A note from Dr. Pabon on FCAG’s newly launched Expanded Infertility Evaluation
The most expensive fertility treatment is the one that was never going to work.
That’s not a provocative statement – it’s a clinical reality I’ve watched play out over nearly three decades in reproductive medicine. A couple undergoes three IUI cycles. They fail. They move to IVF. The first transfer fails. Somewhere in cycle two or three, a finding surfaces that was present from the beginning: sperm DNA fragmentation dragging down embryo quality, BCL6 overexpression quietly blocking implantation, a shared recessive gene that changes the entire conversation. The treatment was real. The effort was real. But the diagnostic foundation wasn’t complete.
That’s what we’re fixing with the Expanded Infertility Evaluation we’ve formally launched here at Fertility Center & Applied Genetics of Florida.
What the Evaluation Covers
The program is built around a straightforward premise: infertility is usually multifactorial, and male factors contribute to roughly half of all cases. Yet in many clinics, the male workup still ends at a single basic semen analysis run by a general laboratory. Ours doesn’t.
On the male side, we run in-house semen analysis through our own andrology laboratory, then go further with sperm DNA fragmentation testing – which evaluates DNA integrity that standard semen parameters can’t see, and which affects fertilization, embryo development, and miscarriage risk. We also offer Sperm QT testing, a newer genetic assessment covering roughly 1,200 functional genes tied to the sperm’s ability to find, bind to, and penetrate the egg. Few clinics offer it. It can give couples a concrete explanation for unexplained infertility or repeated IUI failure that no amount of conventional testing would have uncovered.
For the female partner, the evaluation covers ovarian reserve (AMH, Day 2-3 FSH and estradiol, antral follicle count), full tubal and pelvic assessment including HSG and saline infusion sonogram, thyroid function and infectious disease screening, and immunity screening. Where imaging alone can’t answer the clinical question, minimally invasive laparoscopy remains an option.
Two elements of the female evaluation deserve particular attention. The first is BCL6 protein testing of the endometrium – a marker tied to inflammation and endometriosis-related implantation problems that can be present in patients with no classic endometriosis symptoms. The second is screening for Mycoplasma and Ureaplasma, pathogens now recognized as relevant contributors to recurrent miscarriage and unexplained infertility, combined with CD-138 staining of an endometrial biopsy to evaluate for chronic endometrial inflammation. These are not fringe tests. They address real, documented mechanisms of implantation failure that a standard workup misses.
For both partners together, we add expanded genetic carrier screening covering hundreds of inherited recessive conditions. When both partners carry the same condition, that finding opens the door to IVF with PGT-M – preimplantation genetic testing for monogenic disease – rather than discovering a problem after a pregnancy is already affected.
The Logic Behind the Program
We achieved the first preimplantation genetic diagnosis pregnancy in Florida in 1999, with a live birth in 2000. Today, more than 98% of our IVF treatments include genetic testing of embryos as part of a single-embryo-transfer program. The Expanded Infertility Evaluation brings that same genetic-informed discipline into the diagnostic phase itself.
The goal is not to run every test on every patient. Components are chosen and sequenced based on each couple’s history and prior workup. What the program does ensure is that we aren’t starting treatment before we have an honest picture of what we’re treating.
For some couples, the findings point directly to IVF with ICSI as the most efficient first step – skipping a series of IUI cycles that the data suggest won’t work. For others, testing surfaces a correctable problem before embryo transfer rather than after a failed cycle: a treatable structural abnormality, an endometrial inflammation marker that responds to targeted therapy, a bacteriological finding that clears with appropriate treatment.
The outcome either way is a treatment plan built on evidence, not assumption.
Scheduling
The Expanded Infertility Evaluation is available now at our Sarasota and Bonita Springs offices. Out-of-state and international patients, who make up a meaningful share of our caseload, can coordinate portions of the evaluation in advance of an in-person visit.
To schedule a consultation or learn more, visit geneticsandfertility.com/services/expanded-infertility-evaluation or contact either office directly.
Fertility Center & Applied Genetics of Florida
5100 Station Way, Sarasota, FL 34233 | (941) 342-1568
9420 Fountain Medical Court, Suite 100, Bonita Springs, FL 34135 | (239) 333-2229
Serving patients from Sarasota, Lakewood Ranch, Bradenton, Tampa Bay, Fort Myers, Naples, and beyond.
