Eldon Schriock, MD
Biography

	After a vasectomy reversal, why are we still not pregnant? When should we consider using donor sperm? What is the legal process for embryo adoption? What is the success rate using a donor egg? Are egg-donor procedures covered by insurance?

For couples facing infertility, egg (oocyte) donation, artificial insemination using donated sperm, or embryo donation may be the path that leads to a successful pregnancy. Is one of these the answer for you? Internationally recognized as an expert in infertility, Eldon Schriock, MD, joined us Oct. 26, 2005 to explain these options and answer your questions.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

This WebMD conference is brought to you the WebMD Fertility Center and RESOLVE.

MODERATOR:
Welcome to the 4th annual WebMD/RESOLVE Fertility Cyberconference. As part of National Infertility Awareness Week, the WebMD Fertility Center is teaming with RESOLVE: The National Infertility Association, to bring the top fertility experts to you. Our guest is Eldon Schriock, MD.

Welcome, Dr. Schriock. Can you please tell us a little about yourself and your area of expertise?

SCHRIOCK:
My name is Eldon Schriock. I am a board-certified reproductive endocrinologist and practicing infertility in the Bay Area since 1984. I'm now part of the Infertility Center in San Francisco.

MEMBER QUESTION:
In choosing IVF clinics, would you recommend going with university- affiliated clinics due to their research?

SCHRIOCK:
University-affiliated programs may have more research, but not necessarily. Often research in the university is more basic research, where research in a clinical practice is more patient oriented. Advances in fertility care are now happening faster in private practices.

Universities have some restrictions that sometimes don't allow them to adapt as quickly. This issue has prompted an interesting set of editorials in this month's Fertility Journal, which patients can access and read at the American Society of Reproductive Medicine web page ASRM.org.

Patients should primarily pick a practice where they will have a physician-patient relationship that fosters good communication and a program that has a strong history and track record of getting good care to infertile couples.

SCHRIOCK:
Sometimes after the vasectomy reversal is complete sperm reproduction and counts can be normal but men have developed an allergy to their own sperm and have antibodies on the head of the sperm that can prevent the sperm from fertilizing the egg.

It is possible to do a test for antisperm antibodies on the sperm and if that test is positive, that information could be used as an indication to proceed directly to IVF ICSI. If that test is normal, a complete work-up for other fertility factors in the female patient would be indicated.

"The decision to use donor eggs is usually more difficult than considering donor sperm."

SCHRIOCK:
Donor sperm are usually only indicated if no sperm can be found in the male partner. This would include doing testicular mapping to look for small areas of sperm production within the testicle.

Even if there's only a very small portion of the testicle working, those sperm can be surgically retrieved and used in IVF ICSI. If there are no sperm at all, then donor sperm would be the next step.

MEMBER QUESTION:
When should prospective parents consider using donor eggs?

SCHRIOCK:
The decision to use donor eggs is usually more difficult than considering donor sperm. There's no perfect guess to determine if a woman is out of fertile eggs. Tests that can be used to gather information about egg quality would be an FSH and estridial on the third day of menses, an ultrasound to measure ovarian volume and determine antral follicle count, and finally, the Clomid challenge test, which is probably the best test of egg quality.

These test results would then be interpreted along with the female patient's age to make the best estimate if there are still fertile eggs remaining.

Other signs that egg quality may be poor would be:

• A history of miscarriages
• A history of menstrual cycles that are now coming closer together
• A history of failed IVF cycles when either growing eggs is poor or embryo development is poor

MEMBER QUESTION:
Why are we having such a hard time finding a donor-embryo program? We have heard that the federal government may be getting involved and making donor embryo more difficult for recipients. Is this true? And do you think that more donor-embryo programs will be started?

SCHRIOCK:
Donor-embryo programs are hard to find because most programs do not have embryos donated from other couples. This results usually in a situation where there are many patients on a waiting list waiting for a donated embryo and there are not very many donated embryos available.

Many programs give patients within their own practice first choice at the donated embryos before patients that are outside the practice. I do feel that the number of donated embryos will increase because we find that couples that establish their families through egg donation often have extra frozen embryos and are often emotionally better able to give those embryos for adoption.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.