Discover the legacy and commitment behind Michigan Fertility Services, a beacon of hope for individuals and couples on their fertility journey. Our state-of-the-art clinic offers a wide array of advanced treatments and specialized care.
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Revolutionizing Reproductive Health Care
Experience the most advanced fertility treatments at Michigan Fertility Services.
Transforming Lives Together
Transforming Lives Together
Our Specialties
Couples With Fertility Issues
Couples should be aware that the cause of subfertility is distributed equally between both sexes. Subfertility (infertility) is diagnosed in females and males in equal proportion in 35% of couples, and as a combined problem in 20%, while in the remaining 10%, the cause is unknown after baseline investigations are completed and is termed unexplained.
Couples With Recurrent Pregnancy Losses
Recurrent pregnancy loss (RPL) affects 1-2% of all fertile couples. It is defined as two or more consecutive pregnancy losses in which an appropriately rising quantitative hCG level was documented, pelvic ultrasound had demonstrated intrauterine pregnancy that ultimately fails, or histopathological examination of the product of conception confirmed pregnancy tissue. The American College of Obstetricians and Gynecologists (ACOG) guideline recommends that after two miscarriages, a thorough physical exam and testing should be performed.
Couples Carrying Genetically Inheritable Disorders
Most, if not all, of us carry or inherit abnormal genes. At MFS, we recommend that all our female patients have genetic screening that includes testing the male partner to exclude the inheritance of mutations that their spouse has inherited.
Please visit our For Couples Page under Populations We Serve for more information.
Single Women
At Michigan Fertility Services, we strongly support single women who desire to raise a child, understanding and respecting the diverse paths and circumstances that lead to this important decision.
Women of Advanced Age
While the chances of getting pregnant begin to decrease around age 35, Michigan Fertility Services understands that the desire to build a family can arise at any stage of life and we are dedicated to providing comprehensive support and exploring all available options for women considering pregnancy later in life. Dr. Awonuga offers thorough evaluations and personalized treatment plans, including advanced techniques and donor options when appropriate, to help you navigate your fertility journey with expert care and compassionate guidance.
Egg Freezing
Advances in medical technology now allow women to preserve their eggs while they are still of good quality. Michigan Fertility Services offers Personal Egg Freezing, which increases the chances of a woman having a genetically related, healthy child at an older age through egg freezing.
Please visit our For Women Page under Populations We Serve for more information.
Men With Fertility Problems
At MFS, when sperm concentrations are low or men are showing abnormal sexual functions/findings suggestive of endocrinopathy, we perform evaluations looking into any hormonal (endocrine) causes of male infertility. Evaluation includes physical examination, scrotal and prostate ultrasound, and endocrine and genetic testing to discover the cause of the problem. An appropriate individualized treatment plan is then recommended.
Please visit our For Men Page under Populations We Serve for more information.
Gynecologic Contributors to Infertility
At MFS, we specialize in fertility treatment arising from a range of causes. These can include uterine fibroids, polycystic ovary syndrome, adenomyosis, endometriosis, or other pelvic issues.
Please visit our Gynecologic Diagnoses Page under Populations We Serve for more information.
Those Diagnosed With Cancer Looking to Preserve Their Fertility
Due to advances in cancer therapy, many women and men are successfully treated and survive cancer, hence live normal and productive lives thereafter. For some, returning to a “normal” life includes having children. We offer several treatment options for both men and women looking to preserve their fertility before beginning cancer treatment or those looking to build a family following treatment.
Please visit our Cancer and Oncofertility Page under Populations We Serve for more information.
We Are Different
Services We Offer
Saline Infusion Sonohysterography (SIS)
The Saline Infusion Sonohysterogram is a pelvic ultrasound procedure of the uterus and fallopian tubes to determine if there are any abnormalities. This procedure does not require the use of an anesthetic and is excellent for looking at ... the uterine cavity (inside the womb). Within the uterus (womb), abnormalities such as polyps, fibroids, adhesions, or congenital anomalies may be detected. It can also be used to determine whether the uterine tubes are open.
The test differs from a hysterosalpingogram (HSG) since it is not an X-ray test. SIS test is less effective at determining whether the fallopian tubes are open than HSG. However, unlike HSG, SIS is more effective in determining intrauterine abnormalities like polyps, intracavitary fibroids, and adhesions. Ultrasound detects Large, swollen tubes with or without saline infusion. Lastly, unlike HSG, the SIS procedure can be performed on a patient allergic to iodine or seafood and does not require an iodine-based dilution infusion fluid.
Automated Sperm Analysis
Automated sperm analysis is a process that uses modern technology to analyze sperm samples. It provides results on key parameters such as sperm concentration, motility, and morphology. Referred to as Computer-Assisted Semen ... Analysis (CASA), it offers several advantages over manual analysis. It provides a standardized, objective, and rapid method for evaluating semen quality, potentially reducing human error and improving accuracy compared to traditional manual methods.
Sperm extraction in men who do not have sperm in their ejaculate (Men with azoospermia)
Some men do not have sperm in their ejaculate (termed azoospermia) because of obstruction in the tubes that transport sperm to the urethral opening, while some have reduced sperm or no sperm production from the testicles ...
Some men do produce sperm, but instead of the sperm reaching the penis, it is retrograde into the bladder. This may be due to retrograde ejaculation that can be treated by using medications to help close the bladder neck or by retrieving the urine, processing it, and using it for artificial insemination or other assisted reproductive techniques. Once retrograde ejaculation is excluded, others will need sperm to be retrieved from the epididymis (convoluted tubes behind the testis in men carry sperm from the testis when produced) or the testis. Sperm retrieval techniques are named depending on the method used and the source of the sperm. Examples are:
- Epididymal sperm aspiration (ESA): Involves aspiration of sperm with a fine needle from the epididymis. This can be done by inserting a fine needle through the skin under local anesthesia in a process called percutaneous epididymal sperm aspiration (PESA), or an operating microscope is used to locate and aspirate sperm from the epididymal tubes in a process called microsurgical epididymal sperm aspiration (MESA)
- Testicular Sperm Aspiration (TESA). In TESA, sperm is retrieved directly from the testicles using a fine needle, unlike its counterpart, TESE, which involves biopsy of the testicular tissue.
- MicroTESE involves making small testicular incisions and using a microscope to locate and extract sperm-producing tissue. More sperm is retrieved in the TESE procedures
It should be noted that sperm retrieved by TESA and MESA can only be used in assisted reproductive technologies like IVF, often combined with intracytoplasmic sperm injection (ICSI)
Ovulation Induction and Timed Intercourse
This is the minimum treatment we offer apart from general counseling. Women usually ovulate one egg every month. A subfertile woman is already ovulating; ovulation induction, which makes them ovulate more than one egg, may be ... helpful, provided at least one of their uterine tubes is open and there is no significant sperm abnormality. The chances of getting pregnant from OI and TI are abysmal because women do not usually need to ovulate two eggs to conceive. Women should know that when only one uterine tube is open, an open tube is not necessarily normal because what blocked the other tube probably affected the open tube as well, but it may not be as severe. If the woman is not ovulating normally, OI brings her to normal; therefore, combining this with TI is associated with a reasonable pregnancy rate.
Intrauterine Insemination (IUI)
Intrauterine Insemination is one step up from Ol and TI and therefore associated with a better pregnancy rate. Although it can be performed without Ol, it is often combined with Ol. In IUI, the partner's sperm is processed and ... concentrated, and at an appropriate time during the cycle, is placed inside a woman’s uterus. The success rates from OI and IUI are based on increasing the concentration of sperm that can reach the egg. Ovulation induction in IUI is done using oral medication (Clomid and Letrozole) or injections (gonadotropins). The use of OI increases the chances of getting pregnant with multiples (twins and rarely triplets). At MFS, we try to avoid women getting pregnant with multiple pregnancies because multiple pregnancies are associated with many complications, the least of which are an increased risk of miscarriage and fetal malformation.
In Vitro Fertilization (IVF)
In Vitro Fertilization is the most successful of all assisted reproductive technology (ART) treatments and is the most expensive for infertile couples. The process involves the collection of eggs from the ovaries in an unstimulated or ... stimulated treatment cycle, followed by fertilization with sperm in a laboratory, and the resulting embryo(s) transferred back into the woman’s uterus. First pioneered by Drs Edward and Steptoe in the 70s, bypassing the inability of the sperm and the egg to meet and fertilize in their natural habitat, the fallopian tube, because of blockage from tubal disease. Over the years, there has been tremendous modification to the extent that live birth rates of up to 50% per cycle are now being achieved in young women. A few of these modifications include the ability to biopsy the embryo to ensure normal (euploid) embryos are selected for transfer. At the same time, those who are abnormal or have heritable diseases are excluded. The remaining euploid embryos are frozen and later thawed for use in subsequent treatment cycles. Although some infertile couples elect a stepwise treatment option that involves ovulation induction and timed intercourse, then intrauterine insemination, some take advantage of IVF success rates and go straight to IVF.
Natural (Drug Free) Cycle IVF
Natural cycle IVF, or drug-free IVF, occurs in a woman's natural menstrual cycle without the use of fertility drugs to stimulate the ovaries. Most women release one egg per month when they ovulate, but occasionally two and rarely ... three eggs, as happens when women spontaneously get pregnant with twins and triplets. In most cases, only one or two eggs are naturally produced each month. Therefore, only one or two eggs are collected for IVF in a natural cycle, in contrast to conventional IVF, where hormonal injections are used to produce an average of 8 – 12 eggs. Natural cycle IVF has several advantages and is suitable for some, but not all, patients, and is also associated with certain disadvantages. Please see our Educational Resources page for more information.
INVOcell
Although IVF is the most successful of all ART procedures, it is associated with costs beyond the reach of most infertile couples. Aside from this, there are also religious and cultural objections to the use of IVF to overcome infertility ... INVOcell is an intravaginal culture (IVC) system approved by the FDA. It allows for fertilization and early embryo development in the device using the warmth of the vagina rather than in a laboratory. The embryo(s) are retrieved and transferred into the woman's uterus at the appropriate time. Pregnancy rates using the INVOcell device have been reported to be the same as traditional IVF.
Zymot
Men, like women, have a high proportion of abnormal sperm characterized by abnormalities in their head, neck, and tail. Men with equal to or greater than 4% of their sperm that are normally looking are regarded as having normal ... morphology. Although sperm are processed and selected for IVF, the use of Zymot, a sperm separation device, allows motile sperm to swim through a membrane, isolating the healthiest sperm with negligible DNA fragmentation. The Zymot device has been used in assisted reproductive technology (ART) procedures like IUI, IVF, and ICSI. Studies have suggested better quality embryos when using this device.
Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection (ICSI) is one of the early advances that was introduced to combat the inability of sperm to penetrate and fertilize the egg when put together in a petri dish in the laboratory. This phenomenon occurs ... commonly in men with low sperm count, low motile sperm count, and high percentage of abnormal sperm. The ICSI procedure involves the injection of a single sperm into the egg to effect fertilization. The technique is so effective that sperm retrieved from the testis in men who do not have sperm in their ejaculate (men with azoospermia) can be used to effect fertilization and allow such men to have babies of their own genetic makeup.
Assisted Hatching (HA)
Another innovation in the IVF process is AH, which improves the embryo implantation rate. It is well known that an embryo must hatch out of its shell, called the zona pellucida, to implant into the uterine lining, called the ... endometrium. There is evidence to suggest that one of the reasons why an embryo may not implant is that the zona pellucida is too thick, a phenomenon that is associated with advanced age or high follicle-stimulating hormone. This technique has also been applied to women with a history of failed IVF cycles or those with poor-quality embryos.
Sperm DNA Fragmentation Testing
The chromosomes that make up the sperm can look normal, while the DNA within them can be damaged or broken into small pieces, which is labeled sperm DNA fragmentation. This phenomenon may not be revealed through ... standard semen analysis, yet it can be a significant factor in male infertility. It can affect the sperm's ability to fertilize an egg and impact embryo development and pregnancy outcomes. At MFS, in cases of a varicocele, fertilization failure, poor embryo development after IVF, or recurrent pregnancy loss, we recommend that men undergo sperm DNA fragmentation testing to assess the level of damage or fragmentation in the DNA of sperm cells. The test involves analyzing a semen sample to determine the DNA fragmentation index (the percentage of sperm with fragmented DNA), which may inform a recommendation for the type of treatment to offer couples.
Preimplantation Genetic Testing for Aneuploidies (PGT-A)
Advances in genetics and the ability to test a few cells for genetic abnormalities ushered in the possibility of applying this technology to IVF. In PGT-A, cells are taken from the trophectoderm (the shell that houses the embryo) and tested ... genetically to identify those with an abnormal number of chromosomes (aneuploid), thereby identifying and eliminating aneuploid embryos. The aim is to improve IVF success rates and reduce the risk of chromosomal abnormalities in the resulting child. Attempts to avoid biopsy of the trophectoderm with a minimally invasive procedure that involves aspirating the fluid inside the blastocyst (blastocentesis) with the hope that it contained cells from the embryo itself rather than from the shell (trophectoderm) has to date not shown to have an advantage over the traditional trophectoderm biopsy in determining whether the embryo is euploid (has normal chromosomes) or aneuploid.
Preimplantation Genetic Testing for Monogenic Disorders (PGT-M) and Structural Chromosomal Rearrangement (PGT-SR)
Further advances in genetics, with the introduction of platforms like the so-called next-generation sequencing (NGS), allow for the rapid and parallel sequencing of multiple DNA fragments. This has permitted cells obtained from ... trophectoderm biopsy or those retrieved from blastocentesis to be tested by detailed DNA analysis for monogenic disorders such as Huntington's disease, sickle cell anemia and muscular dystrophy or structural rearrangements [like inversions as in hemophilia A and Hunter syndrome or translocations as in trisomy 18 Edward syndrome, trisomy 13, Patau syndrome]; 45, X (Turner syndrome); 47, XXY (Klinefelter syndrome)] to name a few.
Gestational Carrier/Surrogacy
Some infertile women are unable to carry their pregnancy themselves for various reasons. Such a couple should not be denied the opportunity to have a baby of their genetic makeup. They can use a gestational carrier (also termed a ... surrogate mother) to achieve their objective. A gestational carrier is a healthy woman who has implanted in her uterus embryos which were fertilized outside of her body using the egg and sperm of the intended parents or a donor(s) selected by the intended parents. Indications for use of a gestational carrier include that the intended mother has a medical condition that would put her at serious risk in pregnancy, or she has a uterine abnormality caused by being born with an abnormal uterine formation or absence of the uterus. Intended parents should know that the processes involved in having a baby through the use of a gestational carrier are very complex. It involves screening of the carrier, drawing up a legal contract, being responsible for funds required for the screening, all medications and care if pregnancy ensues after embryo transfer into the gestation carrier’s uterus, and thereafter. Lastly, it should be noted that as of the time of writing, Michigan law states that all surrogacy/gestational carrier contracts are unenforceable.
Onco-Fertility
The discipline of Onco-fertility started in 2007 and has brought together basic scientists, medical researchers, oncologists, and fertility specialists, who now provide real options to people faced with the diagnosis of and treatment ... of cancer. This has revolutionized family planning in women and men with the diagnosis of cancer because it enables them to freeze their eggs or sperm before undergoing chemotherapy or radiation, or surgical treatment that can damage the ovaries and cause infertility. This is particularly important in women as it allows women to preserve their eggs while they are still of good quality, because cancer treatment with chemotherapy may compromise their egg quality or reduce the number of resident eggs that may predispose them to premature menopause.
Fertility Preservation
Advances in medical technology now allow women to preserve their eggs while they are still of good quality at a young age, when they are not in a position to start a family. For women, it is well known that fertility irreversibly ... declines with age, and the proportion of poor-quality eggs relative to good-quality eggs increases as women age. Personal Egg Freezing allows a woman to have some of her eggs retrieved and frozen until she is ready to use them. For example, a woman could freeze her eggs in her early twenties and thirties, then go on to use those eggs to achieve pregnancy in her late thirties or forties, when a high proportion of aneuploid (poor quality) eggs in her ovaries would make natural conception difficult. If such a woman froze her eggs in her late twenties to early thirties, she would then have a cohort of eggs with a high proportion of euploid (normal eggs), with a higher chance of conceiving when used for treatment later. However, women should know that we cannot always guarantee that a frozen egg will lead to a future pregnancy and live birth.