Infertility can be the result of a number of factors such as mechanical, hormonal, and functional problems. In addition to addressing the medical causes of infertility, Dr. Grunert believes that an integral part of his practice is to treat each patient as an individual, addressing the physical and psychological toll that the infertile couple faces. Dr. Grunert appreciates the unique character and quality of each individual and strives to treat each patient as such. Working closely with the patient/couple, he will tailor a personalized treatment plan in order to meet each patient's objectives.

FIRST STEP
The first step in learning the options available to you is a consultation appointment with Dr. Grunert. During your first visit, he will review your medical history and previous infertility workup and treatment. Most couples have sub-fertility, a decreased chance of becoming pregnant per cycle, rather than absolute infertility, an inability to become pregnant.

Once the factors that are important to achieve a pregnancy are evaluated, he will work closely with you to arrive at a tailor-made treatment plan. Key to his considerations will be reviewing and scrutinizing many of the finer details that can often be overlooked. His goal is to offer the best options appropriate for you, give you information about your options, and help you decide what is right for you.

PREGNANCY EXPECTATIONS
Pregnancy rates can be influenced by many factors, including age, cause of infertility, the presence of a male factor, etc. Because each program's patient population varies either by patient selection or general demographics, it is impossible for patients to compare statistics from one Assisted Reproductive Technologies (ART) program to another.

Rather than select only those patients with the best chance for pregnancy, Dr. Grunert believes in trying to help each patient who walks into his office. At your first consultation appointment, he will review your specific treatment options and pregnancy chances and work to educate you about what you can realistically expect.

IN-VITRO FERTILIZATION (IVF)
In-vitro fertilization may be the most effective treatment for infertility for many couples who experience infertility due to tubal disease, endometriosis, male factor, or who have not achieved a pregnancy through more conservative therapy. While IVF may offer the best chance of pregnancy per cycle, it is the most expensive and complex infertility therapy available. For that reason, Dr. Grunert favors a comprehensive diagnostic approach to outline the causes and alternative treatments before proceeding to IVF.

In-vitro fertilization involves stimulation of the ovaries to produce multiple eggs, recovery of the eggs from the ovaries, fertilization of eggs in the IVF laboratory, and then transfer of several embryos directly into the uterus. Viable embryos in excess of the optimal number to transfer are cryopreserved for later thaw and transfer.

MALE FACTOR/ICSI
In approximately 50 percent of couples with infertility, low sperm count or sperm function is a significant contributing factor. Working closely with a sub-specialist in male infertility, the first objective is to identify and treat the underlying cause. This may result in an improvement in sperm function sufficient to allow spontaneous pregnancy or may improve the chances of pregnancy with intrauterine insemination (IUI).

If treatment to increase sperm function is not successful, IVF offers hope for couples with male-factor infertility. In cases where sperm numbers are low, where the sperm are unable to fertilize eggs, or where sperm has to be recovered from the epididymis or directly from the testicles, intra-cytoplasmic sperm injection (ICSI) can result in successful fertilization of eggs at IVF. ICSI is a procedure where a single sperm is injected directly into an egg. ICSI results in fertilization of approximately two-thirds of eggs, giving couples a chance of pregnancy otherwise not available.

DONOR EGG IVF
In-vitro fertilization utilizing eggs donated from a younger woman is indicated for patients who cannot produce their own normal eggs due to premature ovarian failure, diminished ovarian reserve, or menopause, or who repeatedly produce poor quality eggs. This option is also available for those who carry a genetic abnormality that precludes the use of their own eggs.

For anonymous egg donation, Dr. Grunert utilizes an agency that handles all aspects of donor screening, matching, psychological testing, and counseling of the donor and the recipient couple. Dr. Grunert screens the potential donor for any genetic or medical problems that would eliminate her as an egg-donor candidate.

Often patients will know someone who could serve as a potential donor. The same screening will be done for a known donor as with the anonymous donation. Psychological counseling for all parties involved is required.

GESTATIONAL CARRIER IVF
For women who cannot carry a pregnancy due to a medical contraindication or absence or abnormality of the uterus, it is possible to recover eggs from the ovaries, fertilize the eggs at IVF, and transfer the embryos to the uterus of another woman. This woman serves as a gestational carrier for the infertile couple whose genetic embryo she carries.

MIND-BODY CONNECTION
Believing firmly that infertility does not exist as an isolated life factor, but affects the whole patient. Dr. Grunert approaches treatment plans encompassing the whole patient. While the primary aim is pregnancy, it is important to remember that careful attention to all health factors and general wellness are an integral part of his practice. In some cases, the causes of infertility can impact health apart from just the effect on fertility.

Stress has been shown to affect how your body responds to hormones. Stress reduction is an integral and important part of a treatment plan. Recommendations to reduce stress include a healthy lifestyle, balanced eating plan, and regular exercise. Alternative therapies, such as yoga, meditation, and acupuncture, may be helpful to individual couples.

Dr. Grunert and all of his staff are focused on developing a rapport that builds confidence and trust. He and his staff are dedicated to helping reduce your stress with caring and compassion in helping you realize your dream of having a child.
 
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