How does your program work?
We normally offer an intake appointment with a
specialized nurse practitioner (ARNP) who will do a thorough fertility
history, gather any information from previous records and testing, and
perform a gynecologic exam, with cervical cultures. Your case will then
be presented to one of our fertility-trained physicians by the ARNP,
and an evaluation individualized to your situation will be planned.
The testing will be coordinated and followed up on
by Barbara Soto, RN, our Fertility Program nurse coordinator. Once all
testing is completed, a consultation for you and your husband/partner
will be planned with the physician, to discuss findings and
recommendations.
When should I consider an appointment for
fertility evaluation?
If you have not conceived after one year of
unprotected intercourse, it is time to have an evaluation. If you are
over age 35, you should make an appointment after 6 months of
"trying." Those with irregular, infrequent or extremely
painful periods, or who have had fertility treatment in the past,
should schedule an appointment right away.
Are there age cut-offs?
Fertility begins to decline at age 35, and
declines more rapidly over age 40. We do not generally advise beginning
a fertility assessment after age 42.
Many centers will not do ART (assisted
reproductive technology)
procedures on women over age 42, unless
donor eggs are used. We encourage women approaching 40 to move quickly
to assessment and treatment as their biological clock indeed
“ticks louder” and speeds up with age. Many women are also
unaware that the miscarriage rate increases with age, from 19% at age
30, to 25% at age 38, to 40% for women over age 40.
How soon can I be seen?
An intake appointment with one of our nurse
practitioners can generally be booked within 2 weeks. This is a one
hour appointment; please bring all records with you.
What treatments do you offer?
Our fertility services include:
– Treatment for PCO (polycystic ovaries)
with glucophage and ovulation-inducing drugs,
– Laparoscopic and hysteroscopic surgery,
including laser treatment of endometriosis,
– Male factor treatments (including
vasectomy reversal) through Dartmouth-Hitchcock Medical Center,
– Assisted Reproductive Technology (IVF,
ICSI) through linkages with super-specialists at major NE fertility
centers (see next question).
Fertility patients are offered early morning
ultrasound and lab appointments during treatment cycles, starting at 7:
30 a.m. Ultrasounds are performed in our office, 7 days per week if
necessary. Our ultrasound unit is certified by the American Institute
of Ultrasound in Medicine. Nutritional consultation, and psychological
counseling and support are available in our office.
What if I need in-vitro fertilization (IVF) or
other advanced help?
If you are in need of Assisted Reproductive
Technology such as IVF, ICSI, or other services requiring the expertise
of a specialized fertility center, we will arrange a referral
appropriate to your needs.
If you have a need for a Boston program through
geography or insurance preference, we also have a partnership with the
Reproductive Science Center of Boston. Patients having IVF thru RSC can
have many of the necessary labs and ultrasounds necessary done in our
office, minimizing the number of "out of town" trips. RSC has
an excellent program with very high success rates, and we are proud to
have a satellite relationship with them.
How will I know if it is covered by my insurance?
Insurance coverage for fertility is variable in
New Hampshire. Our Fertility Program administrator will check directly
with your carrier to verify what services are covered and what
pre-certification is necessary. She will speak directly with you as
well to clarify your coverage and potential out of pocket costs.
Do you deal with single women, or lesbian couples
who wish to conceive?
Yes, we work with both single women and lesbian
couples, coordinating and performing donor inseminations, and doing
appropriate evaluations and fertility treatment with the woman wishing
to conceive when indicated. We work with California
Cryobank
and Fairfax Cryobank for donor sperm.
Do you treat male factors?
Semen analysis is part of our initial assessment.
The sperm count can be performed in our hospital lab by specialized
technicians with extra training to assess sperm morphology in addition
to count and motility.
When the sperm count is low or in situations such
as vasectomy reversal requests, we refer to and work with Dr. Ajay
Nangia at Dartmouth-Hitchcock Medical Center, a urologist with
additional training in male fertility, a subspecialty known as
andrology.
What happens after I conceive? What about prenatal
care?
Since our doctors are general obstetrician/
gynecologists with a special interest in fertility, we delight in being
able to follow our patients through pregnancy and delivery when
fertility treatment is successful.
Our hospital – the Southern New Hampshire
Medical Center in Nashua, NH – provides family-centered care,
state of the art birthing rooms, deep jacuzzis for water comfort during
labor, doula availability, and our own lactation consultants.This
supportive care is coupled with the safety of in-house anesthesia, in
house ob/gyn residents from Dartmouth Medical School working with your
attending obstetrician, and an Intensive Care Nursery with in-house
neonatal ICU provider coverage should your baby be premature or require
extra care.
Do you have more information on specific
treatments?
