Scroll Down for more Details & links to PDF Articles

Hope IVF & Fertility Center is a full service Reproductive Endocrinology & Infertility clinic featuring state of the ART facilities for comprehensive onsite reproductive evaluation & treatment.

Douglas T. Carrell, Ph.D., HCLD is the IVF & Andrology lab director of Hope IVF & Fertility Center. Professor Carrell is also the IVF & Andrology lab director of the Center for Reproductive Medicine, University of Utah and Minneapolis. He has directed these successful programs for over a decade.

Conditions Commonly Treated:

• Infertility (Female & Male)
• Age Related Fertility Decline
• Ovulatory Problems
• Pelvic Scarring
• Uterine Problems
• Sperm Problems
• Unexplained Infertility
• Recurrent Miscarriage
• Polycystic Ovary Syndrome
• Premature Ovarian Dysfunction

Treatments Commonly Performed (Depending on the Specific Conditions):

• Stimulation of Ovulation
• Intrauterine Insemination (IUI)
• Super-Ovulation + IUI
• Donor Sperm
• Sperm Freezing
• Sperm extraction (epididymal, testicular)
• IVF (In Vitro Fertilization) & other ART (Assisted Reproductive Technologies)
Hope IVF & Fertility Center features state of the ART onsite integrated andrology & embryology laboratories for egg retrieval, and sperm & embryo culture. Superior experience, personnel & equipment with dedicated meticulous attention to detail produce consistent, excellent results.


• ICSI (IntraCytoplasmic Sperm Injection)
• AH (Assisted Hatching)
• Day 3 or Day 5 (Blastocyst) Embryo Transfer
• PGD (Preimplantation Genetic Diagnosis)
• Embryo Freezing
• Donor Eggs
• Gestational Carrier / Surrogacy
• Surgery
• Laparoscopy
• Hysteroscopy
• Laparotomy

Female & Male Infertility: By definition, Infertility is "one year of unprotected intercourse without conception." Using this definition, 15% of couples in America experience infertility.

More accurately, Infertility should be subdivided into Sterility, those who cannot conceive without treatment, and Subfertility, those with a reduced capacity to conceive, but who can conceive with treatment or extra time / chance.
Examples of couples with potential Subfertility are

• A couple in which the female has Ovulatory Problems, she only ovulates four times a year on her own (normally there are 12-13 spontaneous ovulations per year).
• A couple in which the female has mild Pelvic Scarring from endometriosis, making it difficult for her tubes to pick up the ovulated egg.
• A couple in which the male has moderate Sperm Problems. He only has a few million moving sperm per ejaculate (normal total motile count is 20 million or more moving sperm per ejaculate).

Unfortunately, simply allowing more time / chance is unlikely to be enough to conceive if one has been trying for over 2 years. (In the first year of trying to conceive spontaneously, 85% of couples will do so. After 1 more year of trying, only 8% more of couples will conceive spontaneously. In other words, if spontaneous conception is going to occur, it tends to happen sooner rather than later.) Also simply allowing for time / chance can be less of an option when the female is more than 30 years old, as female age is so critical to fertility (see below). Fortunately, for most couples with Infertility (both Sterility and Subfertility), there are usually excellent treatment options depending on the specific issues.

A brief overview of Fertility Factors follows:

• Age Related Fertility Decline. Female age is especially crucial to fertility. Female age is the main factor determining egg and thus embryo health. A healthy egg / embryo is needed for successful conception. For more information, Click for Article "Age & Fertility: Effective Evaluation & Treatment."
• Ovulatory Problems. A history of irregular menstrual periods indicates irregular ovulation or no ovulation. Ovulation refers to the maturation and release of an egg; it is needed for conception.
• Polycystic Ovary Syndrome (PCOS). PCOS is characterized by irregular periods, relatively high levels of androgens (all women make male-like hormones known as androgens, women with PCOS make more), and enlarged ovaries with many little cysts ('polycystic' ovaries). PCOS is also sometimes associated with central obesity, insulin resistance (impaired glucose tolerance, type 2 diabetes), and skin changes (hirsutism, and acanthosis nigricans, velvety brown skin changes, especially on the back of the neck). Women with PCOS are often infertile because of Ovulatory Problems. Treatment will virtually always be able to successfully induce ovulation in women with PCOS. For more information, Click for Article "PCOS, Insulin Resistance, & the Metabolic Syndrome: An Update."
• Other Hormonal Disorders. Thyroid disorders and Prolactin elevation can cause Ovulatory Problems.
• Pelvic Scarring (Adhesions). Scarring involving the Fallopian tubes or ovaries can prevent the tube from picking up the egg. For natural conception to occur, the tube must pick up the egg. Furthermore, the sperm need to be able to reach and fertilize the egg at the end of the tube. Lastly, the fertilized egg (embryo) needs to be able to travel down the tube and implant in the uterus. Besides preventing the tube from picking up the egg, scarring can cause infertility by blocking the tube and preventing the sperm from reaching the egg. Furthermore, scarring can cause the embryo to implant in the tube (ectopic) as oppose to the uterus. Scarring can often be repaired by surgery (Laparoscopy, see below) or bypassed by the process of IVF (In Vitro Fertilization, see below).
• Endometriosis. A common condition in which the lining of the uterus (endometrium) starts growing in the pelvis. This can lead to irritation and Pelvic Scarring, see above. Endometriosis often also starts growing in the ovary, this is called a Endometrioma or 'chocolate' cyst. Endometriosis is not cancer; it does not threaten one's life. Endometriosis however, can affect one's quality of life by causing infertility, pelvic pain, painful periods, and pain with sex.
• Uterine Problems. In order to conceive, an embryo needs a healthy uterus in which to implant. Some women are born with uterine problems (for example, absent uterus, a wall or septum in the center of the uterus, a Y shaped double uterus). Uterine problems can also develop over time (for example, scarring or adhesions in the uterine cavity, fibroids, adenomyosis). General medical conditions such as autoimmunity and possibly alloimmunity can also affect uterine function. Physical uterine problems are often treatable by surgery (for example, Hysteroscopy to remove a septum or fibroids, see below). General medical conditions can often be treated by medications (for example, the autoimmune condition known as antiphospholipid antibody syndrome is treated with heparin and aspirin).
• Sperm Problems. In a natural cycle, for conception to occur, sperm must be able to travel through the cervix into the uterine cavity and into the Fallopian tube. If ovulation has occurred and the tube has picked up the egg, the sperm will encounter the egg, near the end of the tube. For conception to occur, a sperm must then fertilize the egg (bind and penetrate the shell and egg membrane).

  Sperm testing usually starts with a Semen Analysis. Abnormal parameters such as low sperm Numbers (often called a 'Count,' but really a Concentration), poor sperm Movement (Motility), and low number of normally shaped sperm (Morphology) are associated with infertility and rarely other medical problems. Evaluation can include genetic, hormonal, toxic, and anatomic factors. Treatment can be medicinal or surgical, but most practically it is usually insemination, namely IUI (intrauterine insemination - concentrating the sperm and transferring moving sperm into the uterus with a small flexible straw), or in cases of severe sperm problems, IVF-ICSI. IUI allows a higher quantity and quality of sperm to reach the end of the tube, where hopefully an egg awaits. IVF (In Vitro Fertilization) refers to the process of removing eggs with a long needle and having fertilization occur in the lab, where it can be assisted and documented. ICSI (IntraCytoplasmic Sperm Injection) is the process in which fertilization is achieved by physically injecting one sperm into each egg. With ICSI, men with severe sperm problems can have children. For example, with IVF the usual goal is to obtain 10-15 eggs; therefore, with IVF-ICSI, typically only 10-15 viable sperm are needed, a sperm to inject into each mature egg. The resultant embryo(s) are then transfered into the uterus to implant. Even men without sperm present in their ejaculate (azoospermia) will often have sperm recoverable directly from their testicles and are IVF-ICSI candidates. IVF-ICSI can also allow men with previous vasectomy achieve a pregnancy. Sperm can be extracted from the epididymis or testicles and then used to inject a sperm into each egg.

• "Unexplained Infertility." Unexplained Infertility is defined as when pregnancy has not occurred despite 2 years of trying & all standard clinical tests are normal. Couples with "Unexplained Infertility" have about a 3% chance of spontaneous conception per cycle without treatment. (In comparison, when a young couple first tries to conceive, it is estimated the chance of conception is as high as 25% per cycle for the first few cycles.) There are explanations and effective treatments for "Unexplained Infertility." For more information, Click for Article "Explaining 'Unexplained Infertility' and It's Treatment."

Recurrent Miscarriage: Defined as two or more early pregnancy losses. Affects about 5% of reproducing couples. Depending on the specific history, a complete evaluation can involve the assessment of the following factors: Age; Genetics; Endocrine (hormones); Anatomic / Uterine; Infectious; Immunologic (antibodies, autoimmunity, alloimmunity); Hematologic (thrombophilia or clotting tendency). Treatment depends on the underlying cause.

Polycystic Ovary Syndrome: The diagnosis is established by evaluation for Ovulatory Problems, Hyperandrogenism (excessive male-type hormones), and the ultrasound appearance of the ovaries. Known causes of Hyperandrogenism and Ovulatory Problems should be ruled out as needed. Furthermore an evaluation for Insulin Resistance (impaired glucose tolerance or type 2 diabetes) / Syndrome X / Metabolic Syndrome may be indicated. Treatment options depend on the specific goals and findings. For more information, Click for Article "PCOS, Insulin Resistance, & the Metabolic Syndrome: An Update."

Premature Ovarian Dysfunction: Complete evaluation of cause, as needed, including: Genetics (e.g. chromosomal analysis, Fragile X screen), Immunologic (e.g. autoimmune polyglandular endocrinopathies - a condition in which a person makes antibodies against several of their own organs including the ovaries), and Ovarian injury.

Stimulation of Ovulation (Induction or Super-Ovulation).

• Clomiphene (Clomid). Metformin (Glucophage). Bromocriptine (Parlodel). Cabergoline (Dostinex).
• FSH (Gonal-F, Follistim, Bravelle). HMG (Menopur, Repronex).

Intrauterine Insemination (IUI). IUI is excellent treatment for mild to moderate Sperm Problems. IUI involves concentrating the sperm and transferring moving sperm into the uterus with a small flexible straw. IUI allows a higher quantity and quality of sperm to reach the end of the tube, where hopefully an egg awaits.

Super-Ovulation + IUI. Super-Ovulation + IUI involves giving medications to cause, depending on the specific situation, between 2 to 5 follicles to develop. When the follicles are mature, ovulation occurs and one or two timed IUIs are performed. Super-Ovulation + IUI can be excellent treatment for Ovulatory Problems, Unexplained Infertility and Subfertility. (For example, for couples with Subfertility, Super-Ovulation + IUI may overcome mild to moderate Sperm Problems and possibly mild Pelvic Scarring. For severe Sperm Problems or Pelvic Scarring, IVF is usually the treatment of choice). For more information, Click for Article "Explaining 'Unexplained Infertility' and It's Treatment"

Donor Sperm. IUI with Donor Sperm is commonly performed for couples in which the man has no sperm.

In Vitro Fertilization (IVF) IVF typically involves the following steps:

• Prevention of the natural LH surge by administration of medications. This medication is Lupron (started after a short course of birth control pills or about one week after ovulation) or Cetrotide / Ganrelix (started when the growing follicles reach a certain size).
• Stimulating the ovaries to cause a group of follicles / eggs to develop simultaneously. The usual goal is to give medications (Gonal-F, Follistim, Bravelle, Repronex) to cause a cohort of 10-15 follicles / eggs to develop.
• When it is optimal, a hCG injection is administered to mimic the natural LH surge and cause the final maturation of the eggs.
• Before the follicles ovulate in response to the hCG injection, the eggs are extracted using an ultrasound guided needle placed through the vagina ('transvaginal follicle aspiration').
• Fertilization of the eggs in the lab (hence the name 'in vitro fertilization').
• Transfer of the embryo(s) into the uterus with a soft straw placed through the cervix into the uterine cavity.

Procedures that may be performed in conjunction with IVF include:

• Intracytoplasmic Sperm Injection (ICSI). A single sperm is injected into each mature egg, causing fertilization of the egg.
• Assisted Hatching. In order to implant, a dividing fertilized egg (also known as an embryo), must break out of its shell (zona). Assisted hatching helps this occur by creating a small hole in the zona.
• Day 3 or Day 5 (Blastocyst) Embryo Transfer. An embryo is usually about 8 cells 3 days after fertilization. An embryo is about 100 cells 5 days after fertilization and is known as a Blastocyst.
• Preimplantation Genetic Diagnosis (PGD). By removing a cell from the 8 cell embryo, certain genetic conditions may be tested before transferring the embryo into the uterus.
For more information, Click for Article "Preimplantation Genetic Diagnosis: Is it right for you?"

Donor Eggs. The ultimate solution for Female Age Related Fertility Decline is using eggs from an egg donor. It is a commonly performed procedure with the highest per cycle success rate of any fertility treatment.

Gestational Carrier / Surrogacy. A gestational carrier is needed when a couple's female is not able to carry a child. This can be because of an absent uterus, severely damaged uterus, or severe medical conditions.

Surgery (Laparoscopy, Hysteroscopy, Laparotomy).

• Laparoscopy is called "band-aid" surgery. This is because the surgery is accomplished by placing long instruments through small incisions. An optical scope is usually placed at the belly button through a 3/8 inch incision into the abdomen. Further long instruments are placed, as needed, through 1/4 inch incisions to allow surgery on the Pelvis (Tubes, Ovaries, Uterus). Laparoscopy is used to treat Endometriosis, repair Tubes, and remove Scar Tissue. Because only small incisions are involved, Laparoscopy is an outpatient procedure, it does not require hospitalization.
• Hysteroscopy involves placing an optical scope through the cervix to visualize the uterine cavity. Surgical instruments can then be introduced alongside the scope to treat specific problems. Hysteroscopy can treat abnormalities of the Uterus including Scar tissue, Septum, Fibroids, and Polyps. Hysteroscopy is an outpatient procedure, it does not require hospitalization.
• Laparotomy involves a traditional 3.5 inch incision made across the lower abdomen, just above the pubic hair line ('bikini incision'). Laparotomy is used commonly to remove Fibroids that cannot be removed by laparoscopy or hysteroscopy and to Reverse a Tubal Ligation. Following laparotomy, it is typical to recover in the hospital for a few days.