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Frequently asked questions.

Q: Do you perform IVF (in vitro fertilization)? ICSI ( IntraCytoplasmic Sperm Injection)?
A: Both Dr Brinton and Dr Maximovich have been practicing IVF for over 20 years while at Beaumont Hospital in Royal Oak Michigan. During that time, they have managed thousands of IVF cycles with pregnancy rates among the best in the region. They are experienced with all types of patients including those with endometriosis, tubal disease, pelvic adhesions, severe male factor as well as unexplained infertility. Since opening ARMS, they continue to offer a full range of IVF services, including ICSI, pre-implantation genetic diagnostic procedures and cryopreservation.

Q: 2 What insurance do we offer:
A: Insurance coverage varies widely by both the insurer and the type of policy. We fully participate with Beaumont Hospital policies for all types of covered services and BC/BS for all office procedures. Surgical coverage may be available dependent on your specific diagnosis. If your diagnosis is an infertility one, coverage issues will be discussed at your initial evaluation at which time a diagnosis will be established. If you require referral from a provider within your network, please make those arrangements prior to coming for your initial visit.

Q: If I have to pay out of pocket how do I get reimbursed?
A: Reimbursement varies with individual carriers but generally begins by getting a claim form from the employer who provides the primary insurance coverage. They are often available online. We will provide you with a detailed receipt with any appropriate diagnosis code, which you may submit together with the claim form for reimbursement. Keep in mind that coverage for infertility treatment may not be a covered benefit under your policy no matter where you seek care.

Q: Since you may not participate with my insurance, how does reimbursement for surgery work?
A: We will work with the coverage that you do have to help you recover as much of the cost of surgery as you can. Anesthesia charges and hospital charges will be billed separately and will likely be covered by whichever policy you currently have. For surgical fees, we require half of the anticipated surgical fees ahead of the surgical date with the remaining fees due within 60 days of the actual surgical date. Once paid in full, we will send the appropriate paperwork to you so that you may submit the claim to your carrier for reimbursement.

Q:Success rates:
A:
Success rates obviously vary by the specifics of each case. In general, patients who come with treatable problems have at least a two out of three chance of conceiving during treatment, depending on the extent of treatment required and an individual patients’ willingness to undergo therapy. IVF pregnancy rates are largely dependent on age and vary from mid-60% for patients under 35 to 10-20% for patients in their early 40’s. Comparisons between neighboring programs have always been favorable although direct comparisons are not feasible due to so many variations in patient characteristics and prior treatment. Although we are happy to conduct IVF cycles at any point in a patient’s treatment, we generally encourage a less expensive, traditional approach if it is also likely to be successful. A comprehensive treatment plan will be proposed at the earliest possible appointment with a list of your options and realistic expectation of success along the way.

Q: I have a fibroid and have been advised I need major surgery to remove it including a possible hysterectomy. Do I have any other options?
A: Fibroids (also called myomas) are very common tumors, virtually always benign. Although removal has traditionally required a 3 or 4-day stay in the hospital to recover from a standard abdominal incision, there is an excellent chance you may be eligible for laparoscopic (or robotic) minimally invasive surgery, usually done as an outpatient with preservation of your uterus. If you choose to have your uterus removed (have a hysterectomy) it can almost always be accomplished by a laparoscopic route with a much shorter recovery and minimal incisions.

Q: Is donor sperm available and where do you get it?
A: Couples where a husband has very low or negligible sperm can still achieve pregnancy through the use of IVF/ICSI procedures in many cases. Should you opt for a simpler approach by using donor sperm, we will be happy to provide you with a choice of anonymous donors appropriately screened in accordance with stringent requirements as set forth by the American Society or Reproductive Medicine and stored in a locally available sperm bank for your convenience.

Q: Is there a donor egg program?
A: Just as donor sperm may be useful for couples with severe sperm problems, donor eggs from either a donor of your choice or an anonymous donor yield excellent pregnancy rates when a woman’s eggs are either absent or of poor quality because of age or disease. Using donor eggs is more complex than donor sperm as the donor will have to go through an ovarian stimulation and retrieval process to get the eggs but we have had excellent results in these cycles.

Q: What types of surgery do your Doctors offer?
A: We have special training and expertise in both traditional reconstructive pelvic surgery and newer minimally invasive techniques done by either laparoscopic, robotic or hysteroscopic routes. During our 25 full time faculty years at Wm Beaumont hospital, we were responsible for the training and credentialing of many local gynecologic surgeons for laparoscopic laser treatment of endometriosis, pelvic adhesive disease, tubal reconstruction for disease and sterilization reversal as well as management of uterine pathology such as congenital or acquired anomalies such as bicornuate, septate or uterine myomas. Should you be considering a surgical procedure, try to bring any imaging studies you have had done such as ultrasounds, MRI scans, etc. to avoid having to duplicate any procedures unnecessarily.

Q: I am seeing an OB/GYN and have been unsuccessful in conceiving. At what point do I see a fertility specialist?
A: Many, if not all OB/GYN physicians have some experience in managing infertility patients by doing basic investigations and using clomiphene for ovulation induction. If investigation uncovers significant problems or if a pregnancy has not occurred within 3-6 months of treatment, most will discuss referral to a specialist with their patients. Patients who are at high risk for problems, particularly if they are already in their mid 30’s should not delay referral.

Q: How much experience do your doctors have?
A: Both Dr Brinton and Dr Maximovich have been practicing reproductive endocrinology/infertility for over 25 years in both academic/faculty positions as well as in private practice. During those years, they have managed office-based problems, in vitro fertilization cycles and complex surgical cases.

Q: Do you deliver babies?
A: While Dr Brinton and Dr Maximovich both carry lifetime certification in OB/GYN and have been fully trained in obstetrics in the process, we limit our practice to reproductive endocrinology/infertility only with the addition of selected gynecologic conditions/surgery on a referral/request basis. Should you be successful in achieving a pregnancy, you will be referred back to your referring obstetrician for management once we have determined that the pregnancy is healthy. Should you need an obstetrician, we will be happy to refer you to one that fits your needs.

Q: What types of procedures do you do in your office?
A: We offer ovulation induction by means of oral or injectible medications with or without intrauterine insemination using on site ultrasound monitoring and selected hormone testing. Ovarian hyperstimulation and in vitro fertilization with or without ICSI are also available. Our andrology laboratory offers both routine and complex semen analysis as well as semen preparation for washed intrauterine insemination. Infusion sonohysterograms and/or flexible fiberoptic hysteroscopy require only minimal medications; they are done for evaluating intrauterine pathology.

Q: Do you offer any support programs?
A: In addition to individualized, compassionate care from our staff, we are fortunate to be aligned with trained counselors with a great depth of both personal and professional experience in coping with infertility issues, pregnancy losses as well as any marital issues that may have arisen as a consequence of reproductive stresses.