General Practitioners

• Medical Weight Loss
  A diabetes treatment for insulin resistance is also useful in women with PCO. Taking the medication Glucophage (Metformin) will result in a lowering of insulin levels. This frequently results in a return of normal menstrual function including ovulation in about half of women with PCO. In the other half, they then respond more easily to the traditional therapy as outlined above. Patients taking Glucophage for PCO frequently report an increase in energy level and weight loss of about 2-4 pounds per month. Exercising and dieting will accelerate the weight loss, yet not everyone taking Glucophage loses weight. Patients taking Glucophage may also experience gastrointestinal symptoms such as nausea, abdominal cramping and diarrhea the first month on the drug. The symptoms usually disappear after 30 days.
• Primary Care
  In addition, your OB-GYN or primary care physician may have referred you to Bluegrass Fertility Center for special testing or procedures such as semen analysis or sperm washing for intrauterine inseminations.
• Smoking Cessation
  A healthy lifestyle and folic acid supplementation is recommended before attempting another pregnancy. Smoking cessation, reduced alcohol and caffeine consumption, moderate exercise, and weight control may all be of benefit. Counseling may provide comfort and help cope with the grief, anger, isolation, fear, and helplessness that many individuals experience after repeated miscarriages.
• Immunizations

Gynecologists

• Gynecology
  Dr. Akin is a Kentucky native and received a B.S. degree in biology from the University of Kentucky in 1981 with high distinction and a M.D. degree from the University of Kentucky College of Medicine in 1985 with distinction. During medical school he was elected to the Honor Medical Society Alpha Omega Alpha. He completed an OB-GYN residency at UK in 1989 and a fellowship in Reproductive Endocrinology & Infertility in 1991 at the Medical College of Georgia. After fellowship, Dr. Akin was an Assistant Professor at Indiana University School of Medicine in Indianapolis for 3 years teaching medical students and residents prior to returning to Lexington in private practice in 1994.
• Female Infertility
• Obstetrics
  James W. Akin, M.D. Dr. Akin is board certified in Reproductive Endocrinology and Infertility as well as Obstetrics & Gynecology by the American Board of Obstetrics & Gynecology. He founded Bluegrass Fertility Center in 2003 and serves as the medical director of the fertility center.
• Endometriosis
  Assisted reproductive technology (ART) includes in vitro fertilization (IVF), gamete intrafallopian tube transfer (GIFT) and zygote intrafallopian tube transfer (ZIFT). GIFT and ZIFT are now rarely performed due to higher costs and lower success rates than IVF. For IVF, the patient is stimulated with medicine to make several eggs grow within the ovary. The eggs are then collected through the vagina using a sonogram-guided needle under sedation. Sperm is then added to the eggs to allow fertilization to take place. Fertilized eggs are then placed back in the uterus a few days later. IVF is effective for different types of infertility including tubal disease, male factor, ovulation disorders, endometriosis and unexplained infertility.
• Pelvic Pain
• Pregnancy

Internists

• Ovarian Cancer
  The medications used in ART possibly are associated with ovarian cancer. An epidemiological study in the early 1990's suggested that Pergonal use might increase the chances for developing ovarian cancer later in life. However, many more recent studies do not agree. Patients who have infertility already have a higher chance of getting ovarian cancer on the basis of the infertility alone and it is difficult to separate out the various risk factors. Clearly, more study is needed on this matter before definitive conclusions can be made about Pergonal either way. Gonal-F, Follistim, Bravelle, Repronex and Menopur are very similar medications to Pergonal and these concerns may also apply to them.

Endocrinologist

• Diabetes Care
• Endocrinology
  All fertility doctors working at Bluegrass Fertility Center are board certified in Reproductive Endocrinology & Infertility by the American Board of Obstetrics and Gynecology and are members of the prestigious Society for Reproductive Endocrinology & Infertility ( www.socrei.org ).
• Hypothyroidism
  Hormonal abnormalities – Hormone problems account for 25-40% of the causes of recurrent miscarriage. This category includes hypothyroidism, hyperprolactinemia and a progesterone problem called a luteal phase defect whose significance remains controversial. The test for thyroid and prolactin are simple blood tests. While several tests have been used in the past to diagnose the luteal phase defect such as blood progesterone levels and an endometrial biopsy, none have been shown to be accurate. For this reason, supplemental progesterone therapy is started in all recurrent miscarriage patients beginning 3 days after ovulation. Waiting until a positive pregnancy test to start the progesterone may decrease its effectiveness. Progesterone supplementation is continued until the 12th week of pregnancy.
• Thyroid

Radiologist

• Ultrasound
  Uterine factor infertility can be due to an abnormal uterus or uterine cavity that is distorted due to uterine fibroid tumors, polyps, scar tissue or birth defects. The uterine cavity can be evaluated via an X-ray test called a hysterosalpingogram (HSG) or by a special ultrasound known as saline enhanced sonohysterogram (SHG). These procedures can determine if the uterine cavity is abnormal. Alternatively, a minor surgical procedure called a hysteroscopy can be performed where a lighted tube with a camera is inserted into the uterine cavity for evaluation. At time of hysteroscopy, many abnormal findings can be surgically corrected.
• X-Rays
• Chemotherapy
  Benefits of Procedure: Egg freezing provides you with options for various circumstances. Some women store eggs prior to undergoing cancer treatment since chemotherapy may damage eggs. Other women may store eggs if they are single and want to preserve their younger more fertile eggs for use at a later time. Female fertility declines with advancing age. About 2/3 of women at age 35 are fertile, but by age 40 only 1/3 can become pregnant with their own eggs. Freezing young eggs in essence stops the biological clock from ticking. For example, if you freeze your eggs at age 30 but do not use them until age 40, then your chances for conceiving will be that of a 30 year old. Your chances for miscarriage and chromosomal abnormalities such as Down Syndrome will be that of a 30 year old woman as well. Finally, some women may prefer to store extra eggs not used from an in vitro fertilization (IVF) cycle instead of freezing extra embryos (fertilized eggs). Freezing and storing eggs instead of embryos may reduce some moral and ethical concerns. Less controversy surrounds the destruction of unused frozen eggs versus unused frozen embryos.

Surgeons

• Vasectomy
  Sperm can also be aspirated directly from the testes when there is an obstruction in the vas deferens. This can be an alternative to vasectomy reversal, but requires IVF and ICSI as the amount of sperm obtained is very small.
• Hysterectomy
  Endometriosis can only be definitively diagnosed at time of surgery. The most common surgical procedure to diagnose endometriosis is called a laparoscopy where a lighted tube with a camera is placed into the abdomen. Some laparoscopic pictures of endometriosis are shown below. The endometriosis implants are the dark areas. These implants can be surgically treated with laser at time of the laparoscopy which can double the pregnancy rate (Marcoux S, NEJM 1997;337:217-22.). Unfortunately, endometriosis is not cured but only treated with the laser. There is a recurrence rate of 50-60%. Sometimes a hysterectomy with removal of both tubes and ovaries is required to treat the endometriosis if the pain is severe.
• Laparoscopy
  A laparoscopy is a minor outpatient surgical procedure that involves placing a small telescope-like instrument through a small incision near the belly button. Frequently a 2nd or 3rd incision is made in the pubic area to allow further manipulation of the pelvis with additional instruments. The abdomen is filled up with gas so that pelvic structures can be seen.
• Reconstructive Surgery
  If the fallopian tubes are blocked and dilated this is called a hydrosalpinx. Once the tubes are dilated, the chance for successful tubal reconstructive surgery is small and the risk of ectopic pregnancy is high. The fluid present within the hydrosalpinx contains many toxins released from dying cells that line the fallopian tube. This fluid has been shown to be toxic to embryos. Also, this fluid occasionally leaks backwards from the tube into the uterine cavity. For this reason, many fertility specialists recommend having the hydrosalpinges removed surgically prior to doing in vitro fertilization (IVF). This procedure can be done laparoscopically as an outpatient. The removal of the fallopian tubes that are dilated and damaged can double the pregnancy rates with IVF.