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Answers to Questions for PregnancyandBaby.com 6/30/03
Lawrence Werlin is a leader in reproductive technology, research, education, and patient services and the founder and director of Coastal Fertility Medical Center. Werlin is also a principal investigator of GENESIS Network for Reproductive Health, a group of leading independent fertility specialists. He is a member of the American Society of Reproductive Medicine, Pacific Coast Reproductive Society, and the Society of Assisted Reproductive Technologies, an organization in which he held national office from 1991-2000. Werlin is currently leading a team of nationally noted infertility specialists in a continuation study regarding the effects of PGD. He was named as Orange County’s Best Doctor in Infertility 1999 – 2002 and selected to the Best Doctor’s in America from 1996 – 1999.
1) Name: Lawrence B. Werlin, MD, FACOG
2) Professional title: Reproductive Endocrinologist
3) City and State: Irvine, CA & Aliso Viejo, CA
4) Affiliations with hospitals/universities, etc.:
Irvine Multi-Specialty Surgical Care (IMSC), Hoag, South Coast Medical Center, UCI
5) Please explain the process of timing ovulation to achieve pregnancy?
Each month one egg is generally recruited to be the dominant egg in the cycle. As this egg develops and grows, hormonal changes occur which trigger the process of ovulation. This process involves releasing the egg from the follicle which is the structure in which the egg develops. The egg remains viable for approx. 24 hrs. If one were to try to successfully achieve a pregnancy, clearly timing is of the utmost importance.
What signs must a woman look for?
As the egg is developing estrogen levels will rise. As this occurs the mucus becomes very thin, very clear, and very sticky. These are signs that indicate ovulation is imminent.
6) What are the most reliable devices to use in determining ovulation – from OPKs to charting ovulation?
The easiest and probably most reliable devices to use to document ovulation are urinary ovulation prediction kits. These kits utilize the fact that at the time of ovulation, the hormone LH is dramatically elevated in the blood, which will later correspond to demonstrating this hormone in the urine.
7) What advice do you offer to a patient who comes to you and says she wants to get pregnant – How do you best prepare her to take charge of her
fertility and learn when the optimum chances of achieving pregnancy are?
Timing is by far the most critical factor in trying to achieve a successful pregnancy. It is important that a woman understand what changes occur in her cycle, and what they mean, so that she may use these factors as sign posts to knowing when best her chances are to achieve a pregnancy. For example, when her mucus begins to change, and become thin, clear and sticky, she is close to ovulation.
8) At what point is the best chance of getting pregnant – what point in the ovulation cycle?
It is important to remember that the egg remains viable (fertilizable) for a 24 hr period. Thus once a month the patient has the ideal chance to successfully achieve a pregnancy. In looking at a woman’s cycle, the only fixed part of the cycle is from the time of ovulation, to the onset of menses, this measures 14 plus or minus 2 days. So, for example if a woman has a 28 day cycle, ovulation will most likely occur somewhere between day 12 and day 16.
9) Regarding intercourse – do you recommend patients have intercourse every day during ovulation or is it better to “skip a day”? What are the reasons for either explanation?
If a patient utilizes an ovulation prediction kit, I would recommend intercourse on the day of color change, as well as the next. If a woman has regular cycles, for example 28 days, then I would recommend intercourse beginning on day 10 through day 18 every other day.
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Coastal Fertility Medical Center offers one of the most affordable fertility treatments and is completely transparent regarding the costs of procedures and any other expenses that you may have to pay before commencing your treatment. This differentiates us from some fertility clinics that reduce prices before the signing of the contract but charge you extra later on. We make sure our patients are well aware of any possible extra pricing that may occur over the course of their treatment.
Following the Preimplantation Genetic Screening process, which helps ensure there are normal chromosome numbers and detects possible genetic disorders, the most healthy embryo(s) are selected to be implanted into your or your chosen surrogate’s womb. 2 weeks after the transfer of the embryo, your physician will conduct a final blood test to determine the level of hCG (human chorionic gonadotropin) in your body. Increased hCG levels usually indicate a positive pregnancy test.
For fertilization to take place, the collected egg and sperm are combined in a petri dish and cultured in an embryo incubator. This dish is closely watched to check whether any of the eggs have been fertilized. Once the egg is fertilized, it is referred to as an embryo or a blastocyst on the 5th day of development. Our in-house embryologist carefully nurtures every embryo to the right time, even if it means working outside the standard business operating hours. For instance: If an oocyte is not mature, our laboratory will wait for it to mature and then ICSI it at the right time.
The egg retrieval is a slightly invasive medical procedure that takes about 20 to 30 minutes. You will be given an anesthetic to make you sleep for the duration of the procedure. Using ultrasound technology, your doctor will harvest your eggs transvaginally with a small, hollow needle connected to an ultrasound probe. Once your eggs are collected, your partner’s semen or donor sperm you have pre-selected is used for fertilization. The sperm are washed and prepared, and the top-quality sperm extracted is used to fertilize the eggs.
Your doctor will create a customized medication schedule that contains information about the fertility medications and hormone injections you have to take. Medication and injections are taken to encourage your ovaries to mature a large number of eggs for fertilization. Since women don’t respond to fertility drugs and hormones the same way, personalized protocols are crucial to the IVF cycle success. At Coastal Fertility, we will monitor you closely, letting you understand the changes occurring in your body and keeping track of how your egg follicles are growing.
On-site consultations typicallyinclude a standard fertility evaluation, consisting of a physical examination, complementary follicular ultrasound, and testing to enable your doctor to know your present fertility status and draw up a treatment plan.
This consultation includes a detailed medical evaluation with a doctor. You and your physician will review your health records and have enough time to talk about your goals and get answers to your questions. We recommend that you jot down all your questions before the visit to allow you to make the best use of the time spent with your doctor.
Your Reproductive Endocrinologist will take all factors into consideration and create a comprehensive plan of care, otherwise known as the treatment plan. This plan will include treatment recommendations from the physician and enable your financial coordinator to make a precise quotation once you meet.
Our globally respected team of specialists are helping improve IVF technologies to enter into a generation of better outcomes for infertility. Although you’ll have a doctor guiding you, you are also going to benefit from the experience and insights of other doctors during case review collaboration meetings, which take place every week. So, you won’t just rely on the expertise of a specialist but benefit from the knowledge of many reputed fertility experts.
The infertility industry is currently segmented, with each service or treatment being handled by a different provider. Our all-inclusive model simplifies an otherwise complex and difficult process. We are here to revolutionize the infertility industry by offering a one-stop-service model to assist our patients through infertility challenges while reducing physical, emotional, and financial risks.
Our fertility clinic focuses on helping you build your family regardless of your sexual orientation or the gender you choose to identify with. We are even taking further steps to make LGTB people feel more welcome at our fertility clinic. Each of our patient-facing staff goes through LGTB training to let family-building clinicians provide necessary support and make you feel highly welcome.
We know that every situation is different and that everyone requires different treatments. Unlike facilities that take “a one-size-fits-all” approach for all cases, our fertility specialists use more than 40 customized protocols to raise the chances of success. The customized approach even extends to our fertility laboratory. Our on-site lab director and his highly-experienced team nurture every embryo and egg to increase the odds of success of each cycle.
Our team specializes in difficult cases and help patients who may have been considered “hopeless” at other fertility clinics. Thanks to our personalized solutions, expertise, and internal collaboration, weare able to maximize pregnancy success rates that are well above the industry average, even in difficult infertility cases.
Upon your arrival, you will check in with a Patient Care Coordinator. We will obtain your insurance information for benefits verification, a copy of your identification and take a picture for your electronic medical chart
Coastal Fertility is the leading provider of fertility solutions located in Orange County. Join us to get free updates on fertility news, treatments, infertility solutions and more.
Coastal Fertility is the leading provider of fertility solutions located in Orange County. Join us to get free updates on fertility news, treatments, infertility solutions and more.