Welcome to the Southeastern Fertility Center's Home Page
The Southeastern Center for Fertility and Reproductive Surgery offers this site as an information resource for couples coping with the difficulties of infertility. Just as our center provides the most advanced treatment for our patients, this site provides the most recent and accurate medical information concerning infertility and reproductive surgery.
Located in Knoxville, Tennessee, the center specializes in the diagnosis and treatment of male and female infertility problems. Under the direction of Jeffrey A. Keenan MD, HCLD, our patients receive the highest quality medical care available in the region. Dr. Keenan is one of the most experienced and respected specialists in infertility and reproductive medicine and surgery.
We provide updates on this site to ensure you are receiving the latest information. If you wish to schedule an appointment with us or have questions, please call us at (865) 777-0088 or click here to use our appointment request form.
Fall Update 2016
It certainly doesn't feel like fall...yet. This has been an incredibly hot and humid summer, and we're looking forward to the reprieve of fall soon. We have been incredibly busy here at the Southeastern Center for Fertility and Reproductive Surgery, and we apologize for any long wait times that you may have incurred while waiting for an appointment. The good news is that we've had a tremendous number of pregnancies lately! Fall tends to be a slower time as school resumes, so if you've experienced difficulty scheduling an appointment, call today and hopefully, we can get you in sooner. Bonita will be happy to assist you at (865)777-0088.
Breast Cancer Awareness Month
October is breast cancer awareness month! According to the National Breast Cancer Foundation, breast cancer is the most commonly diagnosed cancer in women with 1 in 8 women being diagnosed with breast cancer in their lifetime. Behind heart disease, breast cancer is the 2nd leading cause of death among women. According to the National Cancer Institute, when breast cancer is detected early, in the localized stage, the 5-year survival rate is 98%. The best way to fight breast cancer is to have a plan that helps you detect the disease in its early stages. Create your Early Detection Plan to receive reminders to do breast self-exams, and schedule your clinical breast exams and mammograms based on your age and health history. You can create your plan here: http://www.earlydetectionplan.org/. Or, give us a call to schedule your breast exam and allow us to explain current recommendations to you!
Solstas Lab Partners is now offering a patient portal where you can view your lab results. If you supply your email address to our phlebotomist Sherry, you will receive an email inviting you to enroll in Care Evolve. Once enrollment is complete, you can review the results of any labs that have been drawn at our office (at least any that are drawn after you provide your email). If you have any questions regarding your lab results, don't hesitate to contact one of our nurses, Mari or Lynda. Generally, we will call you if there is a problem with your labs; otherwise, we review your labs at your follow-up visit, so please be sure to keep this important appointment.
The Southeastern Center for Fertility and Reproductive Surgery is now utilizing encrypted email in order to discuss personal health information (PHI) over email. If you receive an encrypted email, be sure to save your login and password for future correspondence, as the password cannot be reset. We will try to let you know via "regular" email before we send any confidential information via an encrypted email.
Online Bill Pay
You now have the ability to pay your balance online. There is a link on the bill statement if you prefer this easy method. If you need assistance, contact our practice manager, Juliana Stanley, at (865) 777-0088, extension 2.
Clomid, Femara, or Injectables? Which One?
A study in the New England Journal of Medicine compared empirical ovulation induction using Clomid, Femara, and gonadotropins (injectable medications). 900 couples with unexplained fertility were randomly assigned to a treatment group and 746 of those couples completed the study. Rates of live birth were 32.2% after gonadotropin administration, 23.3% after Clomid administration, and 18.7% after Femara administration. When individual groups were compared, the incidence of multiple clinical pregnancy was significantly higher with gonadotropin than with Clomid or Femara. The rate of pregnancy loss among established pregnancies did not differ significantly according to treatment. Femara resulted in rates of conception, clinical pregnancy, and live birth that were statistically noninferior to the rates with Clomid; however, Clomid and Femara each resulted in significantly lower rates of conception, clinical pregnancy, and live birth, as compared with gonadotropin. In conclusion, the use of Femara for ovarian stimulation resulted in significantly reduced rates of ongoing clinical pregnancy and live birth, but not of multiple gestations, as compared with a combined group receiving standard therapy (gonadotropin or Clomid). As compared with gonadotropin use, the use of Femara resulted in lower rates of live birth and multiple gestation, whereas the rates of these outcomes did not differ significantly between Femara and Clomid.
Diamond, M., Legro, R., Coutifaris, C., Alvero, R., Robinson, R., Casson, P. ...Zhang, H. (2015). Letrozole, gonadotropin, or clomiphine for unexplained infertility. New England Journal of Medicine, 373, 1230-1240.
Fresh or Frozen? That is the Question!
Once upon a time, oocyte cryopreservation (egg freezing) was considered experimental; however, in January 2013, the American Society for Reproductive Medicine declared that this is no longer the case. Based on data that IVF outcomes with cryopreserved and fresh donor oocytes are comparable, some IVF centers established frozen donor egg banks. A study published in JAMA looked at data from the 2013 annual report of US IVF center outcomes published by the Society for Assisted Reproductive Technology to compare live birth rates using either fresh or cryopreserved donor oocytes. Of 11,148 oocyte donation cycles, 2,227 (20%) involved use of cryopreserved donor oocytes. Per started recipient cycle, the live birth rates were 49.6% with fresh versus 43.2% with cryopreserved oocytes. Per embryo transfer, the live birth rates were 56.1% with fresh versus 47.1% with cryopreserved oocytes. Patients using fresh oocytes had a mean of 1.7 embryos transferred versus 1.6 embryos for patients using cryopreserved oocytes. Bottom line, frozen egg cycle outcomes are almost the same of fresh cycle outcomes. In a frozen cycle, coordination with the donor's cycle is not necessary, and banked oocytes also may reduce costs per IVF cycle because several recipients can share oocytes from one donor.
Kushnir, V., Barad, D., Albertini, D., Darmon, S. & Gleicher, N. (2015). Outcomes of fresh and cryopreserved oocyte donation. JAMA, 314(6), 623-624.
Infertility May Influence Pregnancy Outcomes
A study published in Fertility and Sterility examined the relationship between blastocyst euploidy (chromosomally normal) and implantation rates in a presumed fertile patient population. They found no significant difference in the number of euploid blastocysts between presumed fertile and infertile patients 35 years old. When those same patients underwent a corresponding frozen embryo transfer cycle, presumed fertile patients demonstrated a significantly higher chemical pregnancy rate when compared with infertile patients. Moreover, presumed fertile patients exhibited significantly higher implantation rates compared with infertile patients. In conclusion, when subdivided by maternal age, no significant difference was seen in blastocyst euploidy rates between presumed fertile and infertile patients; however, chemical pregnancy and implantation rates were significantly higher in a presumed fertile patient population even when transferring only euploid blastocysts. Bottom line? It appears that endometrial and uterine factors are often at play in the problems faced by infertile women, although these factors are, at present, difficult to diagnose and treat.
Taylor, T., Patrick, J., Gitlin, S., Crain, J., Wilson, J. & Griffin, D. (2014). Blastocyst euploidy and implantation rates in a young (35 years) presumed fertile and infertile patient population. Fertility and Sterility, 102(5), 1318-1323.