Download - Helping Small Miracles Happen
World-class medicine, sensitive careHoW IVF workson tHe road to parenthood‘he’s our special gift’Parents tell tHeir stories
Reproductive Science Center
of NJ
happen
Smallhelping
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Reproductive Science Center of NJ
Reproductive Science Center of NJ
2 helping small miracles happen
Reproductive Science Center of NJ
WELCOME to the reproductive science center of new
Jersey (rscnJ). as a father, i recognize the strong desire
to bear children, guide their growth and dream of their
accomplishments. that is why every morning, there is no
greater professional joy for me than to come here and share
my patients’ excitement as they hear their baby’s heartbeat
for the very fi rst time.
reproductive endocrinology and infertility medicine is a
fi eld that is ever evolving, which is why dr. Bromer, dr. salas
mann and i fi nd it so exciting and rewarding. our entire team
of fertility treatment specialists brings years of experience,
expertise and research innovations to each patient/couple’s
unique circumstances. our mission is to provide our patients
with compassion and respect, plus offer them the services
they need to become parents.
at rscnJ, our philosophy of care is to create a
partnership with our patients—to give them all the
information they need to make the treatment decisions that
are best for their individual needs, values and timeframes. of
course, our ultimate goal is always the same: a healthy baby.
Within these pages, you will learn more about our
comprehensive medical, fi nancial and psychosocial services
and hear the stories of couples who
have made their dreams come true at
rscnJ. We welcome your calls and
invite you to learn more about us by
visiting www.fertilitynj.com.
Best regards,
William Ziegler, d.o., medical director
reproductive science center of nJ
WE’RE HERE for you
OUR financial SERVICESAT RSCNJ, our financial specialists
can help you work within your health
insurance coverage and personal
budget to obtain infertility treatment.
even before you come for your first
appointment, we will consult with you
on the phone to verify your insurance
information. Within a few days, we will
call you back to inform you of your
benefits, any co-pays and out-of-pocket
expenses you can expect, and any
referrals you may need. We will obtain
any authorizations or pre-certification
for your first visit. there will be no
financial surprises when you come here
for the first time.
“Patients have so many medical
issues on their minds that we make
every effort to take the financial stress
off them,” says rscnJ practice manager
donna a. riggio. rscnJ also offers
self-pay options and medical financing
through advanced reproductive care®
and can work within your employer’s
flexible spending account.
You can rely on us to help you
navigate the financial complexities
of infertility treatment. We encourage
you to keep in touch with our Billing
department at 732-918-2500 at every
step of your journey.
WILLIAM ZIEGLER, D.O.
HELPING SMALL MIRACLES HAPPEN is PUBlisHedBY Wainscot media, montVale, nJ. © 2011.
all riGHts reserVed.
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3helping small miracles happen
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3helping small miracles happen
IF YOU ARE having trouble getting
pregnant, the physicians at the reproductive
science center of new Jersey (rscnJ) can
determine your best treatment option. First,
you’ll meet with one of our board-certifi ed
reproductive endocrinologists. You can expect
to spend 30 minutes to an hour discussing
your menstrual cycle and pregnancy
history, plus you and your
partner’s medical and surgical
histories, exposure to toxins,
environmental infl uences and
any chronic illnesses you may be
experiencing.
a physical examination
and a transvaginal ultrasound
exam may be performed next.
this non-invasive test can
help a woman’s physician
see the shape, anatomy and
endometrial lining of her uterus.
one can also see ovarian cysts, uterine
fi broids and polyps, as well as determine
the number of “resting” follicles within her
ovaries. the latter is called the antral follicle
count (aFc), which gives the reproductive
endocrinologist an idea of how many eggs a
woman has left that can be fertilized.
“as a woman ages, the approximately 1
to 2 million eggs she is born with decreases,
either because the eggs do not ripen for
ovulation and are absorbed into the body, or
because they are not fertilized after ovulation,”
says rscnJ reproductive endocrinologist
Jessica salas mann, m.d. “too few eggs may
indicate advanced age or a history of radiation
or chemotherapy, and can represent a sign of
poor ovarian reserve. too many eggs
could indicate that a patient may
not ovulate.”
in addition to the
aFc, specifi c blood
tests can be performed
in order to get a
sense of a patient’s
“ovarian reserve,” or
the number of eggs that
a patient has left. these hormones include
follicle-stimulating hormone (FsH), which is
produced by the brain and is menstrual-cycle
specifi c, and anti-mullerian hormone (amH),
which is produced by the ovaries and is not
cycle specifi c. other endocrinopathies such
as thyroid and prolactin disorders as well as
preconception blood work are
performed to better guide
patient-specifi c treatment.
an imaging test called a
hysterosalpingogram—during
which a radio-opaque dye is
injected through a woman’s
cervix, uterus and fallopian
tubes so they can be viewed
on moving X-rays—helps
physicians determine if there
are fi broids, polyps, scar tissue,
tubal blockages or any other
abnormalities that would
impede a fertilized egg’s journey from the
tubes to the uterine lining for implantation.
the male partner’s evaluation consists
of a discussion of prior vasectomy, hernia
repair, diabetes or other chronic
illnesses, toxic exposure, smoking,
ejaculatory dysfunction and any
other factors that might affect
fertility. a semen analysis
will be performed by one of
rscnJ’s andrologists. this will
indicate the quality and motility
(movement) of the sperm, as well
as how many sperm are produced.
if a man does not produce sperm
or produces a very low number of
sperm, he may be referred
to a urologist for further testing
or treatment.
once all tests are
completed, the patient
or couple usually
schedules a visit with
their reproductive
endocrinologist to
review all options.
WHAT TO expect BEFORE YOU’RE expectingFERTILITY SPECIALISTS HAVE SEVERAL WAYS TO FIGURE OUT HOW TO HELP YOU CONCEIVE
A PRE-APPOINTMENT PHONE CONSULTATION
WITH ONE OF OUR REPRODUCTIVE ENDOCRINOLOGISTS CAN ANSWER
MANY OF OUR PATIENTS’ MOST COMMON PRELIMINARY QUESTIONS BEFORE
THEIR FIRST VISIT. PLEASE CALL US AT
732-918-2500.
JESSICA SALAS MANN, M.D.
IN COUPLES EXPERIENCING INFERTILITY, PROBLEMS ARE TYPICALLY DUE TO:• FEMALE ISSUES 40% OF THE TIME • MALE ISSUES 30% OF THE TIME• COMBINED MALE AND FEMALE
FACTORS 10% OF THE TIME• PROBLEM CANNOT BE
DETERMINED 20% OF THE TIME
FIR
ST
ST
EP
S
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4 helping small miracles happen
Reproductive Science Center of NJ
released, the greater chance of fertilization.
if conception does not occur after three
or four cycles using these oral medications,
injectable medications are usually next.
these medications, called gonadotropins,
bypass the woman’s pituitary gland
and send a signal directly to the ovaries
to produce more eggs. With frequent
ultrasound exams of the ovaries, ovulation
can be predicted to within almost an hour.
• Intrauterine insemination (IUI): With
this treatment, the sperm is washed and
prepared in the rscnJ andrology laboratory,
drawn up into a thin catheter and then
placed through the woman’s cervix and
into the uterus. iUi brings the sperm closer
to an egg, thus providing a greater chance
of fertilization. the doctors at rscnJ may
recommend iUi alone or in combination with
super-ovulation medications.
NON-INVASIVE/MINIMALLY INVASIVE PROCEDURESif the fi rst-line methods don’t result in a
pregnancy, further insight into the structure
and function of a woman’s reproductive
organs may be needed.
• Hysteroscopy: during this outpatient
procedure, the physician uses a lighted
scope placed through the cervix to view the uterine cavity and check for
abnormalities.
• Laparoscopic surgery: this minimally invasive procedure, which
is performed through several small incisions above the navel, is another
way to diagnose and treat abnormalities of the reproductive tract that can
impede conception, fertilization or implantation.
• daVinci™ Surgical System: this robotic system takes laparoscopic
surgery a step further by giving physicians greater precision and dexterity
in diagnosing and treating endometriosis, blocked fallopian tubes and
uterine fi broids, and in reversing tubal ligation sterilization surgeries.
rscnJ’s medical director, William Ziegler, d.o., and medical associate
Jason Bromer, m.d., performed the fi rst robot-assisted tubal reversal
surgeries in monmouth and ocean counties.
“the robot, with its high-defi nition fi beroptics, superb magnifi cation
of the surgical site and fl exible ‘arms’ that we manipulate through tiny
abdominal incisions, helps us perform intricate microsurgical techniques
that minimize tissue trauma and decrease the body’s infl ammatory
response during pelvic surgery,” says dr. Ziegler. “this gives us the ability
to treat endometriosis and unblock tubes without causing further pelvic
adhesions. We can also use the robot to remove up to 10 uterine fi broids
during one outpatient surgery or to reconnect the fallopian tubes’ tiny
blood vessels that were tied off during tubal ligation.”
robot-assisted laparoscopic surgery holds many advantages
over traditional “open” surgery. small centimeter-sized incisions,
instead of a large incision, mean patients experience less pain, blood
loss and surgical complications. the incisions may be covered by a
simple bandage or closed with a surgical adhesive. most robot-assisted
ONE IN SIX—that’s the number of couples who have diffi culty
conceiving. But with state-of-the-art methods utilized by highly skilled
reproductive endocrinologists, such as those at the reproductive science
center of new Jersey (rscnJ), 90 percent of all cases of infertility can be
treated. Here are some of the advanced diagnostic and treatment options
our board-certifi ed reproductive endocrinologists currently offer.
FIRST-LINE TREATMENTSdoctors often begin your fertility plan with one of these popular procedures.
• “Super-ovulation”: almost 50 percent of patients facing infertility may
be assisted by this treatment, which uses oral and injectable medications
to enhance ovulation and conception. to begin, the couple’s diagnostic
testing must indicate that the man’s sperm is healthy and mobile. in
addition, testing must show that the woman has an adequate number
of good-quality eggs in her ovaries, and that her reproductive organs are
structurally normal and do not contain any uterine fi broids, ovarian cysts,
endometriosis of the fallopian tubes, or other abnormalities.
most couples start with oral medications, called clomiphene citrate or
clomid, which signal the woman’s pituitary gland to produce more follicle-
stimulating hormone (FsH). this hormone causes the ovaries to ripen
and release more than one egg about 10 days into the woman’s
monthly cycle. the couple then plans intercourse
to coincide with ovulation. the more eggs
OUR CUTTING-EDGE PROCEDURES HAVE
HELPED THOUSANDS CONCEIVE
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5helping small miracles happen
WOMEN WITH A FAMILY history of early menopause or
who are undergoing medical care
that may be toxic to their eggs
or reproductive organs, such as
chemotherapy and/or radiation
for cancer, may choose to freeze
their eggs.
While embryos have long
been cryopreserved (frozen in liquid
nitrogen) and then successfully
thawed and used in iVF treatments,
the freezing and future use of unfertilized eggs is now gaining
momentum as new fast-freezing techniques (called vitrifi cation) are
able to protect delicate eggs from the formation of damaging ice
crystals. cryopreserving eggs also gives healthy women who wish
to delay childbearing the ability to freeze their eggs for future use.
research, including that of rscnJ’s Jason Bromer, m.d.,
reveals that pregnancy rates are rising with the use of both
cryopreserved eggs and embryos, but frozen eggs provide several
advantages over frozen embryos, particularly for women who want
to delay childbearing.
“Freezing eggs does not require sperm, which can make
this an attractive option for a single woman,” says dr. Bromer. “in
addition, it gives women the chance to use healthy, young eggs
later in life when the eggs in their ovaries may be older and not
viable. lastly, while there are many who are uncomfortable
with discarding frozen embryos, there are very few
people who have moral or ethical issues
with discarding frozen eggs.”
PRESERVING surgeries do not require an overnight hospital stay, and patients
usually return to their regular activities within a week.
ASSISTED REPRODUCTIVE TECHNOLOGIESFor many couples who are experiencing infertility or same-sex couples
who wish to build a family, an assisted reproductive technology may be
the best option.
• In vitro fertilization (IVF): With this treatment, fertilization of the
egg by the sperm takes place outside the woman’s body in rscnJ’s
state-of-the-art embryology lab at the eatontown facility. the three
major steps of iVF include:
1. Giving follicle-stimulating hormones to the woman to help her ovaries
produce extra eggs. medications are also given to suppress ovulation
until the timing is right. Just before ovulation, the woman’s reproductive
endocrinologist retrieves the eggs from her ovaries.
2. taking the eggs to the embryology lab, where they are fertilized with
a partner’s or donor’s sperm. there they grow in special cultures for
three to fi ve days.
3. transferring one or several of the fertilized embryos (the number depends
on the woman’s age and medical history) back into the woman’s uterus
on day three or fi ve, where, if successful, they will implant and grow into
a baby. if there are additional embryos remaining after the transfer, the
patient/couple can choose to have them frozen and stored for future use.
several other assisted reproductive technologies may be used at
rscnJ in combination with iVF. these include:
• intracytoplasmic sperm injection (icsi), which involves injecting one
single sperm into an egg. icsi can assist men who have a low sperm count
and women who have a low number of viable eggs.
• microepididymal sperm aspiration (mesa) or testicular excisional sperm
extraction (tese), during which a urologist obtains sperm directly from the
man’s reproductive tract
• assisted hatching, which involves opening the shell of the embryo to
improve implantation
• donor sperm, either fresh or frozen
• donor eggs and embryos
• Gestational carriers
• Pre-implantation genetic diagnosis (PGd) to screen embryos for genetic
disorders using comparative genomic hybridization (cGH), the latest
advance in PGd
• Fertility preservation and postponement with frozen eggs and embryos
(see sidebar)
JASON BROMER, M.D.
WILLIAM ZIEGLER, D.O., JESSICA SALAS MANN, M.D., AND JASON BROMER, M.D.
RSCNJ CAN SAVE YOUR EGGS
FOR FUTURE PREGNANCIES
fertility
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6 helping small miracles happen
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RSCNJ’S CARING AND WELCOMING STAFF WAS JUST WHAT THE DOCTOR ORDERED
THANKS TO AGGRESSIVE FERTILITY TREATMENTS, A TOMS RIVER COUPLE WELCOMES A BOUNCING BABY BOY
FEELING RIGHT ‘at home’ S
UC
CE
SS
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OR
IES
What makes a couple choose a
fertility center? although there
are several reproductive
treatment facilities in the
metropolitan area, sometimes the
decision comes down to a feeling.
such was the case for christie and
amanda Beyer of West allenhurst. “We had gone to another
center and did not feel a connection,” says christie. “But when we
came to the reproductive science center of new Jersey (rscnJ)
on the advice of friends, we instantly felt at home with dr. Bromer
and knew that he could help us build a family. We liked the fact
that being a same-sex couple was not an issue at this center;
everyone treated us respectfully.”
christie, 33, and amanda, 27, had been a couple for fi ve
years and had been joined in a civil union for one year when they
chose to pursue motherhood in January 2010. they decided that
christie, who had a strong desire to bear children, would be the
one to become pregnant and carry the baby.
“as a nurse, i was in favor of starting with conservative
ovulation medication treatments combined with insemination
using donor sperm,” recalls christie. “neither one of us had tried
to conceive before, and we thought it would be relatively easy.”
Unfortunately, two rounds of oral medications followed by
two rounds of medication injections failed to produce a baby.
diagnostic tests indicated that christie’s eggs were of
poor quality, and she was probably experiencing premature
ovarian failure syndrome. this condition, marked by the ovaries’
decreasing ability to produce viable eggs, can begin when a
woman is in her 20s. dr. Bromer recommended iVF, but there
were health insurance hurdles to overcome.
“dr. Bromer and his staff took all the insurance pressure off
of us so we could focus on becoming mothers,” says amanda.
christie also credits the nurses at rscnJ for making her feel
safe and comfortable during her fertility treatments and helping
both she and amanda handle the stress that accompanied the three
treatment cycles they underwent until christie became pregnant.
Finally, in august 2010, christie and amanda received the
happy news that they were expecting twins. on march 11, 2011,
after 34 ½ weeks of pregnancy, christie’s water broke. a boy,
Jace, was delivered at 5 pounds, 2 ounces. next came a girl, Julia,
weighing 5 pounds, 3 ounces.
christie and amanda are eager to one day have more
children. When they feel the time is right to add to their family,
they say they’ll go “home” to dr. Bromer and the rest of the
rscnJ staff.
elizabeth and robert Holligan of toms river don’t mind the sleepless nights that come along with caring for
their baby son, Justin. “after years of trying to conceive, all that matters are Justin’s smiles,” says elizabeth.
Justin was born on november 29, 2010, thanks to fertility treatments elizabeth received at the
reproductive science center of new Jersey (rscnJ).
the couple fi rst sought help from rscnJ in 2007 when elizabeth was 30. “everyone kept saying, ‘Just
relax, you’re young, you’ll get pregnant,’” recalls elizabeth. “But we were concerned because we
had been trying for a year.”
despite extensive diagnostic testing, it was unclear why the Holligans couldn’t conceive.
no matter: that didn’t mean there wasn’t a solution. “my best friend had just become
pregnant with iVF administered by dr. Ziegler of the center, so i was completely familiar and
comfortable with this treatment and wanted to try it.” the couple happily learned that their
insurance policy covered four iVF cycles.
But the road to parenthood was a bumpy one for the couple. the hormone medications and
injections necessary for producing extra eggs and timing ovulation made elizabeth experience hot
fl ashes, mood swings and weight gain. the Holligans’ fi rst iVF cycle was unsuccessful; neither of the
two embryos fertilized in rscnJ’s lab and transferred to elizabeth’s uterus had implanted.
Using frozen embryos saved from the fi rst iVF cycle, they tried a second time. But this attempt only
produced a “chemical pregnancy.” that meant that although early blood tests indicated that elizabeth was
initially pregnant by the count of certain hormones, neither of the embryos that had been transferred into her
uterus matured into a “clinical pregnancy,” which is defi ned as the presence of a gestational sac that can be
visualized on an ultrasound exam and a heartbeat that can be heard at about eight to nine weeks’ gestation.
“i was devastated because we had used up all the 30 eggs that had been retrieved during my fi rst iVF
attempt,” says elizabeth. “But dr. Ziegler was hopeful, so we started all over again.”
after two more attempts at iVF, elizabeth found out she was pregnant on april 3, 2010, after receiving a
call from a rscnJ nurse. she delivered Justin at a healthy 7 pounds, 5 ounces. “every day i look at Justin and
feel grateful for dr. Ziegler and his staff for the special gift they gave us,” says elizabeth.
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Reproductive Science Center of NJ fertil
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7helping small miracles happen
WORLD-CLASS MEDICINE isn’t all you’ll fi nd at the reproductive science
center of new Jersey (rscnJ). our staff is also dedicated to providing you with sensitive,
compassionate care throughout your journey toward parenthood.
rscnJ offers comprehensive diagnostic, treatment and research services
in two state-of-the-art facilities in eatontown and toms river. our reproductive
endocrinologists, physician assistant, registered nurses, on-site embryologists and
andrologist, medical assistants, fi nancial specialists, support staff and offi ce personnel
are committed to fi nding answers and developing an individual treatment plan.
Because infertility presents many physical, emotional and social challenges, we also
offer psychological counseling with a licensed clinical social worker.
our physicians are on the
medical staffs of seven hospitals and
one surgical center in monmouth and
ocean counties. rscnJ is a member of
the american society for reproductive
medicine and the society of assisted
reproductive technologies; was
named a center of excellence by
United Healthcare; was the fi rst
infertility practice in ocean and
monmouth counties to be approved
by the Better Business Bureau; and
received the Zenith award from
resolVe of new Jersey. our medical
director, William Ziegler, d.o., has been
named a “top doc” several times by
New Jersey Monthly magazine.
our eatontown and toms river
offi ces are open 7 a.m. to 4 p.m.
monday through Friday, select late
nights until 7 p.m., and on weekends
for cycling patients and new
patient appointments.
WHY RSCNJ?A D VA N C E D M E D I C I N E A N D P E R S O N A L I Z E D C A R E E Q U A L S R E S U LT S
MAKE five!
AND twins
IN VITRO FERTILIZATION HELPS A JACKSON COUPLE COMPLETE THEIR FAMILY
after conceiving her fi rst two children naturally
and easily, Jessica Podlas of Jackson didn’t
anticipate any diffi culties when she and her
husband, rich, decided to try for baby number
three in 2005.
However, after two years of trying to
conceive with home ovulation kits and other
over-the-counter products, nothing happened.
the couple sought help from the reproductive
science center of new Jersey (rscnJ).
diagnostic tests of both Jessica and rich
revealed that rich had a low sperm count,
possibly from handling chemicals during the
course of his work in a sewer division. Because
the couple’s health insurance plan covered in
vitro fertilization (iVF), they chose this method.
“We were successful after our fi rst iVF
cycle,” says Jessica. “our daughter, summer,
was born on december 3, 2007.”
satisfi ed that their family was complete,
Jessica underwent a tubal ligation, only to
change her mind two years later. the couple
returned to dr. Ziegler for iVF.
iVF is an ideal treatment option for
women who have undergone a tubal ligation
and then decide they want more children.
during iVF, the egg does not pass through the
fallopian tube, but instead is fertilized with
sperm by an embryologist in rscnJ’s lab and
then placed into the patient’s uterus, where it
implants and grows.
during Jessica’s third iVF cycle three
fertilized embryos had been implanted,
and when the Podlases went for their fi rst
ultrasound check-up, two distinct embryos
could be seen.
although Jessica experienced
complications that caused her to go into labor
at 29 weeks of pregnancy on January 29, 2011,
today her twins, richard Jr. (r.J.) and Gia ann,
are thriving. “dr. Ziegler and his entire staff
helped us build the family we always wanted,”
says Jessica. “We are grateful for the personal
touch of everyone at the center.”
YO
UR
CH
OIC
E
OUR SERVICES• Infertility evaluations and treatment• Advanced ultrasound pelvic examinations• Semen analysis• Super-ovulation with ultrasound
monitoring• Artifi cial insemination• Advanced robot-assisted and laparoscopic
reproductive surgery• Tubal ligation reversal• Hysteroscopy• In vitro fertilization (IVF)• Preimplantation genetic diagnosis (PGD)
with comparative genomic hybridization (CGH)
• Assisted hatching• Intracytoplasmic sperm injection (ICSI)• Blastocyst transfer• Cryopreservation of eggs and embryos• Medical and surgical treatment for tubal
pregnancies• Endocrinology and endometriosis
treatments• Donor sperm and donor eggs• Gestational carriers
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HelpingSmallMiraclesHappen
Reproductive Science Center of NJDR. WILLIAM F. ZIEGLER • DR. JASON G. BROMER • DR. JESSICA SALAS MANN
FERTILITYNJ.COM • TOMS RIVER, NJ • EATONTOWN, NJ • 732-918-2500
RSC-NJ is the first infertility practice inOcean/Monmouth
County to be approved with the BBB.
RSC-NJ is the first CAP/FDA
approved lab inOcean/Monmouth
County.
RSC-NJ is a member of SART, the primary
organization of professionals dedicated to
the practice of assistedreproductive technologies(ART) in the United States.
Dr. William Ziegler was voted Top Doc by New Jersey MonthlyMagazine in 2007.
RSC-NJ is proud to be a member of the AmericanSociety for Reproductive
Medicine (ASRM).
Dr. William F. Ziegler, Dr. Jessica Salas Mann and Dr. Jason G. Bromer
• COMPREHENSIVE FERTILITY CARE
• TREATMENT FOR RECURRENT PREGNANCY LOSS
• ADVANCED/ROBOTIC REPRODUCTIVE SURGERY
• INTRAUTERINE INSEMINATION (IUI)
• IN VITRO FERTILIZATION (IVF)
• INTRACYTOPLASMIC SPERM INJECTION (ICSI)
• DONOR EGG
• PREIMPLANTATION GENETIC DIAGNOSIS (PGD)
• IVF/DONOR EGG REFUND PROGRAM
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