IVF (In Vitro Fertilization) Program

IVF Clinic Services

IVF (In Vitro Fertilization)

Intrauterine Insemination & Controlled Ovarian Hyperstimulation

Frozen Embryo Transfer

Donor Oocyte

Information for Donors

Micromanipulation for the Male

Micromanipulation for the Female

Sperm Storage

Financial Counseling

IVF Success

2007-08

Age Range (S.A.R.T)	Cycle Starts	Egg Retrievals	Clinical Pregnancies	Clinical Pregnancy Rate*
<35	116	88	45	51.1%
35-37	88	60	32	53.3%
38-40	47	31	13	41.9%
41, 42	19	13	4	30.8%

Egg Donation	25	20	14	70.00%

All Fresh Cycles	295	212	108	50.9%

Frozen Embryo Transfer		108 Frozen Transfers	45	41.7%

*A clinical pregnancy is defined as being confirmed by ultrasound.

In Vitro Fertilization

In vitro fertilization is a technique that gives new hope for achieving pregnancy to couples with infertility due to irreparable fallopian tube damage or endometriosis, a male factor, or undetermined causes. The technique includes stimulating the ovary with special 'fertility drugs' called gonadotropins, which cause the development of multiple follicles, which contain developing eggs. The size and number of developing follicles is monitored in our office with both ultrasound and blood hormone levels. When mature, the eggs are retrieved by ultrasound-guided needle aspiration through the vaginal wall. In the embryology laboratory, eggs are fertilized with sperm and incubated from 2-6 days in fluid closely resembling that found in human fallopian tubes. Embryos are then transferred directly into the uterus through the cervix in a short outpatient office procedure.

Women who are at especially high risk of multiple pregnancy may undergo blastocyst transfer (e.g. previous IVF success, young women with tubal disease, multiple embryos, etc.). This involves the transfer of more mature embryos 5 to 6 days after oocyte retrieval. Our clinic follows the guidelines recommended by the American Society for Reproductive Medicine for the maximum number of embryos transferred.

The egg retrieval and embryo transfer procedures take place on two separate occasions. Immediately after the embryo transfer, the patient rests quietly for a short period of time before going home. Two weeks later, a pregnancy test is performed. After pregnancy is established, the patient returns to the referring physician for prenatal care and delivery. Pregnancy rates depend on many factors, most significantly the woman’s age.

Some patients may prefer to be monitored during IVF at our Specialty Women's Center office in Raleigh. This office can be contacted during regular hours on weekdays at 919-784-6425. Many patients are monitored by their hometown infertility physicians through our satellite program. Satellite monitoring at our Raleigh location is available Monday through Friday. Monitoring at our Chapel Hill location is available seven days a week.

Intrauterine Insemination (IUI) Program

Intrauterine insemination (IUI) involves placing a concentrated number of sperm directly into the uterine cavity. We perform IUI at the approximate time of ovulation, when a mature egg is released. Therefore, we optimize the chances for pregnancy by ensuring that sperm are in the right place at the right time.

There are some specific indications for adding IUI to a treatment plan to help to improve fertility. Some women have problems with poor cervical mucous and IUI bypasses the cervical mucous. Since the process concentrates the sperm, IUI is often used when the male partner has a low sperm count. IUI also improves pregnancy rates for couples with otherwise unexplained infertility.

The procedure can be combined with other fertility treatments, such as taking oral or injectable medication to improve the quality or number of eggs released each month. This procedure is best suited for women with normal fallopian tubes because it relies on the tubes to capture the egg(s) released from the ovaries. The chance of pregnancy is up to 15-20% per cycle.

Controlled Ovarian Hyperstimulation (COH)

Controlled Ovarian Hyperstimulation describes the use of injectable medications, called gonadotropins, to stimulate the ovaries to produce single or multiple mature eggs. COH is sometimes recommended when an infertile couple has not had success using oral medications (usually clomiphene citrate) to induce ovulation or cause pregnancy. Gonadotropins are also used as a primary treatment for in-vitro fertilization (IVF) treatment cycles and certain circumstances where other medications would not be expected to be effective.

The gonadotropin medications used in COH are natural or recombinant forms of one or both of the hormones follicle stimulating hormone or luteinizing hormone. The goal of COH depends on each woman's unique situation but may be to stimulate the growth of one ovarian follicle (with egg inside) or multiple follicles. The dose of the gonadotropins is highly variable but relates to the underlying cause of infertility, age, previous response to medications, and how many follicles your doctor is attempting to stimulate. Every woman responds differently to the gonadotropins so the first treatment cycle of COH often becomes a learning experience as the doctor evaluates how a woman responds. Gonadotropin doses are commonly altered during a treatment cycle.

COH involves daily injections of gonadotropins for about 7 to 10 days. During the treatment, a patient will usually come in 5 days after starting the medications for an ultrasound and a blood estrogen measurement. One to three subsequent visits to the IVF clinic for an ultrasound and estrogen are usually necessary during the treatment cycle. Once the follicles reach a mature size (as seen by ultrasound) this indicates that the eggs are ready for ovulation and gondotropin medications are discontinued. An injection of human chorionic gonadotropin (hCG) is given that evening and ovulation predictably occurs about 36 hours later. Timed intercourse or intrauterine insemination then occurs about 36 hours after the hCG injection.

The use of gonadotropins is discussed in detail during a COH teaching class offered on a regular basis by the UNC Assisted Reproductive Technology (ART) Clinic nurses.

Frozen Embryo Transfer (FET) Program

Often with IVF, a couple will have more embryos than is safe or appropriate to transfer. Embryos that are not placed into the uterus may be frozen, according to the wishes of the couple. Frozen embryos can be transferred at a later time in a brief outpatient procedure. About 60% of the embryos will survive the freeze/thaw process. The women will be required to take hormonal medications to prepare the uterus to be receptive to embryo implantation. Success rates after a frozen embryo transfer are approximately 60% that of a fresh cycle.

Donor Oocyte IVF (DIVF) Program

The IVF Program at UNC Chapel Hill has an anonymous donor oocyte (donor egg) program. This technology offers the possibility of pregnancy to women who have been diagnosed with premature menopause, women whose ovaries have been removed and women whose own eggs are of poor quality and who failed to conceive even after several IVF procedures.

The donors are young women who have been selected after careful screening which includes a thorough medical history, family history, genetic screening, psychological assessment, as well as physical examination and testing for sexually transmitted diseases including HIV.

The eggs (oocytes) are retrieved from the ovaries of the donor after egg development has been stimulated by administration of fertility drugs (gonadotropins). The eggs are then fertilized with the partner's sperm and placed within the uterus of the recipient 2 to 6 days after fertilization occurred. The recipient's uterus must be prepared to receive a pregnancy. This is accomplished by suppression of ovarian function (in those recipients who are not menopausal) with a medication called Lupron and by administration of estrogen and progesterone. The response of the recipient's endometrium (lining of the uterus) is assessed by hormone measurements in blood and by ultrasound measurements

The donor egg program at UNC is highly successful and offers a pregnancy rate of approximately 50-60% per treatment cycle. For more information about donating eggs, please click here.

Intracytoplasmic Sperm Injection (ICSI) Male Factor Micromanipulation

ICSI Intracytoplasmic Sperm Injection (ICSI) is a technique in which a single sperm cell is injected directly into the middle of the egg. This enables fertilization to take place even in cases with extremely low sperm counts or very poor sperm quality. If the man has blocked sperm ducts, enough sperm may be retrieved surgically from a very small piece of testicular tissue. This sperm can also be frozen for future ICSI attempts, which avoids repeat testicular biopsy procedures. Males are usually under the care of a reproductive urologist, who works directly with the IVF team. Fertilization rates with ICSI are comparable to in vitro fertilization rates with normal sperm. Pregnancy rates from ICSI are as good, or sometimes better, than other IVF couple's if infertility is due only to poor sperm quality

Current data from around the world has shown that offspring resulting from IVF or IVF/ICSI have the same rate of birth defects as the general population. However, if the underlying reason for poor sperm production is a male genetic defect, then this defect may be passed on to the offspring. Genetic evaluation and counseling are available, if needed.

Assisted Hatching: Micromanipulation for Female Reproductive Factors

The developing embryo is encased in a clear "shell" called the zona pellucida. This keeps the cells of the embryo together and protects the embryo until it can implant into the wall of the uterus. However, before it can implant, it must "hatch" out of this shell so that the embryo's cells can bind to and invade the lining of the uterus. In the laboratory, we can use micromanipulation techniques to make a small hole in the zona pellucida, which will allow the embryo to move easily, hatch and implant in the uterus. Studies have shown that this technique seems to particularly benefit women who are of advanced reproductive age, respond poorly to medication, or have had previous repeated IVF failure. Increased thickness of the zona pellucida may also encourage the embryologist to suggest assisted hatching. A brief course of antibiotics/methylprednisone will be given to women undergoing assisted hatching.

Sperm Storage

The Andrology Laboratory of the OB/GYN Department of the University of North Carolina offers storage of semen for patients who are planning to undergo procedures which may result in sterility or who wish to do so electively. Some information regarding our program can be provided in advance which will make the process easier for patients faced with this decision.

Semen Collection
First, the patient must be able to collect semen by masturbation into a sterile specimen cup. This can be done in a special room at the medical center or at a local home or hotel (in which case we will give more specific instructions for delivery of the specimen). An effort will be made to accommodate each individual, so please make necessary special arrangements through the lab.

Examination of the Specimen
The andrology laboratory personnel will explain the semen analysis, and current assisted reproductive technologies. Some illnesses can cause temporary or permanent alterations in sperm numbers, sperm motility, or accessory gland function. The patient can view the specimen under a teaching microscope while the lab technologist describes what is known about freezing success, probability of pregnancy, etc. The final decision is ultimately based on the wishes of the patient in most cases. A family member, spouse, or friend is welcome to accompany the patient.

Storage
Semen and cryoprotectant is placed in small plastic vials and stored in a liquid nitrogen "bank". The laboratory sets no limit on the number of vials that a patient may store. Some sperm can retain viability after more than 10 years in storage, but others are not viable after only a few days. We are not able to predict an individual outcome effectively. A Specimen Storage Agreement that describes the basic conditions for providing this service will be signed by both the patient and the Andrology Laboratory personnel. The clinic is pleased to report many successful pregnancies from semen stored in this program.

Initial fee charged for educational discussion, setting up files, and materials for a new patient. This is a one-time charge and only goes into effect if the patient chooses to freeze his specimen after the Semen Analysis.

An annual storage fee must be paid for the initial year or part thereof. Thereafter, the amount is due annually. The storage year runs from January 1 through December 31. It is the patient's responsibility to keep the lab informed of their current address in order for the patient to receive billing. Failure to pay the annual storage fee will result in the specimens being discarded. This fee covers all specimens stored regardless of the number.

Full payment is due at the time of service. Any relevant referrals indicating amount of co-payment or complete coverage must be presented at time of service. For initial billing concerns, call our financial counselor at 919-966-4869.

Future Use of the Specimens
A "Release From Storage" form will be provided when the patient is ready to use the specimens. Physicians of the OB-GYN Department will provide patient care, or the specimens can be shipped to another physician or clinic at the patient's expense. We strongly encourage each patient to select a physician who is experienced at artificial insemination and can offer current technological services.

New procedures are available which can maximize the opportunity to achieve a pregnancy with sperm samples that have reduced numbers, motility, or quality, which may reduce the likelihood of success with simple insemination. The physicians and staff of the OB-GYN Department are able to offer these procedures and will discuss them with the patient if desired.

The following costs are rough estimates and are only offered as an introduction to the financial considerations to be taken into account when planning for the possibility of storing sperm. A simple washed intrauterine insemination of a woman costs approximately $325 to $455 per cycle. Additional costs could be incurred if the woman experiences any fertility problems. If a "test tube baby" (in vitro fertilization) is necessary, one cycle costs approximately $10,000 - $12,000 at our institution. In cases of poor sperm quality, direct sperm injection into the egg costs approximately $2,000.00 over the costs of IVF. The decision to store sperm for later use can be a difficult and expensive one. We hope that this summation will help the patient planning.

It is very important to consider this service as soon as possible when a therapy program is decided so that the patient may have the opportunity to store multiple specimens. Scheduled appointments are necessary. The number to call and schedule an appoint is 919-966-6596. We try to accommodate the patient's schedule as much as possible. Appointments are available between 8:30 am and 3:00 pm weekdays.

Financial Aspects of UNC IVF Program

Thousands of people have made their dream of having a family come true through In-Vitro Fertilization (IVF) treatment. But the reality is that most people will require more than one IVF cycle to be successful. And patients who commit to three cycles almost double their chances of having a baby.

At UNC’s Fertility Clinic we understand that many patients do not have insurance coverage for assisted reproductive technology, and that financial anxiety can complicate the decision to pursue treatment. We’re pleased to announce the availability of the Attain IVF Program (formerly known as the IntegraMed® Shared Risk® Refund Program).

► Watch the video

The Attain IVF Program is designed to increase your opportunity to get the outcome you want—a baby—while managing the cost of IVF treatment.

You pay a single, discounted fee.
You receive up to 6 cycles (3 IVF and 3 frozen embryo transfers).
If you don’t take a baby home from the hospital, you’re guaranteed a refund—70% for IVF treatment plans
Special program for patients using donor eggs —up to 100% refund

Three out of four participants who complete the program take home a baby. There are no risks or obligations to find out if you qualify.

Find out if you qualify—ask our financial counselor to submit a clinical application on your behalf 919-966-4869, or click here to start the application process online.

For more information, call IntegraMed at 1-866-YOUR-IVF (1-866-968-7483) or click here.

UNC’s Fertility Clinic is committed to helping patients increase their chances of taking home a baby. We want to help you build your family.

Patients frequently have questions about the charges and insurance plan coverage for the infertility products and procedures that their doctors have recommended. Charges may vary from couple to couple due to the nature of various procedures and the different needs of each patient. Because of this, we have a financial counselor on-site to help you obtain insurance reimbursement information and a better understanding of your personal payment plan.

Infertility Treatment Pricing Structure

Please feel free to contact our financial counselor Marcia K. Neal, MHA, at 919-966-4869 or Marcia_neal@unchealthcare.org for details relating to prices for infertility services and insurance benefits.

In general, charges for self-pay are as follows

Intrauterine insemination procedures vary from $405 to $500.
Procedures (IVF, Donor Oocyte IVF and Satellite IVF) range from, $5,770 to $15,000.
Charges for medications vary with the individual. Medications usually range between $3,000 and $5,000.

Contacting Your Insurer About Your Benefits

Contacting your insurance carrier by phone to obtain benefit information is helpful and beneficial, but it is always a good idea to also obtain your benefits in writing prior to starting your treatment. Most insurance companies will not commit to paying for any procedure before a claim has been filed, but they will confirm if certain procedures are covered under your policy and at what percentage those procedures will be paid. Benefits are usually covered if they are not denied in writing in the insurance contract.

To obtain written verification, call your insurance carrier and request the address and the name of a person to whom you may send your “Predetermination of Benefits Request”. Be very specific in your letter, which should include your situation and request and also include the CPT billing codes, which can be provided to you by your physician's office.

If you have a managed care plan and it is determined that you do have benefits, you must obtain your authorization number from your primary care physician before your first appointment. Referrals should usually include a few visits, labs, and x-rays. The authorization for treatment, if needed, will usually be obtained by your specialist's office after your referral is obtained. It is important to remember that referrals authorizations do not guarantee payment. This means even if you have an authorization, you must have the benefit before payment will be made.

When you contact your insurance carrier verify if you have the following services covered:

diagnostic testing for infertility
infertility drugs
artificial insemination
in vitro fertilization and
surgeries to correct infertility or restore fertility

If the carrier states infertility drugs and monitoring are covered, verify that you still have the benefit if your treatment includes artificial insemination or IVF. Many times, insurance companies will only cover drugs and monitoring if they are not used with an artificial means of conception. Insurance companies consider artificial insemination and IVF an artificial means of conception. However, it is possible that the carrier will cover drugs and monitoring for IVF or artificial insemination but not cover the actual insemination or retrieval/fertilization/transfer part of the cycle. Always be very specific in your request.

If you have coverage for artificial insemination or IVF, verify what the benefit includes. Does your benefit include a lifetime maximum, and if so, what is the maximum? Does the maximum include past services rendered with previous insurance companies? Ask your carrier if drugs are included in the benefit amount or if there is a separate benefit for drugs.

Verify if there are criteria that need to be met before starting treatment. Often, carriers require that one must meet certain criteria such as proving medical necessity, verifying marriage status, and/or proving length of time trying to conceive before offering treatment.

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