The Latest in Advanced Reproductive Care in Northern Colorado! • Trends in Infertility • Blastocyst Culture and Day 5 Transfers • Infertility Treatments Available • Special Feature • Overcoming Infertility
Since 1995, the Rocky Mountain Center for Reproductive Medicine® has offered residents in Northern Colorado, Wyoming, Nebraska and the region advanced reproductive care close to home. As northern Colorado's only board certified infertility and reproductive endocrinology specialist, Dr. Kevin Bachus has offered state-of-the-art methods in evaluation and treatment of couples with reproductive concerns. Couples are guided through the maze of infertility evaluation and treatment options with clear and accurate information. Couples experiencing miscarriage are supported through a comprehensive course of evaluation. Widely known for excellence in care and a warm, open bedside manner, Dr. Bachus has guided hundreds of couples to their goal of parenthood. As a graduate of one of the finest training programs in reproductive medicine at Duke University, Dr. Bachus brings the most advanced reproductive care to the region in a manner understood by his patients.
Since 1995, Shari Olson, Ph.D. has directed the only advanced reproductive lab in the region. Her lab is the first and only lab in the region accredited by the Society for Assisted Reproductive Technology (SART). The lab routinely unites sperm and egg during In Vitro Fertilization (IVF) cycles and pregnancy rates routinely exceed national averages. Dr. Olson performs technically demanding procedures such as injection of a single sperm into the egg (ICSI) and assisted hatching, where a small opening is made in the outer covering of the embryo to improve pregnancy rates. Freezing of sperm and embryos is routinely performed in addition to advanced sperm testing. The transfer of previously frozen embryos allows couples to increase their chances of conception from a single egg retrieval. Some couples achieve more than one pregnancy from a single egg retrieval by utilizing their frozen embryos after delivery! Pregnancies have been reported using embryos that have been frozen for ten years. The success of the frozen embryo transfer program reflects the remarkable achievements of Shari Olson Ph.D.'s lab and the attentive care each embryo receives.
Our approach is a continuity of patient care that encompasses each member of the clinical staff, as well as the administrative staff. We believe this approach provides our patients with a number of advantages, one of these being a closer doctor-patient-staff relationship than typical, which in turn assists us in becoming more familiar with you and your needs in every aspect.
Our clinical staff, made up of one Physician, two physician assistants, and three registered nurses, not only provides a high level of skill, years of experience and vast knowledge of infertility and women's health issues, but the care they provide is characterized by the empathetic and personal attention each patient receives.
Our office staff is available to assist you in a number of areas relevant to your total care. It is our purpose to provide you our personal, yet professional, attention in scheduling appointments, maintaining accurate records, and coordinating all financial matters associated with your visit.
Since 1995, the Rocky Mountain Center for Reproductive Medicine® has offered state-of-the-art reproductive care close to home. Pregnancy rates for the IVF program consistently exceed national averages and many couples are able to conceive following hormonal treatment, artificial insemination, and surgical treatment. As the region's only board certified physician in reproductive endocrinology and infertility, Dr. Bachus offers advanced reproductive care to women and men close to home.
Recent evidence confirms that damage to the genetic material (DNA) in individual sperm can greatly reduce the chance for pregnancy. Abnormal sperm can also increase the chance for individual pregnancies to end in miscarriage. We are pleased to be the only center in Northern Colorado offering the evaluation of the DNA in individual sperm. This testing can assist couples in identifying why they are having problems with reproduction and what might be effective treatments.
Dr. Bachus provides care to many men in the region with abnormalities in their sperm count. Some can be treated hormonally and artificial insemination can assist  many couples in achieving pregnancy. For men with severe abnormalities in the semen analysis, Shari Olson Ph.D. lab has a great deal of experience in sperm injection. Using this technology, a single sperm can be injected into a single egg to facilitate fertilization. The developing embryos can then be transferred to the uterus (womb) or frozen for later use. Other couples prefer to use donor sperm for artificial insemination. Sperm donation is a good alternative for some couples and can often be preformed with a favorable outcome.
Surgeries using the microscope for magnification allow women who have had their tubes "tied" (tubal ligation) to become fertile again. This process of a tubal reversal or "untying" of the fallopian tubes is often quite successful and most times can be performed on an outpatient basis. Patients who have had their tubes tied who wish to avoid surgery frequently make excellent candidates for IVF.
Our donor egg program is gratifyingly successful and donors are currently available to those women wishing to pursue pregnancy. Egg donors are useful for women no longer producing high quality eggs or women who have had their ovaries removed. While this can occur at any age, it is most common in women over 35 years of age. Rocky Mountain Center for Reproductive Medicine® offers important testing to assess a woman's ovarian reserve. This reserve can be likened to a woman's biological clock and can greatly assist women in choosing when to pursue care and what care should be performed.
Many couples experience the pain and frustration of miscarriage. When miscarriage is a recurrent problem, Dr. Bachus is experienced in this area. A thorough evaluation can identify causative factors in many cases. For those couples whose tests are normal, treatments are available to increase the likelihood of conception each month.
The team also helps a large number of women with pelvic pain and painful menstrual cycles. While mild cramps may be normal, missing work or pain not responding to medication or requiring bed rest is not. Many women are unaware that endometriosis, a medical condition, is present in a significant number of women with pain during menstruation or intercourse. Both medical and surgical options are available to reduce or even eliminate monthly pain. Outpatient surgeries performed through tiny incisions using a telescope (called a laparoscope) are often performed. Patients frequently recover over the weekend and miss very little work.
The care at Rocky Mountain Center for Reproductive Medicine® is confidential, supportive, and individually tailored to the needs of each patient or couple. The center is open seven days a week for couples requiring ultrasounds, inseminations, egg retrievals, embryo transfers and other procedures requiring precise timing. The team at Rocky Mountain Center for Reproductive Medicine® is well aware of the substantial emotional and financial demands when receiving treatment for infertility and pregnancy loss. Patient support and education are high priorities for the center and counseling is available to couples. Dr. Bachus prides himself in providing an honest, accurate assessment of each couple's prognosis in a supportive and sensitive manner. We provide the expertise and the alternatives and allow couples to choose their path to parenthood or relief from problems with the reproductive system.
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Fort Collins - With increasing public attention on the topic of infertility, one might think that infertility rates are increasing. Actually, the incidence of infertility is probably the same as it has always been at about 15%. The good news is that the treatment options for patients who suffer from infertility are dramatically improving - so much so that recently the results of "over-success" have focused the attention of the media on the problems of multiple pregnancy.
Despite the improvement in treatment techniques, fertility rates based on age decline significantly as a patient goes through her thirties. Pregnancy rates stay the same through the teenage years and through the twenties. But, at age 35, we begin seeing a significant decline in fertility potential, and by age 40, an individual is about one-sixth as likely to conceive as someone at age 30. Similarly, the risk of genetic abnormalities in the baby increases, as does the risk of miscarriage. So, when is the ideal time to conceive? From a success standpoint, the baby's health, and the lowest risk of miscarriage is during the 20's and the early 30's, says Dr. Bachus of the Rocky Mountain Center for Reproductive Medicine® in Fort Collins, Colorado.
 Though it is mostly couples who seek consultation, there are increasing numbers of singles that are also interested in starting a family. Most of all, age is an important determinant. "Sadly enough, it is not uncommon to see patients who have tried for up to ten years before seeking helping in conceiving," continues Dr. Bachus.
Is It Infertility?
By definition, infertility is the inability to conceive after 12 months of unprotected intercourse. The first step is to diagnose the problem that is causing the lack of conception. Primarily, there are 3-4 tests necessary to determine the cause. "It's important to immediately inform patients that there is an attempt to keep costs down by virtue of what tests are ordered," states Dr. Bachus.
The first test is to document that ovulation is occurring in the woman. Documentation of ovulation can be done in a variety of ways, "I prefer to do a blood test timed one week prior to the next anticipated menstrual cycle. It is a hormone test, called progesterone, that documents that ovulation is occurring. The second test is a semen analysis to make certain that there is an adequate numbers and quality of sperm," Dr. Bachus said.
Next, a hysterosalpingogram (HSG) is performed to document that the fallopian tubes are not blocked and that the lining of the uterus appears normal. This is an x-ray test in which "dye" is injected through the cervix into the uterine cavity. Eventually the dye goes into the fallopian tubes and should flow out through the end of the tubes. This documents that the sperm are able to get to the fallopian tubes where fertilization normally occurs, and that the egg can be captured by the fallopian tube. These three tests are the cornerstones to infertility evaluation.
A fourth test that may be indicated is a laparoscopy. Done in the hospital as outpatient surgery, a small incision is made at the base of the belly button and an instrument is placed through the opening to visualize the pelvis. This allows the physician to inspect the surface of the uterus, ovaries and fallopian tubes for scar tissue (adhesions) or endometriosis, either of which can be associated with infertility.
The laparoscopy is also a test that can become a treatment, since the specialist may attempt to correct abnormalities involving endometriosis or pelvic adhesions at the time of surgery. A certain number of people will be pregnant spontaneously within a few months of undergoing laparoscopy.
After identifying a problem, for example, lack of ovulation, abnormal sperm count, or a blockage of the fallopian tubes, the specialist can direct therapy where the abnormality exists. "If there is a problem with sperm counts, we can either proceed with treatment that may include inseminations or the male partner may need to see a urologist. If there is a problem with the fallopian tubes, either surgery or in vitro fertilization (IVF) may be necessary," states Dr. Bachus.
Current Treatments
Should testing not indicate a specific problem, treatment may consist of a combination of medications given to the women, combined with appropriately timed inseminations using her husband's (or donor) sperm. The woman receives a medication (either oral or injectable) to stimulate development of more than one egg, thereby increasing the chances of fertilization.
The idea behind inseminations is to increase the number of sperm capable of fertilizing an egg within the fallopian tube. A necessary step prior to the insemination involves specially washing the sperm, which results in a better chance of fertilization of the egg. The success rate for this is typically between 15-20 percent per attempt, depending on the age of the couple and the actual sperm specimen.
Multiple Pregnancies
When a patient takes the oral medication Clomid, there is a 5 percent chance of twins and, rarely, triplets, quadruplets, or more. This is compared to a 1% twins rate with natural conception. For people who take the injectable medication, such as Follistim®, or Gonal-F, there is approximately a 20 percent chance of multiple pregnancy, with approximately 3-5 percent chance of being triplets or more. Commonly, patients conceiving greater than twins are using injectable medications.
In Vitro Fertilization (IVF)
It is becoming increasingly popular to do IVF over other treatments because it gives greater control over the probabilities of multiples. In an effort to control the multiple pregnancies associated with in-vitro, the Rocky Mountain Center for Reproductive Medicine® was one of the first centers to do blastocyst cultures, or day-5 embryo transfers. According to Dr. Bachus, "This allows us to pick the truly best embryos that resulted from the egg retrieval. When we choose the best embryos, we can then put fewer back into the uterus, thereby keeping pregnancy rates relatively high and the possibility of a multiple pregnancy relatively low." He continues, "In 1997, we were so successful that we ended up having a higher multiple rate than we would like. Then we went to day-5 transfers in an effort to minimize the number of triplets. As a result, most of our pregnancies in 1998 were singletons or twins."
Another significant development focuses on severe male infertility. Because of the process called Intracytoplasmic Sperm Injection (ICSI), individual sperm can be injected into the interior of an egg, thereby completing the fertilization process. This truly gives new meaning to the saying, "it only takes one (sperm)" for fertilization to occur and result in a baby.
Before the advent of ICSI, a certain number of people would go through all the treatments leading up to egg retrieval. The egg retrieval would occur, but some sperm samples were such that no fertilization would occur. With ICSI, this problem is nearly eliminated.
Egg Donors
A number of women require the help of an egg donor in order to conceive. This is most commonly necessary in case of cancer of the ovaries where removal has taken place, if there is premature menopause of the ovaries, or when age is a deterrent to being able to get pregnant.
Dr. Bachus said it actually gets fairly complicated in the sense that it is not possible in the mainstream of infertility treatment to take eggs and freeze them, as is the case with sperm. Instead, the egg donor's cycle must be coordinated with the recipient's cycle. The eggs are taken from the donor and later added to a sample of the sperm from the recipient's husband. The resulting embryo(s) is then placed into the recipient's uterus that has been hormonally prepared to receive the embryo(s). This allows the embryo(s) to then grow and develop normally in the recipient's uterus.
The good news is that the pregnancy rates for this technology are high. For someone who is 45, we would anticipate the ability to have a baby at somewhere in the neighborhood of 5 percent after undergoing conventional in-vitro. The rate often goes up in excess of 75 percent if an egg donor is used in that same individual.
Summary
The patient's age is a very important determinant for success in any form of infertility treatment. Fertility rates do decline with age. The younger the woman, the better her chances are of conceiving, whether it involves low or high tech options. Dr. Bachus advises, "I would encourage people to actively think about this issue when deciding when the best time is to start a family."
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News of advances in assisted reproductive technology (ART) has spread across the country. One "new" technique in particular has received a great deal of press and has generated much interest by ART practitioners and consumers. This technique is called "day 5" or "blastocyst" transfer, which simply means that embryos are grown longer in the lab (for five days after oocyte retrieval and IVF or ICSI) than in traditional IVF, in which embryos are transferred on day 2 or 3.
Despite the hype surrounding this advancement, culturing to blastocysts does not necessarily require additional skills or training by the embryo laboratory, since it utilizes the same procedures as culture of earlier stage embryos. The difference is that culture media are now available that can, when used at the appropriate stages, support embryo growth from fertilization to the blastocyst stage.
At the blastocyst stage, the embryo can be distinguished by a fluid filled center known as a blastocoele, and has begun to differentiate into two types of cells: cells destined to become the fetus and cells destined to be placenta and other extra-embryonic structures.
Different formulations of culture media have been designed and tested for this extended culture and are available to the embryology laboratory. Here at the Rocky Mountain Center for Reproductive Medicine®, we began blastocyst transfers in April of 1998 with good success. Probably the main benefit of this procedure is that it allows the embryologist to select the most viable embryos for transfer and thus transfer fewer embryos, reducing the possibility of a multiple pregnancy.
Despite selection of the best embryos, even if they appear perfectly normal at the 4 or 8-cell stage, some will stop growing before becoming a blastocyst. If at least 2 or 3 embryos develop to the blastocyst stage in culture and are transferred, chances of pregnancy are high. It is important to note that culturing longer cannot "produce" good embryos from poor ones, and a majority of couples will end up with no viable embryos to transfer.
However, those embryos may not have survived in utero if transferred earlier either. Some clinics may have certain requirements (like age, number of eggs retrieved, etc.) for doing blastocyst culture/transfer, so be sure to ask about that if you expect to be involved in the decision to transfer at day 3 or 5. But generally, if there are few (less than 4-5) viable embryos on day 3, there is no benefit to an extended culture period.
As this is a relatively new option, few it may be difficult to assess the success of a particular lab. However, because this procedure relies on established culture practice, a clinic's success with traditional day 2 and 4 transfers is probably a good indicator of their likelihood of success with blastocyst transfer. That may be more important than how long they have been doing day 5 transfers.
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Fertility declines with age. Considering that many couples today are starting their families later in their 30's, more and more are experiencing problems with infertility as they wonder how to get pregnant. There may be some relatively simple solutions to these problems, but some couples require more extreme measures to conceive, such as in vitro fertilization (IVF).
Infertility is the inability to conceive without contraception for a year. Infertility affects about 15 percent of people, according to Kevin Bachus M.D., an infertility specialist at the Rocky Mountain Center for Reproductive Medicine® in Fort Collins.
"Most women in their mid-20's who are not using protection have a 20 percent chance of getting pregnant each month," Dr. Bachus said, "That chance declines substantially for women in their late 20's. By the 40's, it drops to a 5 percent or less chance." Women's reproductive health is extraordinarily important.
Aging also increases the risk of miscarriage. Both are due to a general decline in egg quality. The first step in solving a fertility problem is a round of tests. Physicians verify that the woman is ovulating regularly and that her uterus and fallopian tubes are normal. The man's semen is also analyzed.
"If we find a problem, the solution is sometimes as simple as prescribing medicine to increase sperm or egg production," said Dr. Bachus. In some cases, Dr. Bachus recommends taking the sperm and, after appropriate laboratory preparation, inserting it through the cervix into the uterus at ovulation. This process is called Intra Uterine Insemination or IUI. If these options don't work, Dr. Bachus moves to in vitro fertilization.
For women, in vitro fertilization involves injecting medicine daily to increase egg production. Then, a needle is used to "retrieve" eggs from the multiple fluid filled pockets (follicles) within the ovary. Each egg is isolated and combined with sperm. Finally, resulting embryos are inserted into the woman's uterus.
Due to the financial commitment per try and with no financial help from most insurance companies, couples often want to know their chances of getting pregnant with IVF. On a per try basis, Dr. Bachus estimates couples less than 35 years of age have a 50 percent to 70 percent chance of pregnancy. For those in their late 30's, that number drops to 20 percent to 30 percent.
Dr. Bachus has had good success with IVF. In 1997, his delivery rate for younger patients was 65 percent. He was happy with the high delivery rate but was bothered by the number of multiple births that resulted.
Dr. Bachus made it a goal to keep delivery rates high, but to lower multiple births. The key, he decided, was to transfer higher-quality embryos from the laboratory - one that would be more likely to implant. That way he could insert fewer embryos, minimizing the chance of high multiple births.
"I decided to try something fairly new in the human infertility field, to incubate embryos to the blastocyst stage," said Dr. Bachus.
Many clinics in the United States culture embryos for just three days before inserting the embryos into the uterus. But at five days, an embryo reaches the blastocyst stage and is much more likely to attach to the uterine lining and establish a pregnancy.
"By recognizing the value of different nutritional requirements of the developing embryos beyond the third day, we are able to develop healthier embryos," said Dr. Bachus.
Most of his patients choose to transfer two or sometimes three of the advanced-stage embryos back into the uterus. As a result, Dr. Bachus has been able to lower the multiple birth rate significantly while still maintaining a high pregnancy rate for his patients. Dr. Bachus performs IVF for over 50 couples each year.
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Sometimes, having a baby can be a difficult task. But in Northern Colorado, the Rocky Mountain Center for Reproductive Medicine® has made it their primary focus to help couples conceive. Kevin Bachus, M.D. and his staff utilize advanced reproductive technologies for couples who are experiencing infertility problems. The Center provides not only hope for these couples, but also offers the personal supportive atmosphere necessary to offset the inherent stresses many couples feel. The necessity for this stable, relaxed environment is key, due to the inherent stress that accompanies the treatment of infertility.
An infertility diagnosis usually can be established within one or two months of a patient's first visit. Dr. Bachus focuses on the less expensive and less invasive tests initially - including documentation of ovulation by a mid-luteal phase progesterone and semen analysis, then evaluation of tubal patency and normalcy of the endometrial cavity via hysterosalpingogram (HSG). He calls these the "cornerstone tests to an infertility evaluation." Provided these are normal, a discussion with the patient is undertaken to address the option of proceeding toward ovulation induction combined with appropriately timed intrauterine insemination, or alternatively, performing a laparoscopy to further assess for endometriosis or pelvic adhesions that can hinder fertility. Unfortunately, the tests are not always normal. When one of these tests identifies a problem, a specific therapy can be planned. Each patient will be given individualized treatment specific for her problems, taking into consideration the optimum treatment approach.
- Anovulation (a lack of ovulation) is treated with ovulation induction medications;
- Oligospermia (a low sperm count) is treated with inseminations, in vitro fertilization, Intracytoplasmic Sperm Injection (ICSI) or referral to a Urologist; and
- Anatomical problems are treated with surgery or possibly in vitro fertilization.
The specific and most common treatments for patients at the Rocky Mountain Center for Reproductive Medicine® include the following:
Intrauterine Insemination (IUI): Appropriately timed intrauterine inseminations clearly work best when combined with medical induction of several oocytes. At the Rocky Mountain Center for Reproductive Medicine®, careful consideration is given to the number of oocytes that develop, so as to minimize the risk of multiples. Despite a conservatively low rate of multiple pregnancies (five percent chance of twins, triplets or more), the monthly conception rate approaches that of normally fertile couples. The primary advantage to these low multiple pregnancy rates is that the Center provides a low complication rate without significantly compromising fertility rates.
In Vitro Fertilization (IVF): For patients with irreparably damaged fallopian tubes, profound oligospermia, or failure to conceive after adequate attempts of intrauterine inseminations, in vitro fertilization (IVF) has become the treatment of choice. This technology involves incubating the oocytes and sperm in the laboratory and allowing the resulting embryo(s) to develop for a number of days prior to transferring them into the endometrial cavity.
In the 1980's, pregnancy rates for IVF were relatively low, at approximately 15 percent. As the nutritional requirements for the embryo growth within the laboratory became better understood, conception rates began to increase. Currently, anticipated pregnancy rates for many patients may exceed 50 percent. The Rocky Mountain Center for Reproductive Medicine® is proud of the fact that our pregnancy rates as reported by the Society of Reproductive Technology (SART) were reported for the latest year among the highest in the country, expectancy for patients 35 years of age or younger and for egg donor recipients as well.
Intracytoplasmic Sperm Injection (ICSI): This is perhaps the single largest advance in the treatment of severe male factor infertility. It is now possible to offer couples a good pregnancy rate where previously low sperm counts had prohibited patients from conceiving. This very technical procedure involves isolating an individual sperm cell and injecting the sperm into the cytoplasm of the oocyte. It is frequently the treatment of choice for men who have low sperm counts or poor motility.
Blastocysts: An additional benefit of understanding embryo nutritional requirements has been the option to culture the embryo(s) for five days prior to uterine transfer. By the fifth day, healthy embryos should have reached the blastocyst stage of development. On this day, the selection of blastocysts for transfer improves the percentage of embryos that actually implant within the uterus. This improvement in "implantation rate" allows for the transfer of fewer embryos, which also helps limit the number of high-order multiples. The Center was among the first to use blastocyst culture as a way to maintain high pregnancy rates while controlling the number of high-order multiples. This has been successful in reducing the rate of multiple pregnancies by 50 percent without affecting the pregnancy rate.
Egg Donor: Some women are incapable of conceiving with their own oocytes (i.e., patients with bilateral oophorectomy, premature menopause or age deterrent). In these patients, an egg from a donor can be utilized. The donor and the recipient's menstrual cycles are synchronized with medication, after which oocytes are taken from the donor, then incubated with sperm from the recipient's husband. The resulting embryos are placed in the recipient's uterus, which has been hormonally prepared to receive the embryo(s). High pregnancy rates can normally be anticipated by utilizing such a process.
Tubal Reanastomosis: For people with surgically occluded fallopian tubes, two treatment modalities exist to assist with conception. IVF may be successfully used or, alternatively, for those desiring a surgical approach via a tubal reversal, pregnancy rates can be high. Provided that only a small section of the fallopian tube was actually removed or, alternatively, banding techniques such as Fallope® rings or Hulka® clip applications were performed, conception rates in relatively young individuals typically exceed 75 percent. Many of these conceptions are possible within a few months of actual surgery.
Most important to Dr. Bachus and the entire staff is that each patient who comes to the Center receives the highest personalized care, utilizing the latest in infertility technology services. They also know the value of working within the medical community as partners. As many patients are referred by primary-care physicians or OB/GYN colleagues, they work hard to assure that referrals by primary-care physicians are a part of the teamwork that assists the Rocky Mountain Center for Reproductive Medicine® to "create a spark of life".
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Among the most gratifying things in Kevin Bachus, MD's life is when he holds a baby brought into the office by previous patients. You see, as a gynecologist and an expert in infertility at Fort Collins' Rocky Mountain Center for Reproductive Medicine®, Dr. Bachus works with those couples who have found the process of conceiving a baby to be one of those things not easily taken for granted. In simplistic terms, you might say that Dr. Bachus is in the business of assisting Mother Nature, not by the wave of a magic wand, but through some awesome miracles of modern science. His specialty, aided by the staff at the center, is helping infertile couples, wondering how to get pregnant, have children.
A native of Fort Collins, Dr. Bachus enjoyed a successful career as a staff member at the Duke University Medical Center in the Division of Reproductive Endocrinology and Infertility. He relished the research and the academic climate but, as one might expect from a doctor in the business of helping families come into being, the lure of family and lifestyle drew him back to Fort Collins. The opportunity to practice with his father, along with the chance to be near his and his wife's families, proved to be compelling factors in his decision to relocate. He decided to join his father, Dr. Nelson Bachus, now retired, who had enjoyed a long and notable career as a respected gynecology, infertility and menopause expert here in Fort Collins. Dr. Bachus also saw Fort Collins as a prime location for establishing a regional center for reproductive medicine. Though a much smaller locale than that in which one would normally expect to find such a highly specialized center, Fort Collins provided, in Dr. Bachus' eyes, not only a prime location, but also the type of atmosphere that could best serve the needs of the couples he wished to serve. Says Dr. Bachus, "The last thing couples need is to drive a long distance to a hustling, bustling, high-pressure, high-cost metropolis." Continues Dr. Bachus, "By providing this kind of center, here in Fort Collins, we remove that stress and enable people from throughout our region to take advantage of the advanced technology once found only in large medical centers. After all, this is the kind of experience that should be a positive one."
There are those perpetuators of doom and gloom who perpetuate the theory that infertility is increasing due to the cumulative effects of environmental toxins and their contribution to dilemmas such as diminished sperm counts. While experts estimate the number of infertile couples in America at 2.3 million, Dr. Bachus would conjecture that the problem is more likely due to age and the fact that more and more couples, these days, are postponing child rearing. As most of us well know, age changes a lot of things and for those who have delayed the process, it's an immutable fact: the older people get, the more fertility rates decline.
"On average, people are starting families later," Dr. Bachus said. "We now have two-income families and two careers to consider. Naturally, this tends to delay having children. These days it's very common for couples to be between 30 and 35 when they first consider having children." That desire can run smack into the realities of nature, which are less likely to be accommodating than they might have been five or ten years earlier. Dr. Bachus is not one for metaphors, especially the one about the biological clock ticking. It's too powerful for his taste because it stokes the worst fears of childless couples; fears that their time has passed, that the family they always wanted isn't possible. Dr. Bachus is more comfortable with educating couples to possibilities, realities and options. That's why he utilizes charts and graphs that put a couple's situation in accurate, more readily understood terms. And those kinds of pertinent facts, diagrammed in clear terms, put the anxious couple at much greater ease.
Says Dr. Bachus, "It's important to educate couples about all their options and, more importantly, for them to know that we don't immediately jump into the most complicated options. We are committed, at this center, to making sure we have explored the simplest options, before jumping into more extensive, more expensive, procedures. Then, once we've been successful and seen our patients through the most critical early weeks of a pregnancy, we are thrilled to return them to their referring OB/GYN or family physician for obstetrical care."
This process of educating the patient becomes significant when you consider Dr. Bachus' patients range in age between the early 20's and mid-40's, with most of them between 30 and 40. "One of my functions is to inform people of the advisability of when to wait and when not to wait," Dr. Bachus said. When it comes to his younger patients, Dr. Bachus has learned that you can't just pat them on the hand and tell them to be patient. "People need a suitable explanation they can grab on to," he said. "They need to be dealt with on their terms, in terms of their priorities." Sometimes a simple diagram can help facilitate a factual understanding and that's the basis from which Dr. Bachus wants his patients to make their decision. "Time is often on their side," said Dr. Bachus. "With people between 25 and 30, we often take a low-tech approach. Sixty percent of couples in this age group get pregnant in an average of six months. Eighty-five percent get pregnant after a year…just by trying in the appropriate manner."
Conversely, Dr. Bachus counsels couples 35 and beyond that time is definitely more critical and, if they have been trying to have a child for a year with no results, the course of action should definitely be more aggressive.
Dr. Bachus' first step is to investigate the source of the problem. For the male, only one test is relevant: the semen analysis. Unfortunately, the answer is not usually that simple. The quality of sperm in a man usually doesn't begin to decline until he reaches his fifties. "About 20 percent of infertility problems are complicated by the fact that there are contributions to the fertility problem of both partners."
On the female side, the investigative process requires more testing. In Dr. Bachus' experience, 50 to 60 percent of infertility problems are female-specific. The problem may be rooted in ovulation problems or irregularities, blocked fallopian tubes that keep sperm from reaching the egg, scar tissue around the ovaries that prevent eggs from escaping or scar tissue that pulls the fallopian tubes out of position preventing the capture of the egg.
Once the problem is diagnosed, treatment can begin. The array of technology Dr. Bachus has at his disposal and the center he has built is more than impressive. Attired in the booties, surgical coverings and the masks required to maintain sterility, a lay person touring the Rocky Mountain Center for Reproductive Medicine® can readily see why most facilities of this type are usually found only in large cities or prestigious schools of medicine. Equally impressive is Dr. Bachus' gentle demeanor and his vast knowledge of, and tremendous enthusiasm for, his specialty.
Surgery to correct anatomical problems may be one course of action. Ovulation induction is another option available at the center. This procedure uses medication or injections, combined with intrauterine insemination, to increase the number of eggs and the potential chance for successful conception.
Dr. Bachus' center is currently the only one in northern Colorado with a successful in vitro fertilization, or IVF, program. This procedure begins by utilizing the  drugs necessary to increase egg production. In IVF, however, the eggs are then retrieved, fertilized in the laboratory with the sperm, and the subsequent embryo implanted into the mother's uterus. Any additional embryos can be frozen to be used at a later time when the couple wants to try for a sibling.
A particularly mind-boggling procedure, and one that Dr. Bachus calls one of the first new break-throughs in the treatment of male factor infertility in the last ten years, intracytoplasmic sperm injection (ICSI), involves capturing a single sperm cell and a single egg cell with miniscule pipettes thinner than a human hair. The sperm cell is then injected into the egg with one of the pipettes. The operator must work in a three-dimensional picture and on a scale of intense magnification. It is one of the first procedures that allows people with very low sperm counts to conceive. "ICSI is a very, very detailed and involved procedure," said Dr. Bachus. "It takes a highly-trained specialist to deal with the procedure we perform in this lab. It demands a complete, skilled staff and highly knowledgeable fertility doctor. Because of the complexity involved, there is no way to perform this level of work without the assistance of a skilled embryologist and a dedicated office staff."
In cases where ovulation is not possible, either due to prior surgical treatment, premature menopause, or in patients beyond age 40 where traditional IVF is not commonly successful, an anonymous egg donor may be used. In this procedure, the female recruited as the donor undergoes egg induction and retrieval. Once the egg is recovered in the laboratory, it is combined with the sperm of the patient's partner or donor and the embryo is transferred into the patient's uterus. This procedure is not to be confused with surrogacy, where another woman carries the pregnancy.
"Much of my first visit with a couple deals with helping them to explore the options that will help them reach the decision that is best for them and their specific situation," said Dr. Bachus. "Everyone is different and has different needs; in-vitro is certainly the best option for many couples, but may not be the best starting point for everyone." Dr. Bachus notes that other, less complicated and less expensive options often work very well for a large number of couples. Because of the costs that can be involved, Dr. Bachus is conservative, especially when he first starts to explore treatment options with a couple.
When Dr. Bachus first decided to specialize in this area, he was intrigued by the research, the required level of skill, but most of all, the idea of contributing to the conception of new life. It's the very thing that first attracted his father to the profession over 25 years before. However, at that time, the technology now available, specifically in this region, may have seemed light years away. Yet, here and now, in Fort Collins, it is a reality for Dr. Kevin Bachus and his patients. Dr. Bachus will tell you with a broad smile just how proud he is of his center and of the success they have had to this point. "It's a wonderful thing to see people who have tried so hard and so long, in an attempt to have a family, begin to realize their dreams."
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