessary for producing extra eggs and timing ovulation made elizabeth experience hot flashes, mood swings and weight gain. the Holligans’ first iVF cycle was unsuccessful; neither of the two embryos fertilized in rscnJ’s lab and transferred to elizabeth’s uterus had implanted.

Using frozen embryos saved from the first iVF cycle, they tried a second time. But this attempt only produced a “chemical pregnancy.” that meant that although early blood tests indicated that elizabeth was initially pregnant by the count of certain hormones, neither of the embryos that had been transferred into her uterus matured into a “clinical pregnancy,” which is defined as the presence of a gestational sac that can be visualized on an ultrasound exam and a heartbeat that can be heard at about eight to nine weeks’ gestation. “i was devastated because we had used up all the 30 eggs that had been retrieved during my first iVF attempt,” says elizabeth. “But dr. Ziegler was hopeful, so we started all over again.” after two more attempts at iVF, elizabeth found out she was pregnant on april 3, 2010, after receiving a call from a rscnJ nurse. she delivered Justin at a healthy 7 pounds, 5 ounces. “every day i look at Justin and feel grateful for dr. Ziegler and his staff for the special gift they gave us,” says elizabeth.

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YOUR CHOICE

AND

twins MAKE five!

IN VITRO FERTILIZATION HELPS A JACKSON COUPLE COMPLETE THEIR FAMILY after conceiving her first two children naturally and easily, Jessica Podlas of Jackson didn’t anticipate any difficulties when she and her husband, rich, decided to try for baby number three in 2005.

However, after two years of trying to conceive with home ovulation kits and other over-the-counter products, nothing happened. the couple sought help from the reproductive science center of new Jersey (rscnJ). diagnostic tests of both Jessica and rich revealed that rich had a low sperm count, possibly from handling chemicals during the course of his work in a sewer division. Because the couple’s health insurance plan covered in vitro fertilization (iVF), they chose this method.

“We were successful after our first iVF cycle,” says Jessica. “our daughter, summer, was born on december 3, 2007.” satisfied that their family was complete, Jessica underwent a tubal ligation, only to change her mind two years later. the couple returned to dr. Ziegler for iVF. iVF is an ideal treatment option for women who have undergone a tubal ligation and then decide they want more children. during iVF, the egg does not pass through the fallopian tube, but instead is fertilized with sperm by an embryologist in rscnJ’s lab and then placed into the patient’s uterus, where it implants and grows. during Jessica’s third iVF cycle three fertilized embryos had been implanted, and when the Podlases went for their first ultrasound check-up, two distinct embryos could be seen. although Jessica experienced complications that caused her to go into labor at 29 weeks of pregnancy on January 29, 2011, today her twins, richard Jr. (r.J.) and Gia ann, are thriving. “dr. Ziegler and his entire staff helped us build the family we always wanted,” says Jessica. “We are grateful for the personal touch of everyone at the center.”

WHY

RSCNJ? A D VA N C E D M E D I C I N E A N D P E R S O N A L I Z E D C A R E E Q U A L S R E S U LT S W O R L D - C L A S S M E D I C I N E isn’t all you’ll find at the reproductive science center of new Jersey (rscnJ). our staff is also dedicated to providing you with sensitive, compassionate care throughout your journey toward parenthood. rscnJ offers comprehensive diagnostic, treatment and research services in two state-of-the-art facilities in eatontown and toms river. our reproductive endocrinologists, physician assistant, registered nurses, on-site embryologists and andrologist, medical assistants, financial specialists, support staff and office personnel are committed to finding answers and developing an individual treatment plan.

Because infertility presents many physical, emotional and social challenges, we also offer psychological counseling with a licensed clinical social worker. our physicians are on the medical staffs of seven hospitals and one surgical center in monmouth and ocean counties. rscnJ is a member of • Infertility evaluations and treatment the american society for reproductive • Advanced ultrasound pelvic examinations • Semen analysis medicine and the society of assisted • Super-ovulation with ultrasound reproductive technologies; was monitoring named a center of excellence by • Artificial insemination United Healthcare; was the first • Advanced robot-assisted and laparoscopic infertility practice in ocean and reproductive surgery monmouth counties to be approved • Tubal ligation reversal by the Better Business Bureau; and • Hysteroscopy received the Zenith award from • In vitro fertilization (IVF) resolVe of new Jersey. our medical • Preimplantation genetic diagnosis (PGD) director, William Ziegler, d.o., has been with comparative genomic hybridization (CGH) named a “top doc” several times by • Assisted hatching New Jersey Monthly magazine.

• Intracytoplasmic sperm injection (ICSI) our eatontown and toms river • Blastocyst transfer offices are open 7 a.m. to 4 p.m.

• Cryopreservation of eggs and embryos monday through Friday, select late • Medical and surgical treatment for tubal nights until 7 p.m., and on weekends pregnancies for cycling patients and new 0 • Endocrinology and endometriosis 50 patient appointments. treatments 8.2

OUR SERVICES

• Donor sperm and donor eggs • Gestational carriers

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Helping Small Miracles Happen • COMPREHENSIVE FERTILITY CARE • TREATMENT FOR RECURRENT PREGNANCY LOSS • ADVANCED/ROBOTIC REPRODUCTIVE SURGERY • INTRAUTERINE INSEMINATION (IUI) • IN VITRO FERTILIZATION (IVF) • INTRACYTOPLASMIC SPERM INJECTION (ICSI) • DONOR EGG • PREIMPLANTATION GENETIC DIAGNOSIS (PGD) • IVF/DONOR EGG REFUND PROGRAM Dr. William F. Ziegler, Dr. Jessica Salas Mann and Dr. Jason G. Bromer

RSC-NJ is the first infertility practice in Ocean/Monmouth County to be approved with the BBB.

RSC-NJ is the first CAP/FDA approved lab in Ocean/Monmouth County.

RSC-NJ is a member of SART, the primary organization of professionals dedicated to the practice of assisted reproductive technologies (ART) in the United States.

Dr. William Ziegler was voted Top Doc by New Jersey Monthly Magazine in 2007.

RSC-NJ is proud to be a member of the American Society for Reproductive Medicine (ASRM).

Reproductive Science Center of NJ DR. WILLIAM F. ZIEGLER • DR. JASON G. BROMER • DR. JESSICA SALAS MANN FERTILITYNJ.COM • TOMS RIVER, NJ • EATONTOWN, NJ • 732-918-2500

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