Assisted Reproduction

Cutting-edge fertility program at UH emphasizes options, convenience, support for patients

UH Clinical Update - November 2017

 Rachael Weinerman, MD

Patients having trouble conceiving and carrying a pregnancy to term have access to all the services they need in one convenient location at University Hospitals Ahuja Medical Center.

“We have our own lab and an operating room attached to the office,” says UH fertility specialist Rachel Weinerman, MD. “All procedures are done here. Having everything in this office means patients don’t have to go to multiple places.” If they wish, patients can also be seen for office visits and routine monitoring at main campus and UH Westlake Health Center.

Dr. Weinerman and her colleagues offer fertility treatments ranging from the straightforward and relatively low-tech to the more extensive and cutting-edge. When no obvious cause of infertility is found -- which happens about 30 percent of the time-- couples typically start with cycles of oral ovulation-stimulating drugs paired with timed intercourse or intrauterine insemination (IUI).

“About 25 percent of patients with unknown causes of infertility will get pregnant with IUI if we try it for three or four months,” Dr. Weinerman says.

If that is unsuccessful, patients progress to in vitro fertilization (IVF), assisted by intracytoplasmic sperm injection (ICSI).

“We are offering all the cutting-edge technologies that exist right now in the field,” Dr. Weinerman says. “We are doing ICSI, where the sperm is put directly into the egg. But what’s most cutting-edge in IVF right now is pre-implantation genetic diagnosis and pre-implantation genetic screening where we can biopsy the embryo and test its genetic contents before we put it back. It allows us to detect genetic diseases in the embryo if the couple are carriers. We can also screen embryos to make sure they have a healthy number of chromosomes.”

Many IVF cycles are completed with frozen embryos, Dr. Weinerman says, which allows the time for the pre-implantation testing and for some patients creates greater odds of success.

“When we do a fresh IVF cycle, we give the woman high doses of hormones to grow a lot of eggs,” she says. “Traditionally, we’ve taken those eggs, fertilized them and put them back into the uterus right away. What we’re seeing now, though, is that the environment following hormonal stimulation may not be optimal for the embryo to grow. There is a growing movement to freeze the embryos, wait until the woman’s body has recovered from the excess hormones and then put the embryos back when the uterus is more naturally prepared. I have done a lot of research in this area, including in animal models. In those models, we do see differences in embryos that are born following the super-ovulated environment compared to a more natural environment.”

IVF success rates at UH are on par with national averages, and are between 30 and 50 percent for most women, Dr. Weinerman says.

Beyond these procedures, UH fertility specialists work to assist with reproduction in other ways.

“We have a very large third-party reproduction division,” Dr. Weinerman says. She and her colleagues facilitate access to sperm banks and agencies that represent women choosing to be egg donors or gestational carriers.

“The other cutting-edge technology we currently offer is egg freezing – being able to do fertility preservation for any reason,” Dr. Weinerman says. “In 2012, the American Society for Reproductive Medicine evaluated the data. It concluded that there were enough babies born from egg freezing that it was not considered experimental anymore. Now we are seeing many women taking advantage of this option for many reasons. There are women in their early or mid-30s who haven’t found a partner and want to preserve the option of having biological children. Some have cancer or other medical conditions that don’t allow them to get pregnant currently but want to in the future.”

With all the fertility treatments available at UH, Dr. Weinerman says, there is a clear-eyed focus on what can often be the substantial financial costs. The program has an on-site financial counselor to help patients navigate the financing options for medications and other treatments. Patients can also apply for support from the Partnership for Families, a foundation founded by UH fertility specialist James Goldfarb, MD.

“We are extremely aware of the cost and try to make it as affordable as possible,” Dr. Weinerman says. “There are programs that we participate in to help patients have access to IVF who may not be able to afford it otherwise. Through Partnership for Families, patients doing egg freezing and IVF for cancer or genetic disease or couples who have already paid for an IVF cycle and have failed may qualify for a grant for a free IVF cycle.”

“For some couples, extensive treatment may not even be necessary,” Dr. Weinerman adds. “There are some treatments we can offer that may not be as expensive as patients expect. IUI and oral medications are fairly inexpensive. It is important for patients to understand there are options for them to see a fertility doctor even if they think they can’t afford it.”

For more information about fertility services at UH or to make a referral to Dr. Weinerman or one of her colleagues, please call 216-285-5028 or visit the UH Fertility Center. Patients can also join the University Hospitals Fertility Center Facebook group for more information.

The UH Fertility Center, headquartered at UH Ahuja Medical Center in Beachwood, provides leading-edge technology in a patient-friendly suburban location. Satellite fertility centers on the Westside and in University Circle are available for patient convenience.

The UH Fertility Center also provides financial support for qualifying patients through the Partnership for Families program. Advanced male and female infertility therapies and services available at the UH Fertility Center include:

• Medications to stimulate ovulation
• Minimally invasive reproductive surgery to treat scarred tubes and microscopic uterine anomalies, and to reverse previous tubal sterilization and more
• Intrauterine insemination
• In vitro fertilization (IVF)
• Egg freezing
• Intracytoplasmic sperm injection
• Preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS)
• Sperm extraction
• Donor insemination
• Egg donation
• Gestational surrogacy
• Fertility preservation for cancer patients (sperm and egg freezing)

UH Fertility Center locations:

UH FERTILITY/MATERNAL FETAL CENTER
UH AHUJA MEDICAL CENTER
Kathy Risman Pavilion
1000 Auburn Drive, Suite 310
Beachwood, Ohio 44122
216-285-5028

UH MACDONALD WOMEN’S HOSPITAL
11100 Euclid Avenue, Suite 1200
Cleveland, Ohio 44106
216-844-1514

UH FERTILITY/MATERNAL FETAL CENTER WEST
Crocker Corporate Center
2055 Crocker Road, Suite 206
Westlake, Ohio 44145
440-808-5100