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Helping Women and Men Fulfill the Dream of Parenthood

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LOUISVILLE In 1978 the world’s first baby conceived via in vitro fertilization (IVF) was born in Manchester, England. Fast forward 42 years, and today IVF is a mainstream treatment for infertility.

IVF is just one of the many ways Fertility & Endocrine Associates (F&EA) can help patients achieve successful pregnancies.

The practice’s main providers — Robert J. Homm, MD, Kit S. Devine, DNP, and Miriam S. Krause, MD — have 50 years of reproductive endocrinology and oncofertility experience between them.

Homm was doing an obstetrics & gynecology residency in the 1980s when reproductive endocrinology became a recognized specialty. He completed a fellowship in the new discipline and attained dual board certification in both fields.

In the 1990s, Homm helped found Kentucky’s first private reproductive endocrinology and infertility practice in Lexington. He also launched the state’s first private IVF lab (now Louisville Reproductive Center) and has been its medical director since 1994.

Krause, like Homm, is board certified in obstetrics & gynecology and reproductive endocrinology & infertility, a distinction few physicians hold. As a leader in both specialties, she presents at many national conferences and has published numerous articles. She sees each patient as unique and focuses on providing customized solutions for every family.

Devine holds a doctorate in nursing practice and is a licensed advanced practice registered nurse and certified women’s health nurse practitioner. She had worked in two general OB-GYN settings and served on the nursing faculty at two area universities before teaming up with Homm 17 years ago.

She says with a smile, “I realized I was cut out to care for people instead of administrative tasks and budget sheets.”

Preserving Fertility After a Cancer Diagnosis

While Fertility & Endocrine Associates treats a wide range of complex issues, infertility related to a diagnosis of cancer presents special challenges.

Cancer accounts for under 10 percent of infertility cases F&EA treats, yet it can be a shocking diagnosis.

The good news, according to the National Cancer Institute, is that more people are surviving cancer. The United States saw about 15.5 million cancer survivors in 2016. By 2026 that number is expected to grow to 20.3 million.

The less-than-good news is certain cancer treatments — particularly chemotherapy and radiation — may destroy a patient’s future potential to conceive children. For women, cancer treatment can damage the ovaries or oocytes (eggs) or lead to early menopause and other reproductive problems. For men it can damage their ability to produce viable sperm.

The F&EA team encourages oncologists and surgeons to refer patients with cancer to an oncofertility specialist. They agree that raising awareness is “a crucial need” so more patients of childbearing age routinely understand their fertility preservation options.

Raising awareness is “a crucial need” so more patients of childbearing age routinely understand their fertility preservation options.

Devine says that F&EA has all kinds of resources and ways to help cancer patients. They can mobilize quickly since timing is often critical and decisions must often be made prior to the start of treatments. “The process of preserving eggs or sperm can actually be very fast,” Dr. Devine said. “We’re often able to see patients the same day or the very next day after they contact us.”

According to Krause, when it comes to retrieving and quickly freezing eggs or preserving embryos, advanced technologies and procedures are “real game changers.” Preserving sperm has long been a relatively simple procedure but because eggs are relatively larger cells with a high water content, they are been more prone to damage during freezing and thawing processes.

Using vitrification, a new ultra-rapid process, eggs are quickly plunged into liquid nitrogen. This lessens potential damage and allows 99 percent of eggs and embryos to survive freeze and thaw cycles.

Krause points out that even when patients undergo cancer treatment prior to taking action to preserve their fertility, there is still hope for parenthood. Some patients may opt to utilize third-party reproduction which involves using donated sperm, eggs, or embryos to become pregnant.

The office serves as a regional referral center for embryo adoption services in the southeast area. Beyond this, the group often writes letters of support for patients who decide to pursue traditional adoption.

Tackling Other Infertility Challenges

Beyond cancer, any number of other issues or conditions can cause infertility.

The Centers for Disease Control and Prevention report about 10 percent of women ages 15 to 44 in the United States experience infertility. About one-third of cases involve problems unique to females; one-third involves problems unique to males. The remaining third is typically a combination of issues that can affect both genders or stem from unknown causes.

F&EA is uniquely qualified to address a diverse range of complex gynecological issues. Three common conditions they see are:

Hormonal abnormalities that cause irregular menstrual cycles or a total lack of menses.

Polycystic ovary syndrome (PCOS), which typically causes irregular ovulation and is often corrected with hormone therapy.

Uterine fibroids are non-cancerous growths that develop from muscle tissue inside or on the uterine surface and can cause pain, pressure, an enlarged uterus, and menstruation problems. They can typically be removed during outpatient surgery.

Looking Ahead, Building Capacity

F&EA recently updated its space and added state-of-the-art technology and equipment. They enlisted advice from a top design company and noted chemical hygienist, Antonia Gilligan, CEO of Alpha Environmental, Inc. who specializes in IVF laboratory design.

At a time when many medical practices are affiliated with specific hospital systems, F&EA remains independent. “Being independent gives us more flexibility and time to spend with each person so we can deliver individualized care to meet each patient’s unique needs,” says Homm.

Looking ahead, genetic testing is an area of growing interest. Next generation sequencing technology can be used to screen embryos for a variety of genetic abnormalities. For example, if a patient carries BRCA 1 or 2 genes, her embryos can be screened for these genes, commonly associated with increased risks for breast and ovarian cancer.

Another future focus is encouraging insurance coverage for fertility preservation procedures. Now in its relative infancy, fertility-related services receive essentially no coverage. This has changed somewhat, but F&EA says there is room for improvement.

As to what lies ahead, Devine sums it up with one word: Hope.

“We are devoted to helping those who walk through our doors with little hope of fulfilling their dreams to become parents,” she says.