The Fertility Institutes

There are certain “basics” to be investigated in nearly every couple with an infertility condition Infertility Work Up Treatment Options Determining the Cause of a Couples Infertility One of the most frequent concerns conveyed on this web site involves the thought by many that their infertility evaluation, carried out attempting to uncover the “cause” of an infertility problem, may have been incomplete or may have overlooked something. There are many valid approaches to the work up of a couple who have been unsuccessful in their attempts to become pregnant. While the angle of the approach to a fertility problem may vary from physician to physician, and from Center to Center, it is generally felt by us that there are certain “basics” to be investigated in nearly every couple with an infertility condition. pregnant flower These baseline studies may be slightly modified based on the initial history of the couple involved, but in general, the items presented here are considered very important to us in the study of nearly all couples. While reading this, it is important to remember that these are generalized protocols and the studies mentioned may not be applicable to every couple. These suggestions represent the protocols in effect at our Centers, and they are not meant to indicate a suggested treatment course. You should always attempt to obtain the most qualified medical help available and work together with your health care providers to obtain the highest quality opinions about your workup. And of course remember that we remain at your service at any time should you elect to see us for an initial evaluation, for a second opinion or after failed treatment elsewhere. We specialize in reevaluating those that have not achieved success in their earlier treatment attempts. Summary of an Infertility Work Up At the Fertility Institutes, we ask new patients to complete a very detailed medical history questionnaire prior to presenting for their first appointment. These history forms are forwarded to patients in advance to allow them adequate time to complete the forms at home and to obtain the very detailed information asked for. We include questions related to the patient, details of the pregnancy of the patient’s mother (both husband and wife), fertility histories of the patient, brothers, sisters and immediate family members. We question very closely about life styles and diet, history of “health food” ingestion, vitamin history, and any history of food supplement use (herbs, etc.). Questions about possible occupational exposures to hazardous environments or chemicals and high stress environments are included. Possible detrimental effects on fertility of all of the above have been reported. A sexual history is obtained and the correction of any misconceptions or misinformation is carried out and cleared up. After a complete history has been obtained, we outline a detailed, intense diagnostic program to allow us to arrive at a rapid diagnosis of the underlying fertility problem. While many variations of the protocol are employed to account for items uncovered in the history, we always begin with baseline studies that, if not recently performed elsewhere, include the following: lab 01 min Vaginal and cervical viral and bacterial cultures These are used to detect any possible adverse infections that may be interfering with conception. Semen analysis and semen cultures Various test to determine if the male is contributing to the infertility Sperm morphology (“anatomy”) and sperm function studies Including genetic and electron microscopy studies where indicated. Female gonadotropin and other pituitary and ovarian hormone studies Some of these studies are performed on the third day of the menstrual cycle in order to allow comparison to fertile “control” subjects whose blood was evaluated on the same day 3. Ohter studies such as aMH (anti-mullerian hormone) may be obtained at any point in the menstrual cycle. These studies also include thyroid function studies, and evaluations of the adrenal gland, ovaries, lactation hormones and the uterus. Hysterosalpingogram This X-Ray examination is able to uncover many abnormalities in the lining and configuration of the uterus, as well as demonstrating the fallopian tubes and detecting any partial or complete blockage of the tubes. Scarring around the tubes and ovaries can often be detected as well. Midcycle testing for the “LH surge” The LH surge is the brain’s signal to the ovaries ordering release of the mature egg. Our patients are asked to monitor their urine at home in anticipation of the LH surge that will occur just prior to ovulation. When the patient detects her LH surge, she is asked to have intercourse in the morning, and then is brought in later that day for several very important timed studies:

In Vitro Fertilization (IVF) Welcome to the IVF information pages of The Fertility Institutes. We maintain our own world recognized In Vitro Fertilization laboratories at each of our centers in Los Angeles, New York and Guadalajara, Mexico. Our combined success rates for pregnancies achieved and healthy babies born have remained one of the top programs nationwide for over 30 years. Summary of the IVF Process The Fertility Institutes Laboratory Your IVF care will be carried out by a dedicated team headed by reproductive endocrinologist Dr. Jeffrey Steinberg. Unlike many multi-physician programs that divide patient care between sometimes dozens of physicians, all professionals in our practice will know your individual case intimately. We begin IVF cycles based on your individual menstrual pattern, rather than grouping cases together for clinic convenience. For those undertaking IVF in our program, we offer an additional option of PGD gender selection that allows you to choose the sex of your pregnancy. We are the world's largest and most successful gender selection program (click here) and have performed hundreds of cases while maintaining a 100% success rate in achieving the desired gender outcome! Phase Purpose Drugs and Procedures % Reaching this Step 1Ovarian stimulation and monitoring To cause ovaries to produce many mature oocytes in a single cycle GnRH analog injections hMG or FSH injections, ovulation trigger injection, frequent blood tests, frequent ultrasound examinations 100% 2Egg collection To collect oocytes before they are released from ovaries Needle puncture(s) through vaginal wall into ovaries or laparoscopic surgery 92.5% 3Fertilization and embryo culture To create viable embryos Sperm preparation Fertilization Laboratory culture 90.0% 4Embryo transfer To establish a pregnancy Embryo evaluation in laboratory Determining number of embryos to transfer Insertion of catheter through cervix into uterus 77.8% (nationwide) 92.5% (The Fertility Institutes) 5Pregnancy To gestate developing fetus(es) Progesterone/other drugs* Fetal reduction* Prenatal diagnosis* SART Report 6Delivery To deliver live infant(s) Cesarean delivery* SART Report Affordable IVF At The Fertility Institutes, we pride ourselves on the practice of Reproductive Medicine based on a solid foundation of science. Our commitment to providing the absolute highest quality medical care has resulted in an outstanding reputation with the consistent achievement of excellent pregnancy statistics. You are urged to compare our price per cycle and explore our highly discounted multi-cycle packages. Qualified patients can obtain FULL IVF services for $5,800.00. NEW! We now offer very low cost "Minimal Stimulation" IVF for those unable to afford "standard" IVF or those that do not wish to undertake the standard fertility drug stimulation protocols. This process avoids the use of most of the standard fertility medication dosages, instead using very low dosages and provides an opportunity to achieve pregnancy utilizing the world's most advanced infertility technologies at a greatly reduced cost. Pregnancy rates with this method ARE NOT as high as with our standard IVF protocols and this method should only be considered by those with financial constraints or an objection to standard fertility medication treatment used in IVF. Our low cost pricing makes this method as affordable as non-IVF treatments that offer nowhere near the success rates as this new minimal stimulation technique. Fertility medication costs are very, very low. Please call us for additional information on this procedure. Costs are approximately $3,000 which is 1/4th to 1/5th the cost of standard IVF. We look forward to answering your questions about this exciting new option! For those that may require the additional services of a surrogate mother or egg donor, we maintain our own, in-house roster of young, screened and tested University student egg donors. There are no agency fees charged for our donors. This can lead to a savings in the thousands of dollars! We have near immediate availability of tested and screened gestational surrogates as well. Unlike the often very long waits for a suitable surrogate, we are often able to effect a match within days to weeks. We are able to accommodate demanding patient work schedules by offering early morning evaluations that can put you back on the road to work efficiently. IVF In Mexico! Provided by United States board certified reproductive endocrinologists and fertility specialists. Cycle Price: $4,000 U.S. Dollars. Interested non-mexican patients should call our Los Angeles facility at telephone 818-728-4600 or please e-mail us your name for full details. We offer travel assistance and coordinate all arrangements including arranging local preliminary monitoring near your home to keep your visit in Mexico limited to as short as 3 days! Call us today.

Advances in Egg Freezing (Oocyte Cryopreservation) Exciting new advances in the ability to successfully cryopreserve (freeze) human eggs now allows us the option of extending the fertility of women far beyond nature's boundaries. You can now have your eggs frozen and stored for use at a later time in life while still maintaining the fertility potential of a younger woman. World renowned scientists, physicians and cryobiologists have come together at the Fertility Institutes to offer patients with a variety of medical indications or a simple desire to do so, the ability to preserve their fertility by suspending their eggs in time. We also offer those women in need of donor eggs the choice of frozen, prescreened frozen eggs donated by young volunteer University students. Egg Freezing Program Candidacy Scientists working at the Fertility Institutes have further refined the egg freezing process to allow women of all ages from all corners of the world the ability to participate in our program. For those interested in freezing their own eggs, evidence suggests egg freezing to work best for younger women. Our experience thus far with oocyte cryopreservation allows us to provide you with the following guidelines for determining if egg freezing may work for you: Group "A" Candidates Best -- excellent chances for success Under age 35 years A serum FSH "fertility thermostat" value less than 7.1 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, no prior exposure to chemo or radiation therapy. Group "B+" Candidates Good chances for success Ages 35-37 years Serum FSH "fertility thermostat" value less than 8.1 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, short term, limited exposure to radiation or chemotherapy with no direct radiation of ovaries. Group "C" Candidates Moderate chances for success Ages 37.5-39 years Serum FSH "fertility thermostat" value between 7.1 and 9.0 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, short term, limited exposure to radiation or chemotherapy with no direct radiation of ovaries. Group "C-" Candidates Some guarded chance of success Ages 39.1 to 40 years Serum FSH "fertility thermostat" between 5.0 and 8.5 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, no more than short term, limited exposure to radiation or chemotherapy with no direct radiation of ovaries. Non-Eligible Candidates Age over 40 years or any woman with unsatisfactory ovarian reserve testing outcomes. Serum FSH "fertility thermostat" levels greater than 10.0 mIU/ml on cycle day 3 If being treated for cancer, extended chemotherapy or direct radiation of the ovaries. You can find other programs that will freeze your eggs at this age, but there are NO reports from anywhere in the world that such freezing offers a reasonable chance for success. Steps in the Egg Freezing Process Our treatment protocol involves the preparation of your ovaries for the production of the mature eggs needed for the freezing process. Full details of this process will be provided at the time of your formal entry into the program, but a summary of the process is provided here for your reference and understanding: Step 1 Normal Menstruation Involves waiting for your normal menstrual period to begin. Depending upon the treatment protocol prescribed for you, with the beginning of your menses, you will either be given instructions to begin your fertility drugs, or instructions to wait for a certain date within the three weeks following the start of your period to begin a medication to allow the Doctors the opportunity to optimize your ovaries for the fertility drugs that will follow. Step 2 Ovarian Stimulation Involves the administration of fertility medications designed to allow your ovaries to begin the growth of the several eggs that will be removed for subsequent freezing. During this phase, you will be self-administering daily fertility injections to allow for the successful production of multiple healthy eggs. You will be shown how to take these injectable medications prior to using them. While taking these medications, you will need to be seen for painless ultrasound studies and blood tests 3-4 times over the 10-12 day period these medicines are being used. These studies may be carried out near your home, or at any of our offices. Step 3 Egg Retrieval After your eggs have been determined to have matured adequately, you will be scheduled for the surgical harvesting of your eggs. This is done by the Doctor at our facilities. In nearly all instances, the procedure is carried out with a light sedative and pain medication that allows for a very rapid recovery. You will be discharged from the office when it has been determined that you are stable, usually within 1-3 hours of your procedure.

Sperm Evaluation sperm and egg representing fertility One of the biggest concerns of couples involved in an infertility work up relates to the status of the male partner's sperm evaluation. While the thorough evaluation of sperm and sperm function should be given high priority in any infertility evaluation, we have found from our web page interactions with patients that often times the couple are told very little related to test results in this area. Or, in other cases, we hear of couples being told about "high numbers" of "abnormal" sperm, or "low" numbers of "good" sperm with little additional information about what those results mean to their chances for conception. Other very concerned couples have sent us copies of original semen analysis reports, having been told of "problems". On review, many of these reports have been printed with very out of date data related to what "normal" fertility test results should be in a fertile man. While there is no substitute for the evaluation of semen and sperm testing results by a highly trained and specialized professional, the truth is that many modern laboratories and even some very well qualified physicians have not kept totally abreast of our changing understanding of sperm function, and our new and evolving views of "fertile" sperm test results. In our laboratory, we arrived at our "normal" values for sperm test results by closely watching the fertility course of the many, many patients that we have tested and followed over the years. If 60% of our male patients with sperm counts of 20 million/ml (considered "low" by many laboratories) are able to produce pregnancies without medical assistance, should a count of 20 million be considered "infertile"? In the 40% of men unable to produce a pregnancy with a count of 20 million/ml, they may indeed have a fertility problem. The point is that there are no absolutes in the area of sperm evaluation. This is true between different laboratories, and even within the same laboratory. It is our opinion that sperm test results should not be presented to patients by way of a five minute telephone conversation. Instead, we feel each couple is entitled to sit in consultation with their physician or nurse or Laboratory Director and be advised of the specific results, and how those results compare to the results of known fertile males tested in that laboratory. Couples should also ask and be told about how the "Normal" ranges for the individual laboratory were established. There are, of course, many more things to be elicited from the laboratory, but we feel this to be a good starting point. Male Reproductive Semen and Sperm Testing The Fertility Institutes have Board Certified, male reproductive MEDICAL (Urologist/Andrologist) AND LABORATORY (Embryologist/Andrologist) specialists available at each location, including MEXICO. We provide all advanced male reproductive semen and sperm testing in-house and with our affiliated laboratories worldwide. Common sperm abnormalities tested for: Sperm Counts Laboratories performing sperm "counts", in general, vary in the details that they provide the physician requesting the "count". A general sperm count as part of a fertility evaluation should include the total density or count (20 million per ml or above), and the motile density (8 million per ml or higher). The motile density is perhaps the most important part of the semen analysis, as it reports the total number of sperm thought capable of progressing from the site of sperm deposition to the site of fertilization. This value is essential in both allowing a determination regarding whether or not a semen analysis is "normal", as well as in providing prognostic information should advanced reproductive medical assistance be required. (Numbers in italics are what "normal" values should be.) Definitions of "abnormal" counts: Polyzoospermia: Excessively high sperm concentration Oligozoospermia: Sperm count less than 20 million/ml Hypospermia: Semen volume < 1.5 ml Hyperspermia: Semen volume > 5.5 ml Aspermia: No semen volume Pyospermia: Leukocytes (germ fighter cells) present in semen Hematospermia: Red blood cells present in semen Asthenozoospermia: Sperm motility < 40% Teratozoospermia: > 40% of sperm seen are of abnormal form Necrozoospermia: Nonviable ("dead") sperm Oligoasthenozoospermia: Motile density < 8 million sperm/ml Sperm Morphology (Shape and Appearance) The evaluation of sperm size, shape and appearance characteristics should be assesed by carefully observing a stained sperm sample under the microscope. The addition of colored "dyes" (stains) to the sperm allow the observer to distinguish important normal landmarks (characteristics) as well as abnormal findings. Several methods of staining sperm are used, and the method employed should be one with which the examiner is comfortable and experienced.

Genetic Screening and Diagnosis DNA strands representing Preimplantation Genetic Diagnosis (PGD) The Fertility Institutes have been providing advanced genetic analysis of embryos to avoid serious genetic diseases for well over a decade. As one of the worlds largest providers of Preimplantation Genetic Diagnosis (PGD) genetic screening to the International community, the physicians and scientists at the Fertility Institutes have unmatched experience in coordinating, accommodating and facilitating the complex medical procedures involved in advanced genetic screening of human embryos. You could not choose a more dedicated, experienced group of physicians and scientists than those at the Fertility Institutes. Once you contact us, you will receive detailed instructions for providing our Doctors with the important details of your or your family's history with sickle cell disorder. The Doctors will request additional preliminary testing and you will be sent special kits to have your blood collected and shipped to our laboratories in the United States. In most instances, arrangements for treatment can be carried out within 30-60 days of your initial contact with us. Among the Diseases Detectable with PGD The accuracy of PGD in determining genetic abnormalities exceeds 98%. Once we have the genetic information about each embryo available, we are able to sit down with each couple prior to the embryo transfer, discuss the genetic health of each embryo, explain how the genetic information has improved the chances for pregnancy success compared to their prior unsuccessful attempts at IVF elsewhere, and make a determination about the return of the now "known to be normal" embryos to the mother to be. Because PGD so improves the success of IVF, many couples elect, in consultation with us to decrease the total number of embryos placed back in the womb. This also decreases the chance of multiple birth and the chance of prematurity. It also allows for the cryopreservation of extra "normal" embryos for future pregnancies. Our experience has shown that even when far fewer embryos are returned to the uterus, pregnancy success increases following PGD. Current Detectable Diseases Adrenoleukodystrophy Amyotrophic Lateral Sclerosis Becker Muscular Dystrophy Beta Thalassemia BREAST CANCER Central Core Disease Centronuclear (Myotubular) Myopathy Cerebellar Ataxia Charcot-Marie-Tooth Disease Chondrodysplasia Punctata Congenital Aganglionic Megacolon Conradi-Hunnerman Syndrome Cystic Fibrosis Duchenne Muscular Dystrophy Factor VIII Deficiency Factor IX Deficiency Familial Spastic Paraparesis Fragile X Syndrome Friedrich's Ataxia Gardener Syndrome Glycogen Storage Disease Happle Syndrome Hemophilia Huntington's Disease Retinitis Pigmentosa Prostate Cancer Sickle Cell Anemia Tay-Sachs Disease Von Willebrand Disease Many Other Diseases See an example of a PGD genetic analysis report. Though these embryos appeared "normal" under the microscope, it can be seen that many carried genetic abnormalities that would not allow for pregnancy. Only those truly "normal" embryos were returned to the mother, with a healthy twin pregnancy resulting. PGD Technology Can Guarantee a Sickle Cell Free Baby Baby representing fertility Sickle cell anemia is an inherited disease of the red blood cells which can cause attacks of pain and damage to vital organs which can lead to premature death. The genetic basis of sickle cell inheritance has been known for many years. It is just recently however that this genetic knowledge has become useful in helping those families known to carry the sickle cell gene avoid the birth of infants affected with the sickle cell disease disorder. The sickle cell prevention PGD program at the Fertility Institutes in Los Angeles and New York approaches 100% certainty in helping couples assure that a pregnancy will not result in the birth of a baby with sickle cell disease. The sickle cell disorder is known to occur when a person inherits two sickle cell genes (one from each parent) or a combination of one sickle cell gene from one parent and any one of several other abnormal hemoglobin genes from the other. The sickle cell disorder may be the world's most commonly inherited disorder and is clearly the most common genetic affliction seen in African infants. 1% to 2% of babies born on the African continent are afflicted with sickle cell disorder or one of its variants. The genes for the sickle related disorders arose in the evolution of mankind as a result of gene mutation. Because of the partial protective effects of sickle genes against the dangers of falciparium malaria, these gene abnormalities proliferated in areas where there was or is a high incidence of malaria. Currently, the Bantus in African countries north of the Zambesi River have a high incidence of sickle cell disorder, with the prevalence varying but significant in all other parts of the African continent.

Vasectomy Reversal Our Centers are staffed by Board Certified Urologists that specialize in male infertilty. We provide classic microsurgical vasectomy reversal procedures, along with techniques such as MESA, TESA and PESA (see below) which include simple, through the anesthetised skin, needle aspiration of sperm, and methods to overcome failed vasectomy reversals. Cost for vasectomy reversal is approximately $6,400.00. Tubal Ligation Reversal We perform both laparoscopic and "open" microsurgical tubal reanastamosis. Success rates in selected cased approach 85%. The "open" procedures are also offered at our Guadalajara based facility in Mexico at substantially lower hospital prices ($4,200 total hospital cost (subject to change without notice; effective 1/09, less than one half comparable U.S. prices, with no compromise in success. Surgeon's fees are extra but are also substantially lower than U.S. prices. Surgery is carried out by Board Certified U.S. Reproductive Specialists at the Center for Reproductive Medicine at Hospital San Javier in Guadalajara, Mexico. Hospital San Javier is Mexico's leading medical and surgical facility. The hospital can be found listed on the very exclusive U.S. Department of State referral site for advanced medical care in Mexico. Alternatives to Vasectomy Reversal (MESA, TESA, PESA) For those wishing to avoid the reversal of a prior vasectomy, either for standard In Vitro Fertilization (IVF) or for advanced IVF procedures involvng guaranteed gender selection, we are able to offer MESA (Microsurgical Epididymal Sperm Aspiration), TESA (Testicular Sperm Aspiration) or PESA (Percutaneous "no incision" Sperm Aspiration). These procedures involve our board certified fertility Urologist aspirating sperm directly from testicular structures at the same time that the eggs from the female are obtained. The recovered sperm are then used to inseminate the waiting eggs. Fertilization and pregnancy rates approach the same levels achieved with successful vasectomy reversal procedures with minimal or no incisions. This procedure is most appropriate for couples interested in one or perhaps two additional children. "Extra" sperm obtained from the aspiration in excess of that needed for the initial egg insemination may often be frozen and cryopreserved for future use.

Surrogacy Programs Largest non-agency surrogacy center in the United States World Leading Surrogacy Programs All In One Centers: Physicians, Surrogates, Donors, Attorneys Largest non-agency provider of surrogacy services Leading provider of surrogate gestational services Large selection of well screened egg donors and surrogates The ONLY U.S. program with ownership affiliations in Mexico World’s leading center for 100%* gender selection Critical procedures performed by MD and PhD specialists All legal and attorney services in-house Affordable high quality services gf FREE INFORMATION PACKET! World Leading Provider of Surrogacy Services We are the largest and most successful “All-in-One” non-agency provider of surrogate services in the United States (Physicians, Surrogates, Donors, Attorneys) and one of the leading providers of surrogate gestational services in the world. We assist couples and singles considering the use of a surrogate and help those interested in becoming a surrogate. International Programs Available! We are pleased to announce that all medical services offered by The Fertility Institutes are available internationally. We work with affiliate clinics in over 42 countries. Learn More Surrogacy Considerations While surrogacy is clearly not for everyone, in our experience, many couples and singles that were close to “throwing in the towel” have found that surrogacy has provided a long awaited answer to their problems. Considering the use of a surrogate or serving as a surrogate can be an issue that requires a great many questions to be answered. We work with many, many couples, singles and surrogates, so we know and understand this: Seeking the assistance of a screened, highly qualified surrogate? Interested in working with The Fertility Institutes as a surrogate? Surrogacy programs FAQ Affordable Surrogacy program Fees Potential parents and surrogates that are matched through our program are united through the efforts of the dedicated medical staff in our offices, with well over three decades of successful experience in surrogacy and egg donation. The high quality services we provide are offered at prices that, in most instances are half of the prices charged by other programs. Surrogacy Fees Fees represent estimates for the average patient seen and are subject to minor variations (additional charges for medications are indicated as +Rx). Procedure Fees Surrogacy We understand fully the need to obtain an accurate “estimate” of full surrogacy costs. The Fertility Institutes was the FIRST SURROGACY PROGRAM to provide general surrogacy cost information online. There are a multitude of variables in every surrogacy arrangement. It has become increasingly difficult, especially in this age of “supply chain” shortages of medications, medical supplies and equipment as well as increasing medication costs, travel fares and ancillary expenses, to provide the “latest” cost estimates. In an effort to to keep “up to date” with costs, we have undertaken a survey of the new parents our last 100 successful surrogacy cases. The “average” cost reported to us by parents for the ENTIRE surrogacy cycle – exclusive of the fees paid to the surrogate but inclusive of the surrogates obstetrical care and delivery in year 2022 has been: $84,400 U.S. Fees varied by as much as $12,000. These numbers are provided for reference only and are NOT a quote or prices. We urge you to call to speak to our financial counselors who are able to provide you far more information. Please Call ALL required services in one location: Physicians, surrogates, attorneys, IVF laboratory. Surrogates and egg donors (Caucasian, Asian, Latino, African American) available now.Please call +1 (818) 728-4600 or +1 (212) 725-1177 for surrogate, egg donor and ancillary pricing. Surrogacy Using Frozen Embryos Please call +1 (818) 728-4600 or +1 (212) 725-1177 for discounted pricing

World's Only Fully Integrated Gay Surrogacy Program Our gay surrogacy centers are the largest providers of parenthood options to the worldwide gay community. We are well aware of the patient "run-around" aspects encountered by hopeful new parents when dealing with many other providers of similar services. To assure that our patients do not have to endure the non-centralized hardships encountered with most centers offering surrogacy services, our center incorporates all aspects of the gay surrogacy process into one centralized location: Dedicated Expert, Sub-Specialist, Physicians, Surrogates, Egg Donors, Surrogacy, Egg Donor Contract Attorneys and Fertility Laboratories. This tight integration of services allows those considering this parenthood option the ability to have all of their questions, needs and desires addressed by a sensitive, highly skilled and knowledgeable staff dedicated to assuring that the complex route to gay parenthood is an anxiety free, joyful experience. How it Works: Gay Surrogacy Tiers To facilitate your understanding of the complex arrangements that must take place in order to assure a successful egg donor-surrogacy cycle, we divide the process into 4 tier levels. While each level is as important as the next, such a division helps clarify the process and make it easy to understand how we proceed efficiently through the arrangements that will make your dream of parenthood a reality: TIER 1 Selection of a Fertility Center While various arrangements are made by those seeking egg donors and surrogates at various centers, at The Fertility Institutes, with nearly three decades of experience with arrangements for gay parents, we have found the most efficient and least stress inducing arrangements are those in which we, at the Center assist you with ALL of the necessary details in arranging your treatment cycle. While nearly all competing centers only utilize outside egg donor and surrogacy agencies, as well as outside psychologists and attorneys, at The Fertility Institutes, we offer the option of keeping the majority of the process internal. While we certainly can work with those that have located their egg donor and or surrogate independently or with reputable agencies, we have found that by allowing our physicians to become involved in the screening process of egg donors and surrogates, you are assured a more thorough evaluation and screening than that routinely provided by outside sources. In addition to the rigorous screening of our in-house egg donors and surrogates, we are very selective in our choice of outside agencies, preferring to work with those that allow the screening process details to be ordered and specified by us. We also serve as patient advocates, your advocates as we are often able to reign in the runaway fees demanded by some agencies and their donors or surrogates. The early selection of a Center to assist with your plans is crucial to allowing the process that will lead you to parenthood to proceed. As surrogacy options in the United States become increasingly limited as a result of the dwindling supply of well qualified U.S. surrogates from states that allow surrogacy and the ever increasing demand for these women, the Fertility Institutes organization has responded and is the ONLY U.S. PROGRAM with direct ownership of surrogacy programs in both Mexico and India. While current Indian law prohibits the use of Indian surrogates for gay singles or couples, Mexican legislation allows for totally legal surrogacy for gays. The program operated by the Fertility Institutes at our Mexican facility has been deemed a fully qualified center to provide these services by Mexican authorities.While the majority of our surrogacy matches for our gay patients is with qualified U.S. surrogates, our Mexican match option, with the associated cost savings is growing monthly. As soon as you indicate to us your desire to proceed, all available options, domestic U.S.A. and foreign options will be detailed for you.You will be provided direct guidance and counseling by our physicians and nurses about the course of action most suitable to meet your needs and desires. In many instances, matches with a suitable surrogate can occur in as short as 30 days following the completion of your intake evaluations.Because all subsequent treatment arrangements will need to await completion of your intake evaluations, you are encouraged to schedule these physical examinations and blood tests as soon as possible. At the time initial semen specimens are requested for sperm counts and other suitability evaluations, you (the sperm donor(s)) will be asked to undertake infectious disease blood testing that will include HIV (AIDS) testing, Hepatitis B and C, Syphilis, and HIV I and II testing.

World leading 100%* Gender Selection Programs** Mexico’s first, longest operating and most successful IVF program Screening for over 400 hereditary diseases Now combinable with Microsort sperm sorting Critical procedures performed by MD and PhD specialists Affordable high quality services Discounted travel plans available Unique to the program at San Javier is the exclusive IVF and PGD** program operations and interface with the well known and highly respected successful United States PGD based gender selection and IVF programs at the Fertility Institutes. The U.S. Board Certified physicians and genetic scientists at the Fertility Institutes, with offices and active IVF and PGD centers in Los Angeles and New York City have maintained 100% oversight and management responsibilities for the IVF program at San Javier in conjunction with leading Mexican fertility specialists since its founding in 1990. As part of their commitment to assuring the highest quality of IVF care as well as care in the intricate process of PGD** gender determination, scientific and medical teams from The Fertility Institutes provide total case oversight management, egg retrieval oversight and all PGD procedure supervision carried out at Hospital San Javier. This unique arrangement allows United States, Canadian and other foreign based patients the security of knowing that their treatment will be overseen by highly skilled and successful Board Certified American physicians and scientists while at the same time allowing them to take advantage of the dramatically lower medical and laboratory costs available in Mexico. PGD procedures in Mexico are performed, in coordination with San Javier based fertility specialists by the same highly skilled U.S. reproductive endocrinologists and geneticists that have made the U.S. Fertility Institutes a world renown leader in advanced fertility and PGD treatment. With the cost of U.S. healthcare continuing to accelerate at a rapid pace, “medical tourism” with U.S. patients as well as those from many other nations seeking high quality advanced healthcare outside of the borders of their own countries has mushroomed in recent years. The availability of skilled foreign specialists has been an enticement to those in the United States and elsewhere interested in the cost savings available by obtaining care at high quality foreign centers. In the case of Hospital San Javier, the best of all situations has been created with U.S. based specialists providing coordinated personalized care in a world class foreign center. The scientific demands of the IVF-PGD gender selection and genetic health screening (aneuploidy) process requires 2-3 weeks of treatment preparation that prepares couples for the PGD procedure. This preparation and treatment must be tightly integrated with the fertility center at which patients are preparing to have their PGD procedure. This mandatory coordination, until now has required those considering IVF-PGD abroad to plan to spend weeks away from home being monitored by the foreign center. With the expansion and continued growth of the IVF-PGD center at Hospital San Javier, the reproductive endocrinologists at the Fertility Institutes in the United States are able to accommodate, arrange and coordinate the care of U.S. and other foreign PGD patients interested in services at the Guadalajara center. This allows patients the opportunity to remain at home for the 2-3 weeks required as they prepare for the IVF-PGD and gender determination and aneuploidy screening procedure in Guadalajara. They may then plan on two short trips to Guadalajara of 1-3 days to Guadalajara to allow the entire IVF-PGD process to occur. Interested patients can be initially seen in Guadalajara, at the Los Angeles or New York offices of the Fertility Institutes or can undertake a telephone intake consultation from home with the U.S. based coordinating physician team to allow for entrance clearance into the program. There is a full coordinated effort undertaken to assure the highest chances for a successful outcome. The dramatic cost savings realized with this new treatment option are allowing more people than ever to take advantage of this remarkable leap in the ability of science to allow for gender selection with a virtual guarantee of a preselected gender once successful pregnancy is achieved. To fulfill our obligation to the administrators of Hospital San Javier, Mexican patients will be given scheduling priority for PGD related procedures. We have provided all obligatory fertility services to large numbers of local patients with outstanding and ongoing success. We have now been granted authority to offer the PGD cost savings available in Mexico to foreign (U.S. and other) patients.

Gender Selection Leaders Recognized by ABC, NBC, CNN, Fox and Reuters as among "THE" worldwide leaders in gender selection technology. If you want to be certain your next child will be the gender you are hoping for then no other method comes close to PGD (Preimplantation Genetic Diagnosis). While traditional sperm-screening techniques have a success rates of 60-70%, only PGD offers virtually 100% accuracy. And now, in one of the most major advances in the ability of parents to choose characteristics of their children, the Fertility Institutes announce the availability of EYE COLOR SELECTION. Following years of work and research, eye color selection has become an additional realistic option for those parents with such an interest. Gender Selection Methods The selection of gender has been a quest of couples for as far back as recorded history allows. Early drawings from prehistoric times suggest that gender selection efforts were being investigated by our earliest ancestors. Later history shows intense interest in gender selection by early Asian (Chinese), Egyptian and Greek cultures. This is followed by documented scientific efforts beginning in the 1600's to sway the chances of achieving a pregnancy by a variety of methods. Research and work carried out in the 1980's and 90's have finally provided methods offering the chance of obtaining a desired pregnancy gender outcome that ranges from excellent to virtually guaranteed* with PGD. The steps and procedures for gender selection are as follows: Several eggs are extracted from the mother by our doctors, sperm is supplied by the father. The father's sperm is used to fertilize the mother's eggs in our lab. After 3 days, several 8-cell embryos will have developed (see figure). Our doctor-scientist specialists examine the genetic makeup of the embryos, screening for both genetic diseases and desired gender. Healthy embryos of the gender you desire are implanted in the mother. Any additional healthy embryos may be cryo-frozen for future use. Gestation and birth take place as normal. The Scientific Understanding of Gender Selection DNA strands representing PGD science and technology It has been known for many years that the gender of a pregnancy is determined by the sex chromosome carried by the sperm. Sperm bearing an "X" chromosome, when united with the "X" from the female (females only produce "X") will result in an "XX" pregnancy that produces a female. If a sperm bearing a "Y" chromosome (men have both "X" and "Y" bearing sperm) unites with the "X" chromosome from the female, an "XY" pregnancy will result that gives rise to a male offspring. Armed with this knowledge, science initially worked to allow for an accurate method of safely separating sperm to allow the majority of those sperm capable of producing the desired gender ("X" sperm or "Y" sperm) to be exposed to the female egg (oocyte). While a variety of methods of purifying the sperm separation process have been reported and studied, in reality, very few of these methods have withstood scientific scrutiny that "checks" the validity of claims made by those employing the procedure. Because no sperm separation method thus far developed has produced the high level of sperm separation "X" (for female) and "Y" (for male) needed to provide gender outcome success levels greater than 90%, further work to perfect the gender selection process is being studied. "PGD" (Preimplantation Genetic Diagnosis) has taken gender selection to the next and most successful level ever (greater than 99.9%). Results from our PGD process far exceed reported results from any and all other processes. Sperm that have been filtered by our standard sperm preparation process are allowed to fertilize the eggs obtained from the female "in vitro" (in our highly specialized fertility laboratory). The embryos resulting from this specialized fertilization process are then screened by our genetics team to determine both their gender and that selected chromosome pairs have resulted in an expected normal genetic pairing outcome (this process is called "aneuploidy" screening). This gender determination process at the very early development level as made famous by our Center, has resulted in the ability to provide gender selection results for the chosen gender far in excess of 99.9%. The aneuploidy (abnormal chromosome count) screening process also employed at the time of PGD gender determination also allows for the detection of limited genetic count abnormalities as a routine or for the optional screening of the embryos for a wide variety of additional genetic abnormalities. Upon request, we can screen for genetic abnormalities such as Down's syndrome (one "extra" chromosome 21), Turner's syndrome (the absence of one of the two "X" chromosomes normally found in a female), and Kleinfelter's syndrome (a male with one "Y" chromosome and 2 "X" chromosomes instead of the normally found single "X" chromosome).

At The Fertility Institutes, we offer Platelet-Rich Plasma (PRP) therapy as part of our elevated, personalized approach to reproductive medicine. Designed for patients seeking advanced, fertility restorative options, PRP represents a sophisticated integration of regenerative science and fertility expertise. This minimally invasive treatment harnesses your body’s own biologic potential to support ovarian function and enhance the uterine environment — delivered within the privacy and refinement of our concierge fertility program. A REGENERATIVE APPROACH TO FERTILITY OPTIMIZATION Platelet-Rich Plasma is derived from a small sample of your own blood. Using specialized processing, we isolate and concentrate growth factor–rich platelets that play a critical role in cellular repair, tissue renewal, and vascular support. In fertility medicine, PRP is being explored to support ovarian responsiveness in select patients, enhance endometrial thickness and receptivity, improve uterine blood flow, and complement IVF cycles and embryo transfer preparation. iStock 1374389013 compressed scaled.jpg At The Fertility Institutes, PRP is not offered as a standalone solution, but as part of a carefully curated, individualized fertility strategy. All patients in our programs are carefully evaluated for the ability of their gametes (eggs and sperm) to generate and produce healthy embryos that have a very high potential to lead to successful, genetically and metabolically normal birth, babies and life. We are the world’s leading center for assisting couples seeking to assure normal, healthy genetics in their pregnancies, including the ability to choose with greater than 99% certainty the gender of their child and eye color with 92% accuracy. OVARIAN REJUVENATION As part of our detailed medical work to also assist all of those with fertility issues, we see on a very regular basis, couples or women who have failed to become pregnant with standard fertility treatments including insemination and / or In Vitro Fertilization (IVF) at other centers. We are highly specialized in reviewing these often difficult cases sent to us by fertility centers as well as by patients seeking solutions as we seek innovative approaches to producing more favorable outcomes with our advanced procedures. A very, very common condition seen with prior fertility and especially IVF failure is a problem with the number and/or quality of the ova (eggs). This condition is often termed “diminished ovarian reserve” or “poor responders” or “premature ovarian depletion” and is often predictable in women with low serum “AMH” levels or elevated “FSH” levels. AMH Anti-Müllerian Hormone (AMH) is a hormone produced by small ovarian follicles in women, serving as a key biomarker for ovarian reserve (the quantity of remaining eggs). It is used to assess fertility potential, predict responses to IVF, and help diagnose conditions like PCOS or menopause. We perform AMH levels on all incoming patients and on all those presenting to us with a history of prior failed inseminations or IVF. For women with low AMH levels, with or without prior failed IVF, or for those experiencing diminished ovarian reserve, suboptimal response to fertility drug stimulation, or early ovarian insufficiency, PRP may help promote a more supportive ovarian microenvironment. PRP has been shown to commonly raise low AMH levels, significantly increase IVF pregnancy rates and aid greatly in preventing miscarriage. For those scheduled with us to receive PRP for the ovaries, our physicians utilize advanced ultrasound-guided techniques to precisely administer PRP, ensuring both safety and comfort. ENDOMETRIAL ENHANCEMENT A healthy endometrial lining is essential for successful implantation. Patients with thin lining or recurrent implantation challenges are frequently referred to The Fertility Institutes. Intrauterine PRP, where your platelets, rich in growth and enhancement factors are infused directly into the uterus prior to embryo transfer, may help improve endometrial thickness, support vascularization, and enhance uterine receptivity prior to the embryo transfer. We perform PRP to enhance the uterine environment and achieve much improved IVF success in those with a thin or non-responsive endometrium. This therapy is often incorporated into a tailored IVF protocol. PRICING As noted above, PRP therapy is used in two distinct fertility settings, each with a very specific protocol for success: Ovarian Rejuvenation Obtaining a personal blood sample containing the platelets to be purified Isolating the platelet infusion Injection of the PRP infusion directly into the ovaries Endometrial Enhancement Obtaining a personal blood sample containing the platelets to be purified Isolating the platelet infusion Infusing the PRP isolate into the uterine cavity Combined Ovarian Rejuvenation and Endometrial Enhancement