* What is a reproductive endocrinology and infertility (REI) specialist?

Reproductive endocrinology and infertility (REI) is a subspecialty of obstetrics and gynecology (OB/GYN). The REI specialist is trained in both general obstetrics and gynecology and in diagnosing and treating specific problems such as infertility, recurrent miscarriages, endometriosis, pelvic pain, irregular menstrual periods, fibroids, polycystic ovarian syndrome, menopause, and puberty issues. most REI specialists do not deliver babies and refer pregnant women to general obstetrician-gynecologists (OB/GYNs). To become an REI specialist, one must complete 4 years of medical school, 4 years of OB/GYN residency, and 3 years of fellowship (subspecialty) training in REI.

* What is infertility?

Infertility is defined as one year or more of inability to conceive in a woman is under age 35, or 6 months or more of inability to conceive if over age 35.

* What are the causes of infertility?

Approximately 30-40% of infertility is due to male factors; 50% percent is due to female factors; and 10-20% is due to either combined male and female factors or unexplained infertility. In the female, the combination of endometriosis, tubal disease, or adhesions (scarring), collectively known as the "peritoneal factor", is the most common cause. Problems with ovulation is the second most common cause. Cervical mucus abnormality is the third most common cause.

* Is infertility becoming more prevalent?

Not significantly. There has not been an appreciable rise in the rate of infertility in the United States, though the increasing awareness of treatment options and the increasing success of modern treatment such as in vitro fertilization (IVF) have resulted in an increase in utilization of infertility services.

* When should I see a reproductive endocrinology and infertiliy (REI) specialist?

The basic infertility evaluation consists of a semen analysis, test for the fallopian tubes (hysterosalpingogram, HSG), and tests for ovulation (basal body temperature chart, ovulation predictor test, blood level of progesterone). This evaluation can be performed by a general OB/GYN who is adequately trained to evaluate infertility. Short-term treatment with fertility pills (oral ovulation induction) can also be offered by a general OB/GYN. Generally, infertile female patients over age 35 or patients who have not conceived after at most 6 months of simple therapy should be referred to an REI specialist. If a patient has a complex reproductive issue such as absence of sperm or severe edometriosis or long-term infertility (over 3 years), she should be referred to an REI specialist without delay.

* How should I choose an infertility clinic?

The most important questions a couple should ask before selecting a clinic for evaluation and treatment are as follows:

- Does the clinic provide a wide range of state-of-the-art infertility treatments (e.g. IVF, inseminations)?

- Is the clinic certified by the appropriate national institutions?

- Is the clinic managed by qualified and experienced physicians, including REI specialists?

- Is the clinic staff friendly, well-informed, accessible, and flexible?

- Is the clinic open at convenient and flexible hours?

- Does the clinic observe strict ethical and moral standards?

- What is the clinic's success rates in assisted reproductive technology compared to national standards? Are these success rates readily available?

* Why choose Bennett Fertility Institute?

Bennett Fertility Institute (BFI) at Integris Baptist Medical Center (www.integris-health.com/INTEGRIS/en-US/Specialties/FertilityInstitute/) is a full service, state-of-the-art provider of infertility services in Oklahoma City, Oklahoma. Established in 1985, it serves patients from Oklahoma, Texas, Kansas, and Arkansas. BFI is one of the original members of the Society for Assisted Reproductive Technology (SART), a subspecialty organization of the American Society for Reproductive Medicine (ASRM).

Services: In vitro fertilization (IVF) and embryo transfer (ET); intracytoplasmic sperm injection (ICSI); assisted hatching (AH); embryo and sperm freezing and storage; egg donation; embryo donation; sperm processing for artificial insemination by donor or husband; complex semen analysis with strict morphology criteria; reproductive hormone tests. At present, due to lack of clear criteria and indications, pre-implantation genetic diagnosis (PGD) is not offered at BFI. BFI does not provide sex selection or surrogacy services.

Certification: BFI is certified by the College of American Pathology (CAP) and has passed its strictest criteria in each of the required biannual inspections. It has passed a rigorous inspection by the Food and Drug Administration (FDA). It is one of the Centers of Excellence at Integris Baptist Medical Center. It is a member of SART, meeting its strict success rates, supervision, and staff requirements.

Management: BFI's medical director, Eli Reshef MD, is a board-certified reproductive endocrinology and infertility (REI) specialist with more than 20 years of experience. Its program director and founder, David Kallenberger MD, is an obsterician/gynecologist with more than 30 years of experience in infertility and complex gynecology practice. J. Edward Wortham PhD, HCLD has been BFI's laboratory director since its inception. He has 30 years of experience in high-complexity reproductive laboratory management and serves as an inspector of other IVF laboratories for CAP.

Clinic Staff: BFI's nursing staff has more than 60 years of combined experience in women's and reproductive health care. BFI has consistently been a top performer in Integris Baptist Medical Center's patient satisfaction surveys. The 3 nurses at BFI provide skilled and compassionate care 7 days a week. Treatments are individualized to each patient. Psychological counseling is available. Despite the high-complexity, high-anxiety nature of IVF treatment, patients have consistently commended the staff for guiding them so ably through the process. Patients also interact directly with BFI's embryology laboratory staff and are being fully and constantly informed of the status of their reproductive process by them.

Clinic Hours: Most services at BFI are provided 7 days a week, 365 days a year. In vitro fertilization services are available year around, except during one month from mid-December to mid-January (an annual requirement for quality control). On weekend and holidays, a nurse, a laboratory technician, and a physician are always present on the premises. On these days, services are provided in the morning only. During the week, BFI is open from 8am to 5pm. Hormonal test results are usually available within 1-2 hours. Semen analysis results are available to the patients and their physician the same day or the next day. IVF and ET procedures are performed daily.

Ethical and Moral Standards: While the clinic is non-denominational, it observes the strictest ethical and moral standards dictated by Integris Baptist Medical Center, ASRM, SART, and the American Medical Association (AMA). Most services that are considered assisted reproductive technology (IVF, ICSI, etc.) are performed at BFI. The exception is gestational surrogacy, sex selection, and IVF treatment of unmarried couples. Nevertheless, BFI will assist in referring patients for such services to qualified physicians and in following such patients throughout much of the process.

Success Rates: BFI annually reports its IVF success rates to SART and to the Centers for Disease Control (CDC) as required. One can access the Internet (www.SART.org; www.CDC.gov) for BFI's statistics over the years. BFI's live birth rates per IVF retrieval procedure have consistently been in the top 5-10 percentile among IVF clinics in the U.S. While clinic-to-clinic comparison based on such statistics may often not be valid because of differences in patient populations, BFI has consistently been able to produce superior results in the past 10 years.