FORA: Your Fertility Forum

Modern care | personalized technology

WHAT DO YOU NEED TO KNOW?

You are ready to consider becoming a parent, but need help. Every story is unique and every fertility journey is yours alone.

Maybe you need help because you have been actively trying to become pregnant or have had pregnancies which ended in pregnancy loss.

Maybe you need help because you are currently unpartnered and ready to be a parent or in a same sex relationship.

Maybe you need help because you have low ovarian reserve and want to preserve your fertility.

Maybe you need help because you have endometriosis or polycystic ovarian syndrome (PCOS).

Maybe you need help because you need donor eggs or a gestational carrier.

Whatever your story, at FORA we are here for you.

At Fora, we believe in tailored education and personalized care.

After a complete fertility assessment and consultation, we will customize a treatment plan that is right for you and your family goals.

Fertility treatments provided at FORA include ovulation induction, intrauterine insemination (IUI), INVOcell, In vitro fertilization (IVF), preimplantation genetic testing (PGT), donor egg IVF, gestational surrogacy, reproductive surgery, and more. Your fertility, your family, your way.

At FORA, our goal is to help you achieve the family of your dreams in your forum, on your terms.

FERTILITY TESTING

A forum for your future. At FORA, we believe that you deserve to understand your fertility and your body.
FORA will provide a personalized fertility assessment, including a 60 minute in depth consultation and fertility testing. Once testing has been completed, you will be positioned to make the choices right for you and your future family.
You may be trying to conceive now, or wanting to conceive in the future, or even uncertain about your family planning – but in any circumstance we prioritize understanding your best options for the family of your dreams.
We discuss options for ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF), and collaborative reproduction options including donor sperm, donor egg, and gestational carriers.
Freezing eggs and embryos can be a helpful treatment strategy for those who desire to plan for a future family in the setting of diminished ovarian reserve (DOR), beginning a family a bit later in life and wanting to plan for more than one child, or desiring to postpone conception for other reasons. In addition, fertility preservation helps preserve future fertility in the setting of cancer, surgery, or gender transition.
Women are born with all of the eggs (oocytes) we will ever have. Over time, women spend these eggs, and when we reach a certain critical threshold, that’s when we undergo the menopause. Reproductive lifespan, or the time remaining to complete a genetic family, is therefore dependent in part upon the number of eggs a woman has remaining (also called ovarian reserve).
There are two main ways to assess ovarian reserve: AMH (Anti-Mullerian Hormone) and AFC (Antral Follicle Count). AMH is a blood test of the hormone that comes from the remaining eggs, and results do not vary widely with menstrual cycle. AMH decreases over the lifespan as the number of eggs decreases. AFC (Antral follicle Count) can be done in office as part of an ultrasound at the new patient visit. Although the egg itself is microscopic, the follicle that houses the egg is visible on ultrasound. Counting these antral follicles gives an estimation of ovarian reserve. AFC also decreases over the lifespan as the number of eggs decreases.
At FORA we will provide AMH and AFC as a part of your fertility assessment and discuss these results with you to tailor a treatment plan.
While women are all born with a similar number of eggs, some reproductive age women have fewer eggs than would be expected by age alone. This is called diminished ovarian reserve (DOR). Reasons for DOR can include genetics, autoimmune disease, prior surgical and medical treatments (e.g, ovarian surgery to remove cysts for endometriosis, chemotherapy for cancer) and environmental toxins (such as smoking).
Having DOR is not a cause of infertility. However, DOR can limit the amount of time a woman has to complete a genetic family. DOR can also limit expectations in any given treatment cycle since ovarian reserve correlates with the number of available eggs for a cycle. Unfortunately, women are often told that having low ovarian reserve means that they are not candidates for using their own eggs for fertility preservation or fertility treatment. While expectations on a per cycle basis may be lower, and while it may take more than one cycle to achieve goals, having DOR does not preclude a woman from pursuing fertility treatments with her own eggs.‍
Dr Skillern has a special interest in diminished ovarian reserve, and has been involved in scientific research to better understand the underlying genetic reasons for DOR. She has helped many patients grow their genetic families who had previously been told that their DOR made that impossible.
At FORA, we will discuss your ovarian reserve parameters and realistic expectations with you. Taking into account age, family goals, and other factors, we will make a decision along with you about your best course of action in the setting of DOR.
As a part of your fertility evaluation, your uterus and fallopian tubes should be checked to see if there are any anatomic issues.
Common problems which can impact fertility include blocked fallopian tubes, hydrosalpinx, pelvic adhesions, endometriosis, adenomyosis, uterine scar tissue, uterine fibroids, uterine polyps, or mullerian anomalies (birth defects of the uterus).
Sometimes people can have these medical problems and have no symptoms. Imaging is required to fully evaluate your anatomy and this can include ultrasound, saline sonogram (SIS), femvue, hysterosalpingogram (HSG), or pelvic MRI.
Your Fora physician will carefully review your medical history to determine which is the best course of diagnostic evaluation for you.
Evaluating the partner with sperm is an essential part of the fertility evaluation. A semen analysis helps evaluate the sperm volume, concentration, motility, and morphology (shape).
The semen analysis can provide insight to potential reproductive medicines or procedures which may be needed.
Male factor infertility can be diagnosed when there are semen abnormalities or azoospermia (absence of sperm). Male factor infertility can be treated with medications, surgery, IUI (intrauterine insemination, IVF (in vitro fertilization), or donor sperm.

FERTILITY TREATMENTS

Ovulation Induction (OI) is when medications (pills such as clomid or letrozole) are taken to help a woman develop one or more eggs for ovulation.
All OI cycles include ultrasound monitoring to evaluate ovarian response to optimally time ovulation with intercourse.
OI can help women with anovulation (such as those with PCOS, polycystic ovarian syndrome) ovulate in a predictable and regular fashion in order to time intercourse.
IUI can be utilized to help people conceive in natural cycles (in ovulatory patients) or with ovulation induction.
In IUI, sperm is processed and inserted past the uterus into the uterine cavity. Ovulation induction can also be combined with intrauterine insemination (IUI) to help treat mild male infertility or for unexplained infertility.
With OI/IUI, a sperm sample is collected at the time of ovulation and processed into a highly concentrated specimen.
The IUI procedure is simple and involves passage of a small guided catheter through the cervix, and placing sperm directly into the uterine cavity in the office.
AT FORA, our physicians were involved in some of the initial trials of INVOcell in the United States and we are thrilled to offer this option to our patients.‍
INVOcell is a lower cost, lower complexity version of IVF. INVOcell is also called “in vivo fertilization” since this technology allows sperm and eggs to meet inside the female body rather than inside the laboratory.
INVOcell involves ovarian stimulation with a minimal stimulation medication protocol, limiting potential side effects from medications. Ultrasound monitoring helps to determine when eggs (oocytes) are ready for collection.
These mature eggs are then mixed with sperm and placed in the INVOcell device which is inserted into the vagina for incubation so that the sperm and egg can meet and form embryos.
After vaginal incubation for 5 days, the INVOcell device is removed and the best embryo is selected for transfer into the uterus.
Any remaining embryos will be frozen for future embryo transfers.
Patients are now benefiting from INVOcell technology over the traditional approach of intrauterine insemination.
INVOCELL often results in achieving pregnancy in a shorter period of time for an overall lower treatment cost.
However, INVOcell is not perfect for all people, and a complete fertility consultation and evaluation will help identify couples who could benefit from treatment with INVOcell.
IVF (in vitro fertilization) has the highest success rate of any available fertility treatment. During IVF, a woman takes hormone injections over the course of approximately 2 weeks, while being monitored with blood work and ultrasound in the office to evaluate egg (oocyte) growth.
Once eggs are at a mature size, they are collected and fertilized with sperm in the lab to create embryos (future babies).
The goal is then to grow (culture) embryos in the lab until they reach the potential implantation stage, called the blastocyst stage. At the blastocyst stage, most often embryos are sampled for genetic rearrangements which would make them unable to form a baby, and thus, unsuitable for embryo transfer.
This testing technology is called PGT-A or preimplantation genetic testing for aneuploidy. Embryos found to have the correct chromosomal complement with PGT-A (called euploid embryos) have the highest chance of becoming a baby upon embryo transfer.
Under certain circumstances, embryos may also be transferred to the uterus without such testing or frozen for later transfer to the uterus.
PGT-A has also revolutionized options for those looking to plan for a future family. This process, called embryo banking, allows patients to create and preserve euploid embryos as part of a family building strategy.
Patients who are embarking on their fertility journeys but who desire more than one child can benefit from creating, testing, and preserving embryos for the future.
IVF is also the process by which we fertilize donor eggsto create embryos. We also use this technology to create embryos for patients which require a gestational carrier to complete their families.
At FORA, we understand that IVF can seem like a challenging process, so we are here for you every step of the way. Dr. Skillern’s experience as an IVF Director means that your IVF protocol and journey will be specifically tailed to your body and your goals.
At FORA, we also provide the option of our concierge injection service to make your IVF journey easier.
Sometimes women have a combination of DOR and age related aneuploidy (percentage of abnormal eggs which increases with age) or have failed prior treatment cycles using their own eggs.
In these cases, egg donation (ovum donation) can become an alternative family building strategy. Egg donation is the process of obtaining eggs from egg donors, who are healthy women between the ages of 21-30, and thus have higher numbers of eggs and lower percentages of abnormal eggs. These eggs are then fertilized, and a resulting embryo transferred to a woman’s uterus to affect a pregnancy.
Family building with donor eggs can sometimes seem like a daunting task.
Dr Skillern has a special interest in egg (oocyte) donation as a family building option She has authored peer reviewed articles on the ethics of egg donation and has presented at numerous invited speaking engagements in support of her interest.
With her guidance, FORA has composed a world class team to assist you through the egg donation experience.
At FORA, we know there are many pathways to a family, and egg donation is one option that we are poised to discuss further should the need arise
Sometimes surgery is indicated to improve your fertility or optimize your chance at conception. Your Fora Fertility physicians are experts at intrauterine surgery and optimizing the uterine environment for conception.
These surgeries can include uterine polypectomy, myomectomy, uterine septum resection, and lysis uterine adhesions.

FERTILITY PRESERVATION

Egg freezing (oocyte cryopreservation) provides patients with the opportunity to pause time and keep future options open.
FORA will create a personalized treatment plan based on your fertility assessment and will review realistic expectations prior to your cycle.
Egg freezing requires a woman to take hormone injections over the course of approximately 2 weeks, while being monitored with blood work and ultrasound in the office to evaluate egg (oocyte) growth.
Once eggs are at a mature size, they are collected and frozen for future use. Your eggs will remain safely stored until you are ready to start your family.
Embryo freezing, also known as embryo banking, can preserve future fertility or provide the opportunity to achieve a family size goal of more than one child.
If you are partnered but not ready to conceive, embryo freezing will give the best odds of the future family of your dreams.
Patients who are embarking on their fertility journeys but who ultimately desire more than one child can benefit from creating, testing, and preserving embryos for the future.
Embryo freezing involves a woman taking hormone injections over the course of approximately 2 weeks while being monitored with blood work and ultrasound in the office to evaluate egg (oocyte) growth.
Once eggs are at a mature size, they are collected and fertilized with sperm in the lab to create embryos. The goal is then to grow (culture) embryos in the lab until they reach the potential implantation stage, called the blastocyst stage.
At the blastocyst stage, most often embryos are sampled for genetic rearrangements which would make them unable to form a baby, and thus, unsuitable for embryo transfer.
This testing technology is called PGT-A or preimplantation genetic testing for aneuploidy. Embryos found to have the correct chromosomal complement with PGT-A (called euploid embryos) have the highest chance of becoming a baby upon embryo transfer.
Depending on your family building goals, we will discuss plans for subsequent cycles, current embryo transfer, or delayed embryo transfer.
Some individuals may wish to preserve their fertility when waiting to start a family or when undergoing a gender transition. Options for fertility preservation include sperm and egg freezing.
Sperm preservation (freezing) allows those who may wish to block testosterone to save sperm for use in future conceptions, since medications which stop testosterone production also stop sperm production.
Egg preservation (freezing) involves the removal of eggs prior to testosterone hormone treatment, so that these eggs can be used in future family planning.
At FORA, we believe that there is no one way toward a family. We want to understand your goals and dreams, and help guide you on the best path toward parenthood.

LGBTQIA+ COLLABORATIVE REPRODUCTION

A forum for you. At Fora, we believe that no two families are alike. We are committed to supporting you on your journey, no matter what family looks like to you, now or in the future.
We are proud to support everyone and anyone on their family planning journey – unpartnered, lesbian, gay, bisexual, transgender, queer, and intersex persons. FORA is here to help you achieve the family of your dreams without bias, discrimination, or judgment…this is your forum.
The essential parts of reproduction include a healthy egg, healthy sperm, and a uterus for an embryo to implant. Depending on your goals, this may require that we work with an egg donor, a sperm donor, and/or a gestational carrier (sometimes referred to as a surrogate).
Other essential services for our community may include gamete (egg or sperm) preservation prior to gender transition and reciprocal IVF, where one partner provides the egg and one partner provides the uterus for the pregnancy.
At FORA we want to understand what your ideal family will look like and we can help you achieve that goal.
Donor sperm allows those who lack a sperm source to conceive. Prior to selecting a sperm source, FORA will provide a fertility assessment and consultation to finalize our treatment plan and optimize sperm selection. Conception with donor sperm can include intrauterine insemination (IUI), INVOcell, in vitro fertilization (IVF), and reciprocal IVF.
AT FORA, our physicians were involved in some of the initial trials of INVOcell in the United States and we are thrilled to offer this option to our patients.
INVOcell is a lower cost, lower complexity version of IVF. INVOcell is also called “in vivo fertilization” and this technology allows sperm and eggs to meet inside the female body without in vitro fertilization (IVF) which occurs in the IVF laboratory.
During INVOcell, women undergo ovarian stimulation with a minimal medication protocol, limiting potential side effects from medications. Ultrasound monitoring helps to determine when eggs (oocytes) are mature and ready for collection.
These mature eggs are mixed with sperm and placed in the INVOcell device, which is then inserted into the vagina for incubation, allowing sperm and eggs to form embryos.
After vaginal incubation for 5 days, the Invocell device is removed and the best embryo is selected for transfer into the uterus. Any remaining embryos will be preserved for future embryo transfers.
For same sex couples, our clinical data suggests that INVOCELL results in achieving pregnancy in a shorter period of time for an overall lower treatment cost when compared to sequential donor sperm inseminations.
However, INVOcell is not perfect for all people, and a complete fertility consultation and evaluation will help identify patients who could benefit from treatment with INVOcell.
IVF (in vitro fertilization) has the highest success rate of any available fertility treatment. IVF can be accomplished using donor sperm, donor eggs, or both, depending on your treatment needs.
Eggs and sperm are combined in the IVF laboratory to form embryos. The goal is then to grow (culture) embryos in the lab until they reach the potential implantation stage, called the blastocyst stage.
At the blastocyst stage, most often embryos are sampled for genetic rearrangements which would make them unable to form a baby, and thus, unsuitable for embryo transfer. This testing technology is called PGT-A (preimplantation genetic testing for aneuploidy).
Embryos found to have the correct chromosomal complement with PGT-A (euploid embryos) have the highest chance of becoming a baby upon embryo transfer.
Under certain circumstances, embryos may also be transferred to the uterus without such testing or frozen for later transfer to the uterus.
Reciprocal IVF allows same sex female partners to play different roles in their family building process. Reciprocal IVF involves collecting and fertilizing eggs from one partner with donor sperm to form embryos. A resulting embryo is then transferred into the uterus of the other partner for pregnancy.
Some couples choose to both create embryos using their own eggs and to then each carry their partner’s baby. At FORA, we are proud to have assisted many couples in building their families this way.
Donor eggs allow those who lack an egg source to conceive. Egg donation involves obtaining eggs from egg donors, who are healthy women between the ages of 21-30.
Donor Eggs and sperm are then combined in the IVF laboratory to form embryos. The goal is then to grow (culture) embryos in the lab until they reach the potential implantation stage, called the blastocyst stage.
At the blastocyst stage, most often embryos are sampled for genetic rearrangements which would make them unable to form a baby, and thus, unsuitable for embryo transfer. This testing technology is called PGT-A (preimplantation genetic testing for aneuploidy).
Embryos found to have the correct chromosomal complement with PGT-A (called euploid embryos) have the highest chance of becoming a baby upon embryo transfer.
Under certain circumstances, embryos may also be transferred without such testing or frozen for later transfer.
Family building with donor eggs can sometimes seem like a daunting task.
Dr. Skillern has a special interest in egg (oocyte) donation as a family building option. She has authored peer reviewed articles on the ethics of egg donation and has presented at numerous invited speaking engagements in support of her interest. With her guidance, FORA has composed a world class team to assist you through the egg donation experience.
At FORA, we know there are many pathways to a family, and egg donation is one option that we are poised to discuss further should the need arise.
Some people may need to build their family with surrogacy. Gestational carriers can be helpful for people who do not have a uterus or who have gone through failed cycles in the past or uterine trauma to have a child.
Although the task of finding a gestational carrier can seem overwhelming, we can make the process easy.
We work with a select group of professionals in the fertility space who all have your top goal in mind. We require all carriers to be undergo a complete medically assessment, to meet with our reproductive mental health professional, and we have a reproductive lawyer who can help simplify this process.
Conception with a gestation carrier can occur with either gametes from an intended parent, donor eggs, donor sperm, or donated embryos.
We work to make your family building dreams a reality