Did you know the Center is responsible for nearly 12,000 babies. being born since 1982 through Advanced Reproductive Technologies (A.R.T.

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1 Volume 1 Issue 2 Summer 2016 MALE INFERTILITY IT TAKES TWO {WHEN MEN HAVE FERTILITY ISSUES} Why is it that guys often don t bother to go to the doctor? Are they hoping that if they ignore their symptoms they ll just go away? Well, if you re unable to get pregnant, here s something else your guy can t ignore: He could be the reason. (cont. inside) PHYSICIAN PROFILE Lawrence Engmann, MD, MRCOG One of "America's Top OB/GYN'S" Did you know the Center is responsible for nearly 12,000 babies being born since 1982 through Advanced Reproductive Technologies (A.R.T.) HEALTHCIRCLE Holistic nurses and health coaches are here for you FAMILY BUILDING PROGRAM Fertility issues and options facing gay s and lesbian s paths to parenthood FINANCING OPTIONS Access to a wide range of financial programs FERTILITY 101 VIDEOS Educational videos featuring our doctors with answers to some of the most commonly asked questions Janine Boudo / Bella Blue Photography

2 MALE INFERTILITY IT TAKES TWO {WHEN MEN HAVE FERTILITY ISSUES} (cont. from page 1) It can be hard for a guy to admit that he s not up to the job, but many men have fertility issues. In fact, male factor infertility contributes to about 50% of all infertility problems. That s why, when a couple comes to us, we look at both partners. Because as the saying goes, it takes two. A SIMPLE TEST TELLS A LOT A sperm test, or semen analysis, is the first step in diagnosing male infertility problems. The test is non-invasive, painless, and yields lots of critical information. Our doctors analyze the semen sample for its volume, viscosity (thickness), ph level (acidity) and color, as well as the concentration of sperm (sperm count). They also look at sperm motility (how many are moving), morphology (how many are abnormally shaped), as well as forward progression (are the sperm swimming in a straight line?). It should be noted that all men produce abnormally shaped sperm, and, in fact, as many as 50% of the sperm in a normal sample can be abnormally shaped. In addition to the semen test, the urologist will do a thorough evaluation that includes a medical history, physical examination and, if appropriate, additional sperm function tests. SEVERAL FACTORS CAN CAUSE MALE INFERTILITY Research shows that certain lifestyle choices can be detrimental to sperm quality and fertility. Exposure to toxins including those found in marijuana, cocaine, anabolic steroids and other substances often contribute to acquired male factor infertility. Chronic marijuana use, for example, has been shown to lower testosterone levels and affect sperm quality. The use of testosterone supplements on the rise among men of reproductive age can result in a lowered sperm count, sometimes even to zero. Other toxins can have a similar impact on hormone levels, sperm quality or testicular health. Heavy alcohol use, cigarettes and excessive heat in the scrotal area can also be factors. The use of certain medications for unrelated medical conditions can also affect male fertility. For example, calcium channel blockers taken for high blood pressure may have a direct effect on the ability of sperm to bind to egg receptors. Other medications and forms of treatment chemotherapy, radiation, and hormone deprivation therapy, for example can also negatively impact male fertility. Other medical conditions, such as testicular cancer, can also present problems. MALE INFERTILITY CAN OFTEN BE REVERSED A change in lifestyle can often reverse the effects of acquired male factor infertility. If a specific medication is a factor, other meds with less toxic side effects should be considered. Most of the time, the effects of testosterone supplements are reversible. Other medications that promote the body s ability to produce its own testosterone can be substituted. In some cases, however (such as the long-term use of anabolic steroids for bodybuilding) the effects can be irreversible. Of course, knowledge is always power. Providing more education to men about the potential impact of their lifestyle choices is critical to preventing many male fertility problems before they develop. With comprehensive evaluation, counseling, education and a personalized approach to treatment, our team of urologists and reproductive specialists is committed to maximizing your potential for reproductive success. And, yes, we re making sure men remember that reproductive health takes two. The use of certain medications for unrelated medical conditions can also affect male fertility.

Expanding HealthCircle, Our Holistic Approach to Fertility Care Summer 2016 MARIE HESLIN APRN Certificate of Integrative Nursing, Reiki Practitioner Levels I & II AMI CHOKSHI Certified Health Coach

With an interest in holistic nursing practice, Marie is able to integrate complementary modalities within her fertility nursing practice.

When a practitioner is working with someone having fertility issues, they explore where the energy is blocked or out of balance and then allow the energy to flow to where it is needed most.

Have you considered working with a Health Coach to help you achieve your goals of a healthy pregnancy and enhance your fertility treatment plan?

She also partners with your provider to help you implement his/her recommendations for your health and treatment plan. Most people find great benefits from a health coach.

Lawrence Engmann lead physician at the Center, Dr. Engmann is also the A Director of the Center s Oncofertility program. The Center sees a lot of patients, so we see a lot of problems stated Dr.

3 Expanding HealthCircle, Our Holistic Approach to Fertility Care Summer 2016 MARIE HESLIN APRN Certificate of Integrative Nursing, Reiki Practitioner Levels I & II AMI CHOKSHI Certified Health Coach Are you looking to integrate holistic and complementary medicine into your fertility treatment plan? With an interest in holistic nursing practice, Marie is able to integrate complementary modalities within her fertility nursing practice. Her training includes a foundation of both traditional western medicine and holistic nursing philosophy. Marie is also a Reiki Practitioner, a Japanese hands-on healing modality. When a practitioner is working with someone having fertility issues, they explore where the energy is blocked or out of balance and then allow the energy to flow to where it is needed most. Many times, the energy in and around the reproductive system is very low, particularly if the woman has old emotional wounds stored in this area. Have you considered working with a Health Coach to help you achieve your goals of a healthy pregnancy and enhance your fertility treatment plan? Through lifestyle and behavioral adjustments, Ami provides education and support to patients to achieve their health-related goals. She also partners with your provider to help you implement his/her recommendations for your health and treatment plan. Most people find great benefits from a health coach. Similar to having a fitness coach in a gym or a mentor at the workplace, when you have a Health Coach to help light the way, achieving your goals become a lot easier. Meet Dr. Lawrence Engmann lead physician at the Center, Dr. Engmann is also the A Director of the Center s Oncofertility program. The Center sees a lot of patients, so we see a lot of problems stated Dr. Engmann. We re also involved in cutting edge research. The Oncofertility program is a unique collaboration between oncologists, reproductive endocrinologists and researchers all over the country, created to help individuals who have been diagnosed with cancer, and who are going to be going through chemotherapy or radiation treatment that might render them infertile. Dr. Engmann has been selected by Consumer s Research Council in America to be included in their Guide to America s Top Obstetricians and Gynecologists. He has also been awarded The Berlex Foundation Resident Education Award, the Best Maternal-Fetal Medicine Resident Award, the Alumni Award for Undergraduate Education and The Ludwig Pyrtec Award for Best Scientific Paper. I have a passion for treating patients and helping patients meet their dreams. My patients know they have a trusted friend who will be compassionate, optimistic, and who will be available for them during one of the most difficult times of their lives. HealthCircle

Summer 2016 Family Building Program June is Gay Pride Love month! Sharing Our Patient s Kathy is beyond amazing!! I would not have made it through without her.

Laura was absolutely amazing through my two transfers! So positive and personable, she believed when I could not and I m so grateful for her support.

Important criteria used to evaluate a Center s success include its: experience level or volume live birth rate, and triplet or higher birth rate.

In addition to the range of advanced medical technologies we offer, we can also guarantee the highest level of skill and expertise in successfully using them.

We re pleased that the Center continues to demonstrate success: Not only in the percent of live births achieved, but also in our ability to lessen the potential for pregnancies with twins, triplets

Y our 40th birthday doesn t have to be the end of a dream.

However, in this initial law, the state only required the coverage for people under the age of 40. Now, Connecticut has an updated insurance mandate.

This mandate applies to health insurance plans subject to state regulation.

If you in the past thought that door was closed to you, that door is now open stated Kate. However, the law has many limitations and exemptions.

For more details go to our website where we have specific links to the documents addressing the insurance mandate.

At the Center, we have a trained staff dedicated to do just that.

W e understand how stressful fertility treatments can be, especially for those who do not have coverage for the treatments they need.

For those with insurance, we will help you sort through the confusion and frustration of evaluating your coverage as well as help you find more affordable and immediate ways to pay for testing and

4 Summer 2016 Family Building Program June is Gay Pride Love month! Sharing Our Patient s Kathy is beyond amazing!! I would not have made it through without her. She will forever hold a special place in my heart. Thank you for giving us the two biggest blessings! Your team of doctors and nurses are the best of the best. We are truly grateful. Laura was absolutely amazing through my two transfers! So positive and personable, she believed when I could not and I m so grateful for her support. SARTresults Choosing a quality Center is paramount to having successful outcomes. Not all Centers provide the same infertility treatments, offer the same approach or have the same results. Important criteria used to evaluate a Center s success include its: experience level or volume live birth rate, and triplet or higher birth rate. All of these techniques have been used extensively here at The Center and our experts can help patients determine what is best for their particular situation. In addition to the range of advanced medical technologies we offer, we can also guarantee the highest level of skill and expertise in successfully using them. We are experts in the field of reproductive endocrinology and infertility and have been nationally recognized for our success, compassion and commitment. We re pleased that the Center continues to demonstrate success: Not only in the percent of live births achieved, but also in our ability to lessen the potential for pregnancies with twins, triplets or more. As the largest fertility center in the state with 1,275 IVF cycles in the last year, we continue to lead in both the region and the nation. Y our 40th birthday doesn t have to be the end of a dream. For the past ten years, Connecticut required employer groups and health plans to cover the medically necessary costs of diagnosing and treating infertility. However, in this initial law, the state only required the coverage for people under the age of 40. Now, Connecticut has an updated insurance mandate. For insurance policies sold or renewed after January 1, 2016, the age limit has been revoked, expanding coverage to women over 40. This mandate applies to health insurance plans subject to state regulation. According to Kate Weldon LeBlanc of Resolve New England, there are over 75,000 women in the state experiencing fertility problems. Many of these women, over 40. If you in the past thought that door was closed to you, that door is now open stated Kate. However, the law has many limitations and exemptions. Because of these variables, costs for infertility diagnosis and treatment for couples in Connecticut can be minimal or substantial. For more details go to our website where we have specific links to the documents addressing the insurance mandate. The only way to determine your particular coverage is to work closely with your particular insurance carrier and examine all angles of your plan. At the Center, we have a trained staff dedicated to do just that. Our Insurance Program Coordinators will help patients determine precisely what their insurance plan covers and what you can expect to spend as a result. W e understand how stressful fertility treatments can be, especially for those who do not have coverage for the treatments they need. As participants in the In Vitro Sciences Centers of Excellence program, we have access to a wide range of financial programs. For those with insurance, we will help you sort through the confusion and frustration of evaluating your coverage as well as help you find more affordable and immediate ways to pay for testing and treatment that is not covered by your insurance. You can finance one cycle at a time; or, for IVF, you can apply for our multiple cycle refund program called the IVF Financial Share Program, or purchase a multiple IVF cycle package with no refund. Any of these options can also be financed with a loan. We also have special Possibilities Plans just for selfpay patients including our new IVF Possibilities Plus Plan which will provide increased savings to self-pay patients based upon economic need. Plus discounted fertility medication programs and very special programs just for U.S. military veterans and their spouses. The dream of having a baby can be difficult to plan for financially. Our goal is to help every patient find a way to pay for their care. "Day 3 Testing" 101 To learn more about our success rates and those of other programs, please visit the Society for Assisted Reproductive Technologies website ( Click on IVF Success. A comparison of clinic success rates may not be meaningful because patient medical characteristics and treatment approaches may vary from clinic to clinic. The End to the ticking clock Fertility options for third party reproduction have grown over the years. LGBT individuals and couples now have choices that include not only adopted children, but genetically related children, as well. Females, depending on their health and age, can use advanced technologies such as sperm donation with Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), shared conception, egg donation and egg or embryo freezing to achieve a pregnancy. Males, depending on their sperm quality and surrogacy options, can use technologies like artificial insemination, IVF, egg donation, and gestational carriers. We loved having Marsha as our nurse through the journey on growing our family. Thank you for your gift of patience, love and healing! financing options THERE are many different paths to parenthood. But fertility options and issues facing LGBT individuals and couples are different from others wishing to become parents. There are legal and financial obstacles that need special attention and knowledge to overcome. We love seeing our patients notes, and especially their photographs! Since we started our I am the Center video series, we ve been gratified to see so many messages to our staff. Offering More David Schmidt, MD Have you seen our new educational videos? Our YouTube channel is full of videos featuring our doctors with answers to some of the most commonly asked questions. "Age & Fertility" John C. Nulsen, MD "HSG & Sonohysterography" Andrea J. DiLuigi, MD About fertility surgery Featuring Anthony Luciano, MD Dr. Luciano answers some commonly asked questions about fertility surgery as part of our Fertility 101 series. What are the main problems impacting a woman s fertility that can be treated surgically? We do several kinds of surgical procedures to promote fertility in women who have a difficult time getting pregnant. These procedures have to do with problems with the uterus, problems with the ovaries or problems with the fallopian tubes. By far the problem that can be helped the most with surgery are fibroids in the uterus. These are benign tumors that are very common. They are almost always benign. Most of the time we don t even have to treat them. But when they grow close to the cavity of the uterus, and when they impact the endometrial lining, then they can cause infertility. En el Centro, honramos y celebramos nuestros pacientes y amigos de todas las culturas de habla hispana How are the surgical procedures done? Most of the time the surgery for fibroids can be done minimally invasive. You don t have a major incision. Just a small telescope in the abdomen or sometimes in the uterus itself. These surgeries are done on an outpatient basis and the patient can go home 1 or 2 hours after the surgery. i What are the typical outcomes of these procedures? For uterine fibroids that affect the cavity itself, the only way to treat it is surgical. In fact, the surgery offers an excellent prognosis. By that I mean after the surgery most women s fertility will respond very well. Once surgery is performed, their success rate is very high. My story hasn t defined who I am, but it has shaped me into the person that I needed to be. Janine Boudo Please watch the complete video on our website or on our YouTube channel. WHERE ARE THEY Recently, some of our former patients and their families joined us on Better Connecticut during National Infertility Awareness Week. This year s theme, Start Asking was intended to not only raise awareness about this disease, but also motivate all that are touched by infertility to commit to the cause. "Infertility is like a crazy roller coaster ride of emotions. But when you find someone who has been or is going down the same road as you, it makes you remember that you re not alone." Kelly Drajewicz NOW?

uconnfertility.com for pre-registration information. And like our Facebook page for the most up-to-date information.

5 Come inside! Our new facility offers many features you ll love. An academic affiliate of UCONN School of Medicine MONTHLY EVENTS FIRST & THIRD Wednesdays YOGA 5:30-6:30pm THIRD Thursdays RESOLVE Infertility Peer Support Group 7-9pm Check our website at uconnfertility.com for pre-registration information. And like our Facebook page for the most up-to-date information. The Center recently won the Farmington Chamber of Commerce's Distinguished Business of the Year Award, given to 'businesses that have made a substantial contribution to the community, have employees who individually and collectively participate in the community, and the physical presence of the business adds to the economic vitality and livability of our community.' DID YOU KNOW? The Center is an academic affiliate of the UCONN School of Medicine? We are a specialized program of the division of Reproductive Endocrinology and Fertility and one of the largest and most successful IVF programs in the Northeast. We offer one of less than 40 postgraduate fellowships for Reproductive Endocrinology and Infertility (REI) in the United States. Due to our national reputation as a "Center of Excellence," acceptance to one of our fellowship positions is very competitive. Fellows also participate in ongoing clinical research. This has resulted in several first author publications and national conference presentations for our fellows. Over the past three years, the fellows have presented 18 abstracts at national meetings and have published 13 articles in peer reviewed journals. Plus, we not only have REI fellows, but also Ob/Gyn residents and medical students training here as well. uconnfertility.com 844.HOPEIVF FARMINGTON 2 Batterson Park Road Farmington, CT (844) NEW LONDON 4 Shaws Cove Suite 201 New London, CT (877) NEW! April 2016 HARTFORD 50 Columbus Blvd. Suite 2 Hartford, CT (860)

how father time affects your chances of becoming a mother Your Ovarian Reserve and the Realities of Aging (Cover story begins inside)

Volume 2 Issue 1 Spring 2017 how father time affects your chances of becoming a mother Your Ovarian Reserve and the Realities of Aging (Cover story begins inside) PHYSICIAN PROFILE Andrea DiLuigi, MD,