Category Archives: Blogs

Blogs about infertility by the experts at F.I.R.M. or Florida Institute for Reproductive Medicine cover female infertility, male infertility, and IVF treatments based in Jacksonville, FL

Alphabet Soup

By:  Melinda B. Henne, M.D.

Going to the fertility clinic is scary enough even when you understand all the terms. It’s even harder when it feels like you are reading alphabet soup. Here is a list of common abbreviations used in the clinic. 

ARTAssisted Reproductive Technology include advanced fertility techniques such as in vitro fertilization where an embryology lab is required to help fertilize an egg

ECSExpanded Carrier Screening may be offered to couples planning to have a baby. There are many illnesses that have a genetic cause and require genes from both parents. If a person is a carrier of any of these conditions, they won’t be affected but if they conceive with someone who also is a carrier of these genes, there is a ¼ chance their child could have the condition.

FETFrozen Embryo Transfer is when an embryo grown in the lab is transferred into the woman’s uterus after having been cryogenically preserved (frozen) for some period of time.

HSG—A HysteroSalpingoGram is a procedure where fluid is placed into the uterus and x-ray is taken of the uterus and tubes to see the shape of the uterus and/or to see if the tubes are open

ICSI—Sometimes, advanced techniques are needed to fertilize an egg. IntraCytoplasmic Sperm Injection is where a single sperm is placed directly into an egg to increase fertilization

IUIIntraUterine Insemination is the process where sperm is concentrated and placed into the woman’s uterus.

IVFIn Vitro Fertilization is the process where eggs are retrieved from a woman’s body and fertilized in the laboratory with a man’s sperm to create an embryo. Embryos are then placed in the woman’s uterus.

OHSSOvarian Hyperstimulation Syndrome is a condition that sometimes happens when ovaries have been stimulated to make more than one egg. Sometimes it is serious and requires medical intervention.

PCOSPolyCystic Ovarian Syndrome is a condition where women don’t ovulate (release eggs) regularly. The ovaries have a particular appearance on ultrasound and some women have higher than normal levels of androgens (masculine hormones). There are other conditions that may cause these symptoms that should be evaluated and ruled out before the diagnosis is made. 

PGTPreimpantation Diagnostic Testing is a laboratory procedure where cells are removed from the developing embryo and tested for genetic conditions

SETSingle Embryo Transfer is when one embryo is placed into a woman’s uterus. eSET is an elective SET and means there was more than one embryo available and the woman chose to have only one embryo transferred. Other embryos may be stored for later.

SISSaline Infusion Sonography is a procedure where salt water is placed into the uterus while ultrasound is being performed. This gives a very detailed look at the inside shape and lining of the uterus

TVORTransvaginal Oocyte Retrieval is the procedure where eggs are removed from a woman’s ovaries with ultrasound guidance. This is done by a needle attached to an internal (vaginal) ultrasound probe. Women are often sedated for this procedure.

Modified Natural Frozen Embryo Protocol

A more contemporary way to perform a cryo (frozen) embryo transfer is the modified natural embryo transfer protocol. The concept behind this is to simply perform a frozen embryo transfer at the proper time point during a natural ovulatory menstrual cycle to allow for embryo implantation and development. During such a treatment cycle, the patient’s natural follicle development is followed by ultrasound and blood work. At the time that it is expected that the woman would ovulate, a trigger shot of hCG is typically given to cause ovulation and promote good corpus luteal function, thereby maintaining proper progesterone levels. The day following the follicular trigger shot, a minimal form of Progesterone administration is typically begun. During the natural cycle no supplemental Estrogen is typically required. The advantage to such a cycle is that there is little need for hormonal support and implantation is ultimately allowed to occur in an environment very closely replicating a natural ovulation. Disadvantages to such a transfer cycle mainly focus on our inability to time the cycle to possibly desired calendar days for transfer, as we are simply following along the natural follicle development. Not all women will be candidates for a modified natural embryo transfer cycle. Those patients would include women with irregular menstrual cycles, history of recurrent pregnancy loss, gestational carrier cycles, and others. Better suited candidates are women who have had prior spontaneous successful pregnancies and now have infertility issues due to tubal factor or severe male factor. If such a frozen embryo transfer cycle interests you, please consider discussing this with your physician at the F.I.R.M.

By Michael L. Freeman, M.D.

What fertility treatments are available for LGBTQ patients?

By Teresa M. Erb, M.D.

What does transgender mean?

Most people are assigned a sex at birth (boy vs. girl) based on their external genitalia.  For some people, that “boy” or “girl” label may not feel right.  For example, someone born and labeled female may feel that they are really a male. Conversely, someone born and labeled male may feel that they are really a female. Transgender is a term used to describe people who may feel this way. 

Others may feel that they belong to neither gender or to both genders. Terms used to describe this setting may include “gender fluid,”  “gender queer,” “gender neutral,” and “gender nonconforming.”

Members of the transgender or queer community may decide to change how they dress, change their name and change their preferred pronouns. Some may even choose to take hormones or to have surgery so that their bodies more closely match their gender identity. Others do not. There is no “correct” way to be a transgender person.

Do I need permission for a medical transition?

In most places in the United States, you will need permission from your parent or guardian to do a hormonal or surgical transition before you are 18 years old. You also will need to talk with a mental health professional and get a letter of support before starting treatment. This may involve multiple counseling sessions.

How do hormonal treatments work?

Hormonal treatments are usually managed by a pediatric or medical endocrinologist.  

One way that hormones can be used for a medical transition is to block or delay puberty.  These medications can stop menstrual periods, breast growth, facial hair growth and deepening of the voice. You may need to wait until you have started the early stages of puberty before taking puberty blockers. Most effects of puberty blockers are reversible.  

Another way that hormones can be used is to help you look or sound more masculine or feminine. This also may be called gender-affirming hormone therapy. Depending on the treatment, these medications can help you develop desired characteristics, such as: deepening your voice, growing facial hair, developing breasts, changing your body shape.  Most of these changes cannot be reversed.

What fertility treatments are available for transgender patients?

Some kinds of hormone treatments may make it harder for you to have a baby in the future. Some kinds of surgery may make it impossible. Talk about this with your doctor before you have treatment.  Prior to initiating any hormonal or surgical treatment, it is advisable to meet with a reproductive endocrinologist to review future reproductive treatment options which may include:

  • Freezing your eggs or sperm 
  • Intrauterine Insemination
  • In Vitro Fertilization
  • Freezing Embryo(s) 
  • Using donated eggs or donated sperm to achieve a family
  • Using the help of a gestational carrier to help you achieve a family
  • Adoption

If you have questions about your gender identity:

If you have questions about your gender identity it may be helpful to talk with your parents, a teacher, counselor, doctor, or other health care professional. It’s a good idea to ask about what can be kept private before you talk with an adult.

There are websites and hotlines where you can be anonymous if you need information. These websites also can help you educate your parents, family, and friends about the transgender community. 


  • Centerlink
    (954) 765-6024
    Directory of community centers for LGBT people.
  • Transgender Care Listings
    Directory of trans-friendly health care professionals.
  • Trans Youth Equality Foundation
    Resources for transgender teens and young adults.
  • Campus Pride
    Resources for LGBTQ college students.
    (202) 467-8180
    Network of communities for LGBTQ people, parents, and friends.
  • Gender Spectrum
    Organization that supports gender expansive children, teens, and their families.


  • Trevor Lifeline
    Toll-free: 866-4-U-TREVOR (866-488-7386)
    Hours: 7 days a week, 24 hours a day
    Confidential suicide and crisis counseling for LGBTQ teens and young adults. Text and instant messaging options are
    available on the website.
  • Trans Lifeline
    Toll-free: 877-565-8860
    Hours: 7 am–1 am PST / 9 am–3 am CST / 10 am–4 am EST
    Peer support hotline that is run by and for trans people.
  • LGBT National Youth Talkline
    800-246-PRIDE (800-246-7743)
    Hours: Monday–Friday 1 pm–9 pm PST / 4 pm–12 am EST, Saturday 9 am–2 pm PST / 12 pm–5 pm EST
    Peer support and resources for LGBTQ teens and young adults.

In vitro fertilization numbers!

More and more babies are being born after using assisted reproductive technologies (ART).  This mainly includes babies being born after in vitro fertilization (IVF) when a woman’s eggs are fertilized with a man’s sperm inside a dish in a laboratory.  However other techniques that are under the umbrella of ART are procedures like egg donation, surrogacy and egg freezing.  At our annual meeting in the fall of 2016, an estimated 5 million children were born after ART technologies in the previous six years!  This increase is thought to be due to increasing access in developing countries and increasing insurance coverage in many locations.  According to the Centers for Disease Control and Prevention, about 1% of babies born in the United States each year, so about 60,000, are conceived through ART.  

Kari Sproul von Goeben, M.D.

Low Testosterone – Trying To Initiate Pregnancy

Men with low libido, chronic fatigue are getting checked for low testosterone levels. There is no agreement what constitutes a normal testosterone level – in most reference labs values range from 300 – 1200. Men complaining of decreased libido, chronic fatigue are being treated with a variety of different testosterone preparations. What is not being made clear to these individuals is that exogenous testosterone in any form suppresses sperm production. The higher the dose and the longer the duration of administration, the greater the suppressive effect. If sufficient doses are given for long enough atrophy of the cells that make sperm occur resulting in permanent sterility.

Continue reading


Pre-embryo genetic testing (PGT) is an exceptionally powerful tool increasing in vitro fertilization pregnancy rates, decreasing the risk of a multiple pregnancy, miscarriage and minimizing the number of babies born with genetic anomalies. To understand this technology it is important to understand how the process is performed. Blastocyst (day 5, 6 and 7) embryos derived from IVF typically contain anywhere from 200-400 cells. The embryo consists of an outer trophoblastic layer destined to develop into the placenta as well as an inner cell mass destined to develop into the fetus. Biopsying the inner cell mass would give us the most direct information about the fetus, but poses a risk of injury. For that reason the outer cell mass is sampled. Biopsy of the outer cell mass is limited to 4-10 cells to minimize the chance of embryo damage – herein lies one of the sources of potential sampling error, i.e., only a small percentage of the total cells are tested. The cells of the outer cell mass have a high degree of concordance with the inner cell mass, but not 100% – a second potential source of sampling error. It is believed that often subsets of abnormal cells are destroyed by healthier more rapidly replicating normal cells – a third potential source of sampling error.

Continue reading

Embryo Development: What Happens After My Egg Retrieval?

Day 0 – FIRM physicians refer to retrieval day as day O of embryo development. Before leaving the recovery area, your FIRM doctor will give you the final egg count. Several hours later an embryologist in the IVF lab will inseminate the eggs. Insemination can be accomplished by standard insemination or by ICSI (shown below). Standard insemination involves placing washed sperm with an egg into the culture dish. ICSI, a more involved process, requires that the embryologist insert the sperm into the egg using a specialized needle and a microscope. After insemination, the eggs are placed back into the incubator to allow time for fertilization to occur. Your FIRM doctor will review with you the method to be used for insemination prior to your IVF cycle. However, on occasion, the results of the semen analysis on the day of the retrieval may necessitate ICSI be done, which your FIRM physician would discuss with you in that event. Continue reading

Understanding Miscarriages

Miscarriages are pregnancies that stop developing. Development stops at different times and for different reasons. The great majority of miscarriages are early occurring before 10 weeks due to a genetically/chromosomally abnormal conceptus – the result of an abnormal egg or sperm fertilization.  Most often it is an abnormal egg because the egg is much older than sperm.  Women are born with a certain number of eggs, they never make any more eggs their entire life.  Eggs accumulate genetic/chromosomal errors as a function of time.  Continue reading

Egg Freezing for Fertility Preservation

Fertility preservation offers couples or individuals the opportunity to preserve their ability to have children in the future. For some women a medical reason, such as cancer treatment, may lead them to seek fertility preservation. For others, the reason is personal such as to defer childbearing or to pursue a chosen career path.  Continue reading

The Menstrual Cycle

Throughout recorded history, there have been many superstitious beliefs with regards to menstruation. If a woman does not have a regular, monthly period there are typically a handful of reasons why. The focus of this blog is to help patients understand the normal menstrual cycle.

A normal menstrual cycle typically occurs every 24-35 days. It is divided into two phases, the follicular phase when an egg grows inside a follicle and the luteal phase when the follicle becomes a corpus luteum and makes progesterone. The end of the follicular phase and beginning of the luteal phase is marked by ovulation. Continue reading

friends of F.I.R.M.

As a patient with PCOS, the dream of having a child may sometimes seem out of reach.  But with the help of Dr. Winslow and staff, that dream often becomes a reality. With the care, support and guidance given to me by all of those who helped me along this emotional journey, I am able […]

Read Full Testimonial »

Skip to content