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Obstetrics and Gynecology

Center for Reproductive Endocrinology and Infertility

Overview

At the Center for Reproduction and Infertility at Tufts Medical Center, we provide advanced, specialized care with a contemporary approach to women’s health care. We offer a full range of testing and treatment services for infertility, hormone problems, endometriosis, fallopian tube damage, menstrual pain and irregularity, and more.

Our success is achieved through many years of experience in the field of reproductive endocrinology and infertility and a personal, compassionate approach to treating each patient, male and female, based on his or her individual needs, concerns and desires.

Our program is affiliated with Women & Infants Hospital of Rhode Island, an internationally recognized leader in women’s and newborn health and a teaching affiliate of The Warren Alpert Medical School of Brown University.

Why Choose Us?

Here are 10 good reasons:

1. Record of Success

Since 1989, the fertility specialists at Tufts Medical Center have helped couples living in Massachusetts and Rhode Island achieve pregnancy though options ranging from assisted fertility techniques including in vitro fertilization, to corrective surgery, to treatment for male infertility, to medical management of various female reproductive disorders.

Over these two decades our specialists helped patients conceive and deliver thousands of children. It is a matter of record. The fertility specialists at Women & Infants have consistently produced in vitro fertilization (IVF) pregnancy rates that are highly competitive nationally with some of lowest rates for multiple pregnancies in the region.

Of the clinic's total pregnancies, approximately 2/3 came from IVF and 1/3 came from corrective or reconstructive surgical procedures, treatments to male partners, or medical management of various female reproductive disorders that do not require IVF.

For 2005 Center for Disease Control Prevention Report, click here.
For annual reports since 1994, click here.

2. Well-Known Specialists

Specialists caring for patients at Tufts Medical Center have earned international reputations for their career long contributions and experience in the field of reproductive medicine. They have or currently do serve as officers, committee and board member in numerous national and international academic and professional organizations. They have published hundreds of original research papers, reviews, book chapters, and books in their fields.

3. Experienced Team

Experience counts when seeking fertility assistance. The clinical and laboratory team working at Tufts Medical Center has an accumulated experience of more than 100 years in the field of Reproductive Medicine. Collectively, this knowledge and experience translates to a secure and incomparable experience in a more compact and very personal environment...with the most positive outcome possible.

4. Established Clinical Experience

All of our specialists are certified by the American Board of Obstetrics and Gynecology in the general specialty and also the subspecialty of Reproductive Endocrinology and Infertility. Members of our team have also been recognized for over 12 years by Best Doctors in America, by Good Housekeeping as 401 Best Doctors for Women, the Consumers' Research Council of America's Guide to America's Top Obstetricians and Gynecologists, and have appeared regularly in regionally published "Top Doctors" lists.

5. Care for Couples

Male infertility contributes to approximately half of the all cases of infertility. We partner with a renowned and highly experienced andrology group at Boston University offering expert evaluation in diagnosis and treatment of male fertility issues.

6. Diverse Treatment Options

In vitro fertilization (IVF) does not fit all. We are far more than an IVF clinic, and IVF is not our only business. IVF is an effective treatment, and we are highly experienced with it. We are open to and pleased to offer a variety of other effective treatments that do not necessarily involve IVF when the patient is better treated by other methods. We are experienced at making these choices. A successful pregnancy starts with a thorough evaluation and comprehensive visit. These occur typically within two weeks of your first contact with our office.

7. Academic Center

Our specialists are experienced with both standard and highly specialized interventions that may be required to produce pregnancy. As an academic center, our specialists have unique and extensive surgical experience required for the treatment of extensive endometriosis, fibroid tumors, or reproductive anomalies. They are also highly experienced in the treatment of various female endocrine disorders, which may be associated with infertility. As a training center approved by the American Board of Obstetrics and Gynecology to train fellows in Reproductive Endocrinology, we are expected to serve our patients at exemplary standards.

8. Personalized Care

Ours is a team approach to care. Each of our patients will most likely see all of our physicians at some point during their journey. All of us will know who you are, we will have heard about your concerns, and we will support you in attaining your goals.

9. Practice Philosophy

Our success stems from a sincere and passionate commitment to helping all women seeking pregnancy, with a focus on the least invasive techniques before resorting to more complex and costly interventions.

Our goal is to begin treatment quickly and achieve success with plans designed personally for each patient, as an individual. We fulfill that commitment through many years of experience in the field of reproductive endocrinology and infertility and a personal, compassionate approach to treating each patient, male and female, based on his or her individual needs, concerns and desires. Although we may not be able to solve every fertility problem with a resulting pregnancy, we are honest and forthright in our evaluation and treatment.

We do not believe in turning away women with difficult issues in order to protect or artificially inflate our success rates.

10. Uniquely Convenient

Our Tufts Medical Center Clinic is located in the Financial District of Downtown Boston. We are an easy walk for many of our patients. On the MBTA, we are immediately upstairs from the Orange Line Medical Center Station. We are an easy trip for all of our patients who work and live in downtown Boston.

Center for Reproductive Endocrinology and Infertility
Tufts Medical Center
800 Washington Street
Boston, MA 02111
617-636-0053

Meet Our Team


John E Buster, M.D. has nearly four decades experience as a physician, almost entirely focused in the field of Reproductive Endocrinology and Infertility. Highly experienced in the performance of assisted reproductive technology procedures, medical treatment for infertility and recurrent pregnancy loss, various reproductive surgical procedures, and female sexual dysfunction (FSD).

Dr. Buster is a frequently invited lecturer, consultant and participant in national and international forums and has served as an officer on Boards and Committees of several professional societies, given expert testimony before Congressional and other government Committees, served as a consultant to numerous healthcare companies, and has been interviewed and featured on national broadcast and print media for many years.

Dr. Buster continues to be recognized as a leading expert in women’s health, including infertility, assisted reproductive technology, reproductive surgery, and menopausal hormone replacement. He has special expertise and has earned international recognition for his work in pre-implantation embryology, ectopic pregnancy, and female hormone replacement.

In the past decade, Dr. Buster has been recognized for his clinical expertise by various lay publications, including Castle Connolly's Best Doctors in America, (ranking him among the top 1% in the nation), Good Housekeeping's 401 Best Doctors for Women, the Consumers Research Council of America's Guide to America's Top Obstetricians and Gynecologists, and in 2012 was named a Top Reproductive Endocrinologists by U.S.News & World Report and Boston Magazine. Also last year, he was selected for a Patients' Choice Award, an honor given to just five percent of practicing physicians in the country.

Dr. Buster is also a leading researcher in female sexual dysfunction (FSD), a continuum of psychosexual disorders centered on loss of sexual desire with interrelated problems of arousal, orgasm, and sexual pain. Dr. Buster has recently outlined awareness and treatment for sexual dysfunction for both the physician and post-menopausal woman with the publication of an article "Sex and the 50-Something Woman: Strategies for Restoring Satisfaction" that appeared in the professional journal of Contemporary Obstetrics and Gynecology.

Additional intent was to explain the various causes of what is called female sexual dysfunction (FSD) and the simple interventions obstetrician/gynecologists and primary care physicians can recommend. The article attracted national interest with stories appearing in local media including the Providence Journal.

Additionally, Dr. Buster directed the UCLA research team that performed history's first embryo transfer from one women to another resulting in a live birth in February 1984. To read the full article in Wikipedia click here

For this work and in addition to a number of groundbreaking medical advancements in women's health, notably in the field of reproductive medicine Dr. Buster received the Legends Award in May 2012. "Legends" are selected based upon their internationally recognized contributions to medicine through research and innovative clinical practice. It was awarded by The Los Angeles Biomedical Research Institute (LA BioMed or LABioMed) located at Harbor-UCLA Medical Center.

Training

  • Undergraduate at Stanford University, Stanford, CA.
  • Medical degree from UCLA School of Medicine, Los Angeles, CA.
  • Residency training in Obstetrics and Gynecology at Harbor UCLA Medical Center, Torrance, CA.
  • Fellowship training in Reproductive Endocrinology and Infertility, Harbor UCLA Medical Center, Torrance, CA.
  • Diplomat, American Board of Obstetrics and Gynecology with subspecialty certification in Reproductive Endocrinology and Infertility.

Experience

  • Professor of Obstetrics and Gynecology, UCLA and Director of the Division of Reproductive Endocrinology and Infertility at Harbor UCLA Medical Center, Torrance, CA.
  • Professor of Obstetrics and Gynecology and Director Division of Reproductive Endocrinology and Infertility, University of Tennessee, Memphis, TN
  • Professor of Obstetrics and Gynecology and Director of the Division of Reproductive Endocrinology, Baylor College of Medicine, Houston, TX.
  • Professor of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI and Associate Director of the Division of Reproductive Endocrinology and Infertility, Women & Infants' Hospital, Providence RI and Tufts Medical Center, Boston, MA.

Achievements and Affiliations

  • Well-known guest lecturer and author on more than 200 scientific papers in the field of Reproductive Endocrinology and Infertility.
  • Served as Examiner, American Board of Obstetrics and Gynecology in both general and subspecialty Boards in Reproductive Endocrinology and Infertility.
  • Served as chair or member of NIH Study sections.
  • Served on or chaired committees in various scholarly societies including General Program Chair, Practice Committee member, Continuing Medical Education Committee Chair, Executive Committee, Publication Committee Chair and Director on the Board for the American Society of Reproductive Medicine.
  • Director on the Board for the Society of Reproductive Endocrinologists and Chair of its Practice Committee and Fellowship Committee, and on the Fellowship Committee for the American Gynecological and Obstetrical Society.
  • Consultant to numerous healthcare companies.
  • Served as Associate Editor, Editorial Board member, or ad hoc reviewer for numerous peer review medical journals.
  • Recognized for clinical expertise by various lay publications, including Castle Connolly's Best Doctors in America, (ranking him among the top 1% in the nation), Good Housekeeping's 401 Best Doctors for Women, the Consumers Research Council of America's Guide to America's Top Obstetricians and Gynecologists, and in 2012 was named a Top Reproductive Endocrinologists by U.S.News & World Report and Boston Magazine. Also last year, he was selected for a Patients' Choice Award, an honor given to just five percent of practicing physicians in the country.

 

Kelly Pagidas, M.D. has nearly two decades experience as a physician, most all of which is in the field of Reproductive Endocrinology and Infertility. She is involved in both undergraduate and graduate medical education. Highly experienced in the performance of assisted reproductive technology procedures, medical treatment for infertility, recurrent pregnancy loss, reproductive surgery, and preimplantation genetics and diagnosis, she is accomplished both as a specialist and educator in our field.

Training

  • Medical degree McGill University, Montreal, Canada.
  • Residency training in Obstetrics and Gynecology at McGill University, Montreal, Canada.
  • Fellowship training in Reproductive Endocrinology and Infertility at McGill University, Montreal, Canada
  • Diplomat, American Board of Obstetrics and Gynecology with subspecialty certification in Reproductive Endocrinology and Infertility.

Experience

  • Assistant Professor of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI.
  • Adjunct Assistant Professor of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA.
  • Director, Preimplantation Genetic Diagnosis (PGD) program.

Achievements and Affiliations

  • Research interests including recurrent pregnancy loss, ovarian physiology, reproductive genetics, PGD, and IVF outcomes.
  • Fluent in English, French, and Greek.

 

Beth Plante, M.D. received her medical degree from the University of Massachusetts Medical School. She completed her residency training in Obstetrics and Gynecology at Women & Infants Hospital/Warren Alpert Medical School of Brown University. She then received fellowship training in Reproductive Endocrinology and Infertility at the University of North Carolina School of Medicine. Dr. Plante is board certified in Obstetrics and Gynecology. She is involved in both undergraduate and graduate medical education. Her clinical and research interests include all aspects of reproductive endocrinology and infertility, and in particular, premature ovarian failure, fertility preservation, in vitro fertilization and endocrine disorders of puberty and adolescence.

Training

  • Medical degree from the University of Massachusetts Medical School, Worcester, MA
  • Residency training in Obstetrics and Gynecology Women and Infants Hospital, Brown University Medical School, Providence, RI.
  • Fellowship training in Reproductive Endocrinology and Infertility at the University of North Carolina School of Medicine, Chapel Hill, NC
  • Diplomat, American Board of Obstetrics and Gynecology.

Experience

  • Clinical Assistant Professor of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI.
  • Clinical Assistant Professor of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA.

Achievements and Affiliations

  • Winner of numerous teaching awards, including the Berlex Best Teaching Resident Award at Women and Infants Hospital/Brown University Medical School and the Fellow Teaching Award from the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine.

 

Jeannine F. Witmyer, Ph.D. joined the Tufts Medical Center and Women & Infants' group in 2007. Dr. Witmyer has over 25 years experience working with human oocytes and embryos. Her area of laboratory focus has been blastocyt culture, gamete cryopreservation, and embryonic vitrification. She is amongst the most experienced human embryologists in our field.

Training

  • Undergraduate, B.A. in Biology at Randolph Macon Woman's College.
  • Graduate, Ph.D. in Biology, Boston College, Boston, MA.
  • Certified High Complexity Laboratory Director, by American Board of Bioanalysts, 2004

Experience

  • Andrology Technician, Norfolk IVF Program, Norfolk General and Eastern Virginia Medical School.
  • IVF Laboratory Supervisor, Hillcrest Medial Center.
  • Embryologist, Andrology and Embryology Supervisor, and Andrology and Gamete Cryopresevation supervisor at Boston IVF, Waltham MA, 1986-2007.
  • IVF Laboratory Director. Women & Infants Hospital of Rhode Island/Tufts Medical Center, Boston, MA 2007 to present.

Achievements and Affiliations

  • She recently introduced the vitrification of oocytes and embryos to the laboratory. Vitrification is a cryopreservation technique that increases the efficiency of freezing oocytes and embryos. Vitrification will allow our IVF lab more flexibility in determining the best time for embryo cryopreservation and shows much promise for increasing the success of oocyte freezing. Tufts Medical Center is the first program in the region to use this technique routinely.

Services

The Center for Reproduction and Infertility at Tufts Medical Center is a comprehensive, full service clinic specializing in the diagnosis and treatment of reproductive disorders afflicting women and their partners. We also care for women throughout the spectrum of their reproductive lives: younger women who want to preserve their reproductive potential and for older women in their postmenopausal years who may be afflicted with hormonal disorders or sexual problems and seek help in improving the quality of their lives.

For women and their partners who want children, we provide services intended to produce pregnancy quickly and safely.

For the Female Partner

We provide:

  • In vitro fertilization and embryo transfer
  • Oocyte donation
  • Intracytoplasmic Injection (ICSI)
  • Preimplantation Genetic Diagnosis (PGD)
  • Ovulation Induction
  • Minimally invasive laparoscopic and hysteroscopic surgery:
    • For restoration of reproductive function lost to gynecological disorders such as endometriosis, uterine myoma, and pelvic adhesions
    • For correction of congenital abnormalities of the uterus, ovaries, and vagina

For the Male Partner

In partnership with Boston University, we provide:

  • Epididymal Sperm Aspiration (MESA)
  • Testicular Sperm Aspiration (TESE)

For Younger Women

For the younger woman seeking preservation of reproductive potential, we diagnose, treat and are highly experienced in the surgery for conditions that include:

  • Endometriosis
  • Fibroid tumors
  • Pelvic adhesions and tubal obstruction
  • Polycystic ovarian disease and hyperandrogenism
  • Hyperprolactinemia
  • Premature ovarian failure
  • Developmental anomalies of the ovaries, uterus, and vagina

For Older Women

For older women seeking treatment for menopausal disorders and hypoactive sexual desire disorder, we are experienced in the most advanced methods for safe and effective hormone replacement of bioidentical estrogens and androgens.

Success Rates

We pride ourselves on high success rates yet retain the lowest multiples in the region. Our success stems from a sincere and passionate commitment to assisting women seeking pregnancy. Our focus is on the least invasive techniques before resorting to more complex and costly interventions. Our approach is based on many years of experience in the field of reproductive medicine and personal, compassionate care in which each partner, male and female, is treated based on his or her individual needs.

IVF pregnancy rates are an index of consistency and longevity of a clinic's operations. They are reported annually for fertility clinics throughout the nation by the Centers for Disease Control and Prevention. The most recent figures are for the year 2010. The title of this report is:2010 Assisted Reproductive Technology Success Rates, National Summary and Fertility Clinic Reports

A note about these rates: Our data is reported jointly with Women & Infants Hospital in Rhode Island. These rates usually appear 18 months after the last treatment year because time has to pass for the pregnancy outcomes to be known.

The CDC has reported figures from Women & Infants' and other established fertility clinics throughout the United States annually since 1994. To view the report, for the state select “Rhode Island,” and then select the clinic, “Woman & Infants.

Understanding Infertility

Infertility is a symptom, not a diagnosis. There are many conditions that can cause infertility. Timely diagnosis is critical because almost all effective treatments lose their efficiency with advancing maternal age. Causes of infertility in couples sort out to approximately 1/3 female, 1/3 male, and 1/3 combined medical issues. Diagnosis is not always precise. It is, however, focused toward selecting effective treatment options. Good information is critical to the selection of optimal therapy that gives balance to risk and benefit.

In-vitro Fertilization

In-vitro fertilization, or IVF, is the treatment of choice for a woman with blocked, severely damaged, or absent fallopian tubes. It is also used in cases of endometriosis or male factor infertility. Couples with unexplained infertility over a long period of time may also find success with IVF. While IVF may be the preferred method of achieving pregnancy in these cases, our specialists consider all options for their patients before recommending this complicated, highly technical, and invasive procedure. After all, the objective is having a baby, not having IVF.

First used in the United States in 1981, IVF is a delicate medical procedure performed by highly trained professionals using sophisticated laboratories and equipment. According to the latest statistics from the Centers for Disease Control (CDC), IVF pregnancy rates per treatment cycle have increased steadily since 1984 when the CDC first began reporting national statistics (www.cdc.gov/ART/ART2005/index.htm).

More recently IVF pregnancy rates per cycle have peaked and become comparable among the United States' best clinics where different pregnancy rates between are now heavily dependent on patient selection, clinic policies related to the number of embryos transferred, and policies related to numbers of embryos selected for preservation. National concern surrounding costs and morbidity in cases of multiple embryo pregnancies has resulted in fewer embryos being transferred. This shift has resulted in higher percentages of single, but healthier, pregnancies. In New England where patients benefit from insurance mandates, multiple rates tend to be lower than in other parts of the nation. Consequently, overall pregnancy rates per cycle are lower in the New England region.

Most important for individual patients, IVF pregnancy rates are profoundly affected by maternal age and diagnosis. Each patient is unique, so the overall pregnancy rates of a particular clinic may not be a helpful index of expectation for an individual patient with her unique set of circumstances.

In selected cases, the Tufts Medical Center team may use additional techniques to increase the chance of pregnancy through IVF, including:

  • Micromanipulation of oocytes, sperm and embryos, including assisted hatching, which involves making a hole in the embryo's covering to aid in sperm penetration.
  • Fertilization and implantation of donor oocytes to help older women and women who have undergone premature menopause.
  • Intracytoplasmic sperm injection (ICSI), where a single sperm is injected into the oocyte. This may be combined with surgical sperm recovery procedure from a male partner who has no ejaculated sperm by removing it from the male ducts (microsurgical epididymal sperm recovery or MESA) or from the testicle directly (TESE).

Sometimes multiple cycles of IVF are required, so embryo cryopreservation or vitrification (drying) is used to store embryos for possible transfer at a later date. And for those couples or individuals with serious inherited disorders, the Tufts Medical Center team can perform preimplantation genetic diagnosis, or PGD, to test embryos for genetic disorders prior to their transfer to the uterus.

Ovulation Induction

Failure to ovulate regularly is a common cause of infertility in women. Three of the most common causes are polycystic ovarian disease, hyperprolatinemia, and hypogonadotropism. In many of these cases, particularly with younger women whose partners are not infertile, careful ovulation induction with production of a single monthly oocyte can be accomplished with restoration of reproductive efficiency at close to normal levels. Our approach to these patients is somewhat holistic: we find that weight reduction, dietary measures, and the relatively simple use of ovulation-inducing agents is very effective, as well as less subject to complications. We try to avoid using IVF in these patients and are very frequently successful.

Controlled Ovarian Hyperstimulation with Intrauterine Insemination (COH with IUI)

COH with IUI involves deliberate induction of multiple ovulations, combined with injection of washed sperm cells directly into the uterus where fertilization occurs in vivo. This approach is very effective in younger women with normal pelvic anatomy and fertile husbands. In appropriate patients, this treatment can be very effective; however, it can be most ineffective and result in the loss of valuable time in older women, patients with tubal disease or in association with significant male infertility. Its principal virtue is simplicity and effectiveness in well-selected cases.

Male Infertility

Male factors can include low sperm production, commonly related to genetic mutation afflicting many men. They include blockages in the sperm conducting system, antibodies against sperm, injury to the testes, hormonal problems, poor descent of the testes and varicoceles. Choice of therapies commonly involves consultation with our andrology consultant, Robert Oates, M.D., Boston University. Dr. Oates is located a short distance from our facility and collaborates in the care of our patients on a regular basis. Comprehensive evaluation will include a through history and exam, followed by highly specialized laboratory testing to asses as precisely as possible the cause and a course of treatment to improve the male factor.

Microsurgical epididymal sperm aspiration (MESA), testicular sperm extraction (TESE), electro ejaculation, variocele repair and vasectomy reversal are techniques commonly used to correct or enhance sperm quality prior performance of ICSI in the treatment of some of the more severe male factor cases.

Donor insemination is an approach commonly used when the male factor is severe beyond reasonable treatment. Donor insemination can be a very satisfying approach when standard treatments prove repeatedly ineffective.

Frequently Asked Questions

1. What is IVF?

IVF literally means fertilization outside the body. It involves a number of procedures but begins with an evaluation of your fertility potential. Once you have been found to be an appropriate candidate for IVF, after a series of treatments your eggs will be removed from your body by a minor surgical procedure. The eggs will be placed in a dish in a special incubator. Sperm are added to the dish containing the eggs and fertilization takes place in the lab. The resulting embryos are then placed into your uterus by means of a small plastic tube (embryo transfer). If one or more of the transferred embryos implant within the woman's uterus, the cycle then progresses to a clinical pregnancy. Finally, the pregnancy may progress to a live birth with the delivery of one or more infants.

2. Who is a candidate for IVF?

Candidates for IVF include women who have blocked or absent tubes due to infection, endometriosis or tubal surgery done for sterilization. Women who have had problems with severe endometriosis even with normal tubes may be candidates. Women who do not ovulate regularly and have failed other treatments may undergo IVF. Often men with low sperm counts can be candidates for IVF treatment with their partners. Some couples may be diagnosed with infertility of unknown cause (unexplained) and may also be effectively treated by IVF. Pre-implantation genetic diagnosis (a procedure which tests the chromosomes of the embryo) requires the use of IVF and may be recommended. Lastly, when no other method of infertility treatment is successful, IVF may be used to achieve a successful pregnancy.

3. How common is infertility?

Infertility is very common. According to the recent estimates from the National Center for Health Statistics of the Centers for Disease Control and Prevention, 12 percent of women (7.3 million) ages 15 to 44 years were having difficulty becoming pregnant and carrying a baby to term. In more recent years, there has been a slight decline in infertility because of effective treatments and shifting age demographics. Those statistics, however, will probably increase again for demographic reasons.

4. What causes infertility?

Infertility is a medical condition afflicting many couples. Approximately one third of the cases are caused by conditions solely afflicting the woman, one third caused by conditions solely afflicting the man, and one third are problems involving both partners. In women, the most common cause of infertility is the irregular or defective release of eggs. The most common symptoms of ovulation disorders are a lack of regular or any menstruation.

Other causes of infertility include blocked fallopian tubes or abnormalities of the uterus. Fallopian tubes can be blocked by adhesions from past pelvic infections, endometriosis, or ectopic (tubal) pregnancy. Abnormalities of the uterus include fibroid tumors, malignancy, or developmental problems. In men, infertility is caused by genetic or environmental factors that impair sperm production. This results in too few sperm or defective sperm that cannot fertilize the woman's eggs. Defective, absent or obstructed ducts also prevent sperm from flowing. The defects can be obvious during childhood, but not always.

5. What factors increase the chances of being infertile?

Advanced age is the most common factor increasing the risk of a woman being infertile. Although there is considerable variance between women, reproductive efficiency begins to decline rapidly at approximately 35 years of age, has declined considerably by age 40, and is essentially gone by age 44. This decline is aggravated by lifestyle and health issues such as a poor diet, stress, being under- or overweight, smoking, excessive alcohol consumption, sexually transmitted diseases, chemotherapy or radiation, and general health problems.

For men, there is an age-related decline in fertility but it is slower. Lifestyle and environmental issues impact a man's reproductive efficiency as they do a woman's.

6. At what point should we seek help?

Advanced age is the most common factor increasing the risk of a woman being infertile. Although there is considerable variance between women, reproductive efficiency begins to decline rapidly at approximately 35 years of age, has declined considerably by age 40, and is essentially gone by age 44. This decline is aggravated by lifestyle and health issues such as a poor diet, stress, being under- or overweight, smoking, excessive alcohol consumption, sexually transmitted diseases, chemotherapy or radiation, and general health problems.

For men, there is an age-related decline in fertility but it is slower. Lifestyle and environmental issues impact a man's reproductive efficiency as they do a woman's.

7. What are the chances I will be successful? What about twins and triplets?

The chance of success with IVF is much better than it was 10 years ago. Your individual chance depends on a number of factors including your age and cause of infertility. Overall pregnancy rates range from 20-50% per cycle. The chance of a multiple birth depends on the number of embryos transferred, but in general the chance of twins is about 20-30% of those who conceived and for triplets or more less than 5% on average. In our most recent Women and Infants' experience in Rhode Island, multiples in most years have been less than this.

8. What can be done for male infertility?

Treatment of male infertility will depend on the suspected cause. In cases of varicocele, the primary cause of male infertility, surgical repair can be performed which often results in improved sperm count and motility. Hormonal causes of male infertility can often be treated with exogenous hormones, which often improve sperm count and restores fertility. There are some conditions, however, where medical intervention does not alleviate male infertility. In these cases, more advanced techniques such as Assisted Reproductive Technologies should be used.

9. What can we expect at our first visit?

We suggest that both partners come together for the visit. In many cases, we can determine the cause of the fertility problem at the initial visit simply by reviewing just the couple's medical history. In other cases, several visits may be required to establish the cause.

During the first visit, a history and physical examination is performed and basic tests are ordered to take place over the coming month. These tests normally include: a semen analysis to look at the number, motion, and shape of sperm; blood hormone tests, which are usually done on the third day of the cycle; pelvic ultrasound; and a hysterosalpingogram, which is an x-ray to view normal uterine anatomy and determine if any tubes are blocked.

his is usually enough for us to make a diagnosis leading to treatment. However, more may be required for complex cases. Occasionally, several months are needed to obtain a correct picture of a woman's ovulatory function or to resolve a medical problem that needs attention prior to beginning treatment.

10. How do I get started with the IVF process?

The first step in getting started in the IVF process is to schedule an appointment with one of our specialists. The number in Boston is: 617-636-0053.

11. What sorts of options do I have?

Depending on the ages and individual needs of the couple, we begin with the simplest, least invasive, and least risky treatment methods. At the same time, we are very conscious of the sense of urgency couples might feel and are very attentive to this in designing a treatment plan. We consider the length of time the couple has been trying to conceive, their response to previous treatments, the overall health of both partners, the amount of psychological reserve, and test results.

Treatment choices include: educational interactions such as the timing of intercourse during a woman's cycle; medical treatments such as ovulation induction in the woman or treatments to enhance sperm production in the man; the repair of damaged sperm ducts or tubes; artificial insemination; or in vitro fertilization.

12. How successful are these options?

It is critical for couples to have realistic expectations about treatment. Overall, most couples who are willing to persist and make any necessary lifestyle adjustments will ultimately be successful. However, the beginning of treatment can often be difficult and this must be discussed at the outset. The outcome of treatment depends on the age of the partners and the causes of their infertility. National standards show that most current treatments are successful.

13. Will insurance cover our treatment?

Insurance coverage in the United States differs widely by region. In New England, insurance coverage for infertility tends to be more generous than in other parts of the nation, but is regulated by very strict rules. Experienced clinics are able to help their patients navigate these issues before treatment begins so couples can have realistic expectations about the costs.

14. What is in vitro fertilization?

In vitro fertilization (IVF) is a technique used to treat more difficult forms of infertility and is effective because it bypasses some of the most common causes of infertility such as damaged tubes or inadequate exposure to sperm. It is normally reserved for cases in which the woman has blocked oviducts or the man has a serious problem with too few or defective sperm.

Fertilization in vitro means that the oocyte or egg is fertilized in a laboratory dish under highly controlled circumstances. The woman must first inject drugs to cause her body to recruit and mature multiple oocytes at one time. At precisely the correct moment, a slender needle is inserted through the woman's vagina to remove the mature oocytes from her ovarian follicles. The oocytes are then exposed to her partner's sperm cells in the laboratory, fertilized, and cultured for three to five days.

In cases where sperm are defective or few in number, or there are difficulties with the fertilization process, the sperm cells may be injected directly into the oocytes using a process called intracytoplasmic sperm injection (ICSI). The resulting embryos are placed into the women's uterus through the vagina using embryo transfer. For the following three to five days, the embryos float freely in the uterus and then implant onto the uterine walls. The pregnancy hormone human chorionic gonadotropin (HCG) is first detectable in woman's blood about 10 days after fertilization and three to five days before the first missed menstrual cycle.

15. Are there medications I can be prescribed?

Medications may be prescribed to the woman or her partner depending on the cause of the infertility. Here is a partial list of some of the most frequently used medications:

  • Clomiphene citrate (Clomid R) - this is an oral medication used to stimulate ovulation. It is most commonly used to treat ovulatory failure associated with polycystic ovarian disease, but can be used for other conditions.
  • (Femara R) - this oral medication is used to stimulate ovulation much like clomiphene citrate. Because its mechanisms of action are different than clomiphene, however, it may be successful in inducing ovulation when clomiphene is not.
  • Metformin (Glucophage R) - an oral medication, this was historically used to treat diabetes because it enhances the effects of insulin. It is commonly used to facilitate ovulation induction for patients with polycystic ovarian disease when one of the features of the condition is resistance to insulin. Normally it is used in association with other drugs to induce ovulation.
  • Human menopausal gonadotropin or hMG (Repronex, Menopur®) - this is an injected drug often used to induce ovulation in women who are unable to ovulate effectively with oral medications. It is also used to induce superovulation for women undergoing IVF treatments.
  • Follicle stimulating hormone or FSH (Gonal F, Follistim®, and Bravelle®) - an injected drug, this is often used to induce ovulation for women who are unable to ovulate effectively with oral medications. It is also used to induce superovulation for women undergoing assisted reproductive technology treatments such as IVF.
  • Gonadotropin-releasing hormone (GnRH) analogue (antagonist or agonist) - these are injected drugs modified from the natural brain hormone that controls ovulation. They are used in various ways to induce or suppress ovulation.
  • Bromocryptine (Parlodel R) - this oral medication is used to induce ovulation in women who have problems with excess pituitary prolactin, the hormone that normally induces lactation.

16. How much does IVF cost? Does insurance cover IVF?

In many parts of the country there is no insurance coverage for IVF. In Rhode Island and Massachusetts there are state laws mandating insurance coverage. The co-pay amount will vary from a few hundred dollars to several thousand depending on the plan. Some patients are excluded, such as those who have had a prior sterilization and some companies do not provide this coverage, such as self insured companies and those who are headquartered in other parts of the country.

17. How can you tell if someone is male-factor infertility?

A standard medical workup for an infertile couple usually involves a semen analysis. A standard semen analysis involves a determination of semen volume, sperm count, sperm motility, sperm morphology, and an evaluation of other characteristics of the semen sample.

18. What is ICSI?

ICSI stands for Intracytoplasmic Sperm Injection, and involves a procedure where a single sperm is isolated from a sample and injected directly into the center of the egg. While seemingly very invasive to the egg, this procedure has revolutionized male factor infertility and has given hope to many couples who otherwise would need donor sperm to conceive. Pregnancy rates following the ICSI procedure are similar to, and sometimes exceed those resulting from conventional in vitro fertilization. Data collected thus far on babies produced as a result of ICSI indicate no increase in congenital abnormalities when compared to IVF babies.

19. Who should have ICSI?

Usually male patients with a sperm concentration of less than 3 million/milliliter are counseled to consider the ICSI procedure. Additionally, men with low sperm motility and/or a high percentage of morphologic abnormalities should consider ICSI. In these cases, use of conventional IVF methods will often result in little or no fertilization of eggs retrieved. There are cases where ICSI is the only possible treatment modality for obtaining fertilization and pregnancy including severely low sperm counts or the complete absence of sperm in the ejaculate.

In this latter group, sperm can be extracted surgically from the testis or epididymis and injected into a mature egg. Finally, there is a group of patients that have experienced poor or no fertilization in a previous IVF attempt with no obvious reason. These patients can also be treated with ICSI, although chances of a successful pregnancy are not improved in cases where poor egg quality is a causative factor.

20. How will my ICSI cycle be different from IVF?

Generally, the only changes in an ICSI cycle involve the laboratory. Initial workups, patient stimulation regimens and the egg retrieval are the same as for IVF patients. Once the eggs are received by the laboratory, they undergo a special preparation for the ICSI procedure. The cells surrounding each egg will be mechanically and enzymatically removed, a necessary step for visualizing the egg during the injection process. Sperm will be isolated, placed in a viscous solution and injected into the cytoplasm of the egg. From this point, all lab procedures for assessing fertilization, embryo quality and performing the embryo transfer are identical to those used for standard IVF.

Getting Started

The Center for Reproduction and Infertility at Tufts Medical Center is a comprehensive, full service clinic specializing in the diagnosis and treatment of reproductive disorders afflicting women and their partners who want children. We also care for women throughout the spectrum of their reproductive lives.

Make an Appointment

To make an appointment, please call us at 617-636-0053.

Accepted Insurance Plans

The Division accepts most major insurance plans, including:

  • Blue Cross & Blue Shield of Massachusetts and Rhode Island
  • Harvard Pilgrim Health Care of New England
  • United Health Care
  • Tufts Health Plan
  • CIGNA

Patients may speak with a financial and insurance coordinator to help determine their specific plan participation and eligibility.

Contact Us or Make an Appointment

Contact Us

To contact us, please call 617-636-0053 or email us at info@tuftsmcivf.com.

Make an Appointment

To make an appointment, please call us at 617-636-0053.

Locations + Directions

Tufts Medical Center

Tufts Medical Center
North Building
Mezzanine Level
800 Washington Street
Boston, Massachusetts 02111
617.636.0053

Women and Infants Hospital of Rhode Island

Women and Infants Hospital
One Blackstone Street
Providence, Rhode Island 02903
401.453.7500

The main offices of the Division of Reproductive Endocrinology and Infertility at Tufts Medical Center are located in the North Building on the Mezzanine level.

We also offer patients the convenience of receiving some services at a location which may be closer to their own community. Sites currently affiliated with the group are located in Providence, Rhode Island, Melrose, Fall River, Falmouth and Swansea, Massachusetts. Patients may be evaluated, undergo some treatments, and have IVF cycle monitoring at these sites. Please call for more information about our locations.

For an appointment at any of our locations, please call 617-636-0053.