The Center for Advanced Reproductive Services is a part of the First Fertility family of centers. Learn more.

Fertility Matters

Guidelines for Male Infertility

Newly Released 2020/2021 ASRM/AUA Guidelines for Male Infertility Suggest Greater Role in Evaluation and Treatment of the Male

By Stanton Honig, MD

The American Urological Association (AUA) and the American Society of Reproductive Medicine (ASRM) have combined to release new Guidelines for the evaluation and treatment of male infertility. This updates the guidelines that were last reviewed about eight years ago and gives a much more detailed approach to men who have fertility problems. In this update, we will review some of the important new concepts and why it is important for men to be evaluated.

One of the new guidelines stresses the importance of doctors to review the health risks associated with infertile men with abnormal sperm production. This has been known for years and includes the concept that men with these abnormalities may have some underlying medical conditions such as testicular cancer, genetic abnormalities such as Klinefelter’s syndrome, tumors of the pituitary gland, etc that may be responsible for their low sperm production. This is important because as one of the guidelines says “men with one or more abnormal semen markers should be evaluated by a male reproductive expert with a complete history and physical exam.” In the era of telehealth, discussion is important but physical exam can identify specific abnormalities like a testis mass.

There is also growing evidence that men who have abnormal semen parameters may have a slightly higher mortality rate or “chance of dying earlier.” This is based on preliminary data in one study, is certainly concerning. More studies are necessary to confirm whether this is true or not.

One of the other important new guidelines involves advising couples that “men who are older are at increased risk of adverse health outcomes for their offspring.” This has been noted previously with older women but now there is evidence that this is true for paternal age as well. There is a higher incidence of schizophrenia, autism and chondrodysplasia (genetically caused bony and cartilage disorders). While there is no clear definition for advanced paternal age, this risk starts to increase over the age 40 and increases further above the age of 50.

One of the important new guidelines stresses the importance that doctors discuss risk factors such as lifestyle, medication usage and environmental exposures associated with male infertility. However, the guidelines stress that the current data on the majority of these risk factors is limited. It is clear to most reproductive urologists that a “healthy lifestyle will most likely result in healthier sperm.” So eating healthy, not smoking, not drinking excessively, not using marijuana excessively and generally living a healthy lifestyle is going to portend a better outcome in terms of getting your partner pregnant.

The benefits of supplements such as antioxidants and vitamins in the treatment of male infertility are highlighted in the new guidelines as well. At the present time, existing data is inadequate to provide specific recommendations for men regarding dietary supplements. Supplements that have thought to be valuable for men include vitamin C, vitamin E, carnitine, and Coenzyme Q.

One of the most important guidelines addresses the use of testosterone in men of reproductive years.

Testosterone use will shut off sperm production and is NOT indicated in the treatment of male factor infertility. In patients with low testosterone, these patients may be treated with “off label” use medications such as clomiphene citrate or “clomid,” (a selective estrogen receptor modulator) or human chorionic gonadotropin (hCG) or with a combination of these medicines. These medications will increase testosterone but will not have a negative effect on sperm production.

One of the other new guidelines addresses the use of FSH analogues (Follicle-Stimulating Hormone) with the aim of improving sperm count, pregnancy rate and live birth rates in men with unexplained infertility male infertility. Although these studies are old, there is data to show a benefit to men. Unfortunately, these medications can be expensive and may not covered by insurance plans.

Men who have a clinical or palpable varicocele should be repaired with the hopes of improving abnormal sperm parameters. In this patient population, with normal female partners, a significant # of men will see an improvement in semen quality. In patients who have non-palpable varicoceles detected only by imaging, these should not be repaired as they do not typically result in improvement in semen quality. Seeing a reproductive urologist can be helpful to tell the difference.

In men who have azoospermia as a result of an obstruction, there are two options to achieve a pregnancy. These patients should be counseled regarding the possibility of surgical reconstruction, surgical sperm retrieval and IVF (in vitro fertilization) or a combination. The most common cases are a result of a prior vasectomy or blockages in the epididymis. In the patients who choose surgical sperm retrieval, this can either be performed timed with the ivf cycle or performed prior to an egg retrieval and frozen. The new Guidelines identify that success rates are equivalent.

In patients who have no sperm in ejaculate as a result of low sperm production (non-obstructive azoospermia), a procedure called a microsurgical testicular sperm extraction or “microTESE” should be performed to give the best results in finding sperm. 50% of the time, sperm can be found in these cases and if found, then can be combined with oocytes in vitro to achieve a pregnancy.

It is important for patients and their partners to understand the new guidelines developed by the American Urological Association and the American Society of Reproductive Medicine. Much of this is based on scientific data but it also includes the expert opinions of many reproductive urologists and has been “peer reviewed’ by multiple physicians and scientists from around the country.

Dr. Honig works closely with The Center for Advanced Reproductive Services and is a Clinical Professor of Surgery in the Division of Urology at UConn Health. He is also the Director of Men’s Health and a full time faculty member at Yale University Department of Urology and President Elect of the Society of Male Reproduction and Urology. Dr. Honig sees patients in New Haven, the Shoreline and in Farmington. He can be reached at 203-785-2815 or 860-679-4100.

New Covid Guidelines

Update May 3, 2021

Effective Wednesday, May 19 the governor is lifting all COVID 19 business restrictions in CT. Since late March there has been no travel ban.

In recognition of this, and in an abundance of caution, attached find our revised COVID 19 Mitigation and Travel Policy. Please take the time to read it. Below are highlights. These changes will be effective as of Monday, May 24, 2021.

Please let us know if you have any questions.

Operational updates:

The following COVID mitigation practices will continue until further notice:

Virtual waiting room program [patients wait in cars and are texted in}

  • Virtual New Patient visits.
  • SA produced at home [unless > hour away]
  • Front door screening and temps
  • Scheduled appointments only. No walk-in scans or bloods
  • Virtual follow up visits.
  • No children
  • Continue weekly testing for unvaccinated staff.

However, the following restrictions will be LIFTED:

  • Prohibition on partners. Allow partners [or another family member] in for all live visits. However, PACU is still off limits to partners per anesthesia. No children under any circumstances.
  • Start allowing satellite patients in IF patient was a past patient of CARS.

All of the guidelines outlined in this document are subject to change based upon new local, state and federal recommendations.

COVID-19 vaccination program

  • CARS employees are strongly encouraged to obtain the COVID-19 mRNA vaccine. At this time, it is not a requirement. However, those employees who have not received the vaccine may be asked to undergo serial COVID-19 testing at the cost of CARS.

Addendum to CARS COVID-19 Management and Mitigation:

Travel to States listed on CT Travel Advisory List

Mandatory travel restrictions have been lifted in the state of CT, as of March 19, 2021. However, travel advisories remain in effect from both the state and the CDC. With that in mind, while CARS has modified its travel policy for both staff and patients, restrictions will remain in place in order to maintain the safety of the practice.

For all employees and patients:

Any domestic or international travel will require COVID-19 testing within 3 days of return and prior to entry into CARS.

This policy does not apply to travel to any state that borders CT including MA, NY and RI. No testing is required after travel to these states.

This policy applies to all employees and patients regardless of vaccination status.

PGT: When Is Preimplantation Genetic Testing An Option?

By Claudio Benadiva, MD, HCLD

Of the 150,000 babies born with a birth defect each year, chromosomal and/or genetic anomalies are either solely or partially to blame, according to the March of Dimes. Preimplanatation Genetic Testing (PGT) is a procedure that screens embryos for genetic abnormalities before they are transferred into the uterus. PGT can be used for fertile couples that have been identified as high-risk for passing on a genetic disease, as well as for infertile couples.

The Center for Advanced Reproductive Services at UConn was the first program in Connecticut to offer PGT as an alternative to prenatal testing for those at risk of transmitting a genetic disorder. PGT is most indicated for the following patients:

1. Genetic disorders. PGT-M can be performed to help couples aware of genetic disorders through family history or based on carrier testing. In genetic disorders where the genetic mutation is known, such as Cystic Fibrosis or Tay-Sachs, the actual genes of the embryo are examined for presence of the condition and only the normal embryos are transferred back to the mother.

2. Advanced maternal age. Chromosomal abnormalities due to advancing maternal age are more likely to occur in women over the age of 35. These abnormalities can lead to problems such as Down Syndrome or early miscarriage. PGT-A can determine the number of chromosomes and determine which embryos are the most likely to result in a healthy pregnancy.

3. Recurrent miscarriages. Aneuploidy or structural chromosome rearrangements (translocations) can lead to recurrent miscarriages. PGT-A and PGT-SR can determine which embryos are most likely to result in a healthy pregnancy.

In 2020, approximately 50% of CARS IVF cycles included PGT for aneuploidy screening (PGT-A). PGT consists of the biopsy of embryos at the blastocyst stage and chromosomal analysis using next generation sequencing (NGS) on the biopsied cells. After the biopsy procedure, the embryos are frozen and stored in our liquid nitrogen tanks. Once the PGT results are received, the euploid embryos are thawed and utilized in a frozen embryo (FET) cycle or remain frozen and stored for future use.

The chart below shows ongoing pregnancy rates for CARS PGT patients after their first FET cycle and then for all FET cycles. As the age of the patient increases, so too do the benefits of PGT-A. Specifically, in patients 38 and older, we see an approximate 30% increase in ongoing pregnancy rates per transfer when PGT is used compared to cycles in which PGT-A is not used.

Testing: Accuracy and Process

The accuracy of PGT depends upon the disease being tested for, but overall it is able to diagnose genetic defects with a very high accuracy. The advantage of PGT is that it reveals these genetic defects before pregnancy, as opposed to amniocentesis and CVS which show these defects during pregnancy.

The PGT process begins with the same steps taken during preparation for a routine IVF cycle. Once the embryos have developed, one or more cells are taken from each embryo for analysis. At The Center, we work with dedicated embryologists trained specifically in the most recent biopsy techniques to help insure the highest quality of results.

Timing of Vaccine Administration

As vaccines become more widely available, a practical question has arisen regarding the timing of vaccine administration with respect to certain invasive reproductive care treatments. In general, it is recommended that:

Patients scheduled for elective surgery or outpatient procedures, including oocyte retrieval, embryo transfer, and intrauterine insemination, avoid COVID-19 vaccination at least three days prior and three days after their procedure. This recommendation is not because being vaccinated is unsafe, but rather because known side effects of the vaccine may impact intra-operative and post-surgical monitoring. Common side effects after COVID-19 vaccination, especially after the second dose, include fever, chills, fatigue, myalgia, and headaches, which typically occur and resolve within three days. Anesthesia impairs normal thermoregulatory control and may be impacted by pre-existing fever. Additionally, these side effects would make it difficult to determine if a post-procedure fever is related to the vaccine or to a developing infection related to the procedure. Finally, many medical facilities may not allow patients into their facility or proceed with any elective procedure if a patient has COVID-like symptoms, including those that are possible side-effects of the vaccine, even if their COVID-19 test is negative. Practices should notify and encourage their patients to communicate with their surgeons and fertility programs when they become eligible for COVID vaccination. This will help coordinate planned surgical procedures, fertility testing and treatment, and will decrease the chance of inadvertent procedure cancellation.

Dr. Benadiva Announced as New Medical Director

Claudio Benadiva, MD, HCLD Announced As New Medical Director at The Center for Advanced Reproductive Services

Alison Bartolucci, PhD, HCLD Promoted to Laboratory Director

Farmington, CT, January 19, 2021… The Center for Advanced Reproductive Services (The Center), a prominent family building program, announced Dr. Claudio Benadiva as Medical Director. Dr. Benadiva, who previously served as The Center’s High Complexity Lab Director, replaces Dr. John Nulsen, who is stepping down as medical director to focus more on The Center’s IVF and Donor Egg Programs as well as its academic mission. Dr. Alison Bartolucci has been promoted and will replace Dr. Benadiva as High Complexity Laboratory Director.

As Medical Director, Dr. Benadiva will be responsible for oversight and have responsibility for ensuring appropriateness and quality of services and care is continually provided to all patients and their families as prescribed in The Center’s clinical policies and procedures and applicable national standards.

As High Complexity Laboratory Director, Dr. Bartolucci will be responsible for the day-to-day operation, management, organization and supervision of the laboratory operations and staff and for ensuring that the highest standards in quality, safety and success rates are met.

According to The Center’s CEO, Paul Verrastro, “A cornerstone of The Center’s success is the in-depth experience of our clinical leadership team. Both Dr. Benadiva and Dr. Bartolucci are considered thought leaders in the field of reproductive endocrinology and infertility (REI) and have distinguished themselves nationally as committed clinicians and academics. This combination of clinical care and basic science is what translates into success for our patients. Residents of Connecticut and our surrounding towns are lucky to have this team available to them to meet their family building needs.”

Both Dr. Benadiva and Dr. Bartolucci have extensive experience in the REI field. Dr. Benadiva has been a lead physician at the Center since 1998 and is the former High Complexity Lab Director. Under his direction with Dr. Bartolucci by his side, The Center’s lab has received national recognition for its high standards and has received CAP Laboratory Accreditation, a program designed to ensure the highest standard of care for all laboratory patients. Dr. Benadiva is a Clinical Professor of Obstetrics & Gynecology at UConn Health, is a Fellow of the American College of Ob/Gyn, and is board certified in Obstetrics & Gynecology and Reproductive Endocrinology and Infertility. During Dr. Benadiva’s 3-year REI Fellowship at Cornell, he spent 18 months focusing on IVF research in their world-famous lab. During this time, he worked elbow to elbow with fertility pioneers like Jacque Cohen, PhD (embryology), Santi Munne, PhD (PGD/S) and Gianpiero Palermo, PhD (ICSI).

Dr. Bartolucci joined the Center in 2012 and most recently was Operational Laboratory Director. She received her PhD in 2019 from Eastern Virginia Medical School and is a Faculty Instructor at UConn Health. She started her embryology career at Mass General under the guidance of Catherine Rancowski, PhD, and was later was mentored by embryo grading pioneer Lynette Scott, PhD. Dr. Bartolucci completed her PhD in basic science research at UConn Health under the mentorship of John Peluso, PhD.

2020 Superstar Award

At the Center, we work hard to create a culture of gratitude and appreciation, especially among peers. Very simply, it makes our team stronger. We are honored to announce this year’s nominees for our 2020 Superstar Award. This award is an opportunity for our employees to nominate their peers who excel in the areas of Appreciation, Communication, Hard Work and Customer Service. Please join us in congratulating this year’s nominees and our winner.
This year’s nominees were:
From our Branford Office: Haley
From our Hartford office: Chelsea
From our Farmington Office: Laura F., Keisha, Jen L., Robyn, Lynn, Glorimar, Lindsey, Jenny B, Betsy, Loralyn, Stacey, Demis
And the Winner of Our 2020 CARS Superstar Award! Jane C.

Statement on Covid-19 vaccine

With news of the FDA emergency use authorization of a COVID-19 vaccine, ASRM released a new statement from its COVID-19 Task Force, and joined with other OB/GYN organizations on a statement.

Click here for statement from American Society of Reproductive Medicine [ASRM]

The ASRM COVID-19 Task Force statement emphasizes the importance of shared decision making between patients and their physicians but is very clear that, “The Task Force does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are breastfeeding (1,2,3) and encourages patients undergoing fertility treatment to receive vaccination based on current eligibility criteria.”

The report also states that virus mitigation strategies, such as universal masking, physical distancing and reducing social interactions must be followed even though some people now have access to a vaccine.

In addition, the statement addresses head-on a piece of misinformation which has been circulated by antivaccine ideologues and states that the mRNA vaccines “are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies.”

ASRM also joined with the American College of OB/GYNs, the Society for Maternal Fetal Medicine, the Society for Gynecological Oncology and the AAGL in a joint statement from the OB/GYN community. It too emphasizes access to the vaccine for pregnant and lactating women and the importance of decisions about the vaccine being made by patients and their physicians.

Fertility Treatments and COVID 19 Vaccine

We are all excited about the recent developments and promise regarding Covid 19 vaccines. These vaccines have not been extensively studied in pregnant women. However the American College of Obstetrics & Gynecology [ACOG] is recommending that for Health Care Workers [HCWs] who are pregnant or trying to get pregnant the vaccine should not be withheld.

The vaccine may have side effects including chills, muscle aches, possible “fever” (3 % incidence of fever after first injection and 15 % incidence of fever after the second injection) lasting up to 3 days. If you chose to take the vaccine and develop  a fever (100 degrees or higher); per CARS COVID 19 screening policy you will not be allowed in a CARS office as we will be unable to ascertain if the fever is the result of vaccine reaction or an actual COVID infection. This may result in your treatment and/or cycle being postponed or cancelled.

Therefore, it is ultimately your choice to take the Covid 19 vaccine during fertility treatment, however you must understand a possible reaction may be cause for us to postpone your treatment or cancel your cycle.  Another choice for patient’s choosing to be vaccinated is to postpone fertility treatment until completion of the 2 step vaccine process. Thank you.


Important: Inclement Weather Notice

Important: Inclement weather notice for Thursday, December 17, 2020.

Branford and New London offices will be closed on Thursday, December 17. If you have services scheduled on this day in these offices, they will be canceled. Please call your nurse with any questions.
Hartford and Farmington will be open for all services. If you have a non-urgent appointment in either of these offices and wish to cancel, please call us ASAP.

2020 Holiday Hours

Christmas Week

Thursday, Dec 24. All offices opened but closing by 2-3pm. If you have an emergency please call The Center’s main number and you will be connected to MD on call.

Friday, Dec 25. Farmington office opened for scheduled cycling patients only. All other offices closed. No unscheduled clinical services. If you have an emergency please call The Center’s main number and you will be connected to MD on call. No IUIs. Follow directions provided on the IUI line.

Sat, Dec 26 & Sun, Dec 27. Will operate as a normal weekend. Farmington office will be open and all other offices close

New Years Weekend

Thursday, Dec 31. All offices opened but closing by 2-3pm. If you have an emergency please call The Center’s main number and you will be connected to MD on call.

Friday, Jan 1. Farmington office opened for scheduled cycling patients only. All offices closed. No unscheduled clinical services. If you have an emergency please call The Center’s main number and you will be connected to MD on call. No IUIs. Follow directions provided on the IUI line.

Sat, Jan 2 & Sun, Jan 3. Will operate as a normal weekend. Farmington office will be open and all other offices closed.

Our Winning Team

Once again, the Center has distinguished itself at the American Society for Reproductive Medicine (ASRM) Virtual Congress through our commitment to academics and research. ASRM’s annual meeting is the premier education and research meeting for Reproductive Medicine. Our clinical team of MDs, fellows [past and present], residents, and lab staff worked tirelessly throughout the year to complete a variety of thoughtful and relevant research projects. Below is a list of all the oral and poster presentations that were accepted to ASRM.

Our research mentor of the year award goes to Dr. Lawrence Engmann. He is a wonderful teacher and has shepherded many of these projects to completion. His inspired ideas, knowledge of the literature, his gentle guidance, and knowledge of statistics have guided our residents and Fellows to make these presentations happen. Several manuscripts are in preparation for peer review journals. Dr. Engmann, thank you!

Truly outstanding work!

Oral Presentations

1)      THE EFFECT OF OBESITY ON EUPLOIDY RATES IN WOMEN UNDERGOING IN VITRO FERTILIZATION (IVF) WITH PREIMPLANTATION GENETIC TESTING (PGT) – Stephanie Hallisey, Reeva Makhijani, Jeffrey Thorne, Prachi Godiwala, John Nulsen, Claudio Benadiva, Daniel Grow, Lawrence Engmann

Oral Session Title: IVF Outcome Predictors 2

2)      BLACK RACE RESULTS IN LOWER LIVE BIRTH RATE (LBR) IN FROZEN-THAWED BLASTOCYST TRANSFER CYCLES (FET): AN ANALYSIS OF 7,002 SART FET CYCLES – Reeva B Makhijani, MD, Alicia Y Christy, MD, Prachi N Godiwala, MD, Kim L Thornton, MD, Daniel R Grow, MD and Lawrence Engmann, MD

Oral Session Title: Health Disparities


Poster Presentations

3)      OUTCOMES AFTER ADJUNCT GROWTH HORMONE TREATMENT WITH A LOW, INTERMEDIATE, OR HIGH DOSE PROTOCOL IN IVF CYCLES WITH POOR RESPONDERS – Reeva B Makhijani, MD, Stephanie M Hallisey, MD, Prachi Godiwala, MD, Chantal Bartels, MD, Daniel R Grow, MD, Lawrence Engmann, MD, John Nulsen, MD and Claudio A Benadiva, MD

4)      PREGNANCY OUTCOMES IN LETROZOLE OVULATION INDUCTION FROZEN-THAWED EMBRYO TRANSFER CYCLES AS COMPARED TO NATURAL AND PROGRAMMED CYCLES – Prachi Godiwala MD, Reeva Makhijani MD, Chantal Bartels MD, Alison Bartolucci PhD, Daniel Grow MD, John Nulsen MD, Claudio Benadiva MD, Lawrence Engmann MD


6)      EFFECT OF BODY MASS INDEX (BMI) ON PREGNANCY OUTCOMES IN FROZEN-THAWED BLASTOCYST TRANSFER (FET) CYCLES – Adrienne Schmidt MD, Prachi Godiwala MD, Reeva Makhijani MD, Chantal Bartels MD, John Nulsen MD, Claudio Benadiva MD, Daniel Grow MD, Lawrence Engmann MD

Recent Posts