We can’t say enough great things about Dr. Winslow and the entire staff at FIRM! From day 1 we felt more than just patients; we felt like part of a family. I’ll still love them even at 3am when our triplets (!!!) are keeping us awake!
I would like to give Dr. Erb some praise for helping us bring our bundle of joy into the world. Abbegale will be 7 months old tomorrow! Dr. Erb is considered part of the family.
Blogs about infertility by the experts at F.I.R.M. or Florida Institute for Reproductive Medicine cover female infertility, male infertility, and IVF treatments based in Jacksonville, FL
We’re proud to share that the Florida Institute for Reproductive Medicine (F.I.R.M.) has been recognized by Newsweek and Statista as one of America’s Best Fertility Clinics for 2025.
This prestigious ranking highlights F.I.R.M.’s commitment to excellence in reproductive care, advanced fertility treatments, and unwavering support for families on their fertility journey. Based in Jacksonville, Florida, F.I.R.M. has long been a trusted name in reproductive medicine, helping thousands of patients achieve their dreams of parenthood since its founding in 1993.
Why This Recognition Matters
Newsweek’s list of top fertility clinics is developed in collaboration with research firm Statista and is based on multiple factors, including:
Peer recommendations from reproductive endocrinologists and healthcare professionals
Accreditation data and performance metrics
Patient experience and satisfaction ratings
F.I.R.M.’s inclusion reflects its dedication to innovation, compassionate care, and successful outcomes. From IVF and IUI to egg freezing and male infertility treatment, the clinic provides comprehensive services using the latest medical advancements.
A Trusted Partner in Reproductive Health
With over three decades of experience and a team of nationally recognized specialists, F.I.R.M. has earned a reputation for clinical excellence, ethical care, and personalized treatment plans. The clinic also operates several locations across Florida, making world-class fertility care accessible to more families.
Start Your Journey With Confidence
Being named one of America’s Best Fertility Clinics 2025 is more than an award—it’s a promise to continue serving patients with the highest standards of care.
Patients ask if IVF is safe. I advise them there are two primary risks associated with the procedure – ovarian hyperstimulation syndrome and a multiple pregnancy.
Ovarian hyperstimulation is a condition where the ovaries get too stimulated resulting in leakage of fluid from blood vessels into various body spaces including the abdomen and lungs. Most cases are mild and resolve spontaneously over a period of days. In moderate to more severe cases draining of the fluid from body spaces is required. In rare cases pulmonary emboli and death have occurred. At the Florida Institute for Reproductive Medicine we have not had to tap a patient in the last ten years. We attribute this to our close monitoring of patients and the use of the safest stimulation protocols possible.
A multiple pregnancy is caused almost always by the transfer of more than one embryo. A multiple pregnancy poses numerous risks to mom and babies primarily associated with premature delivery. Risks include blindness, deafness, cerebral palsy. Almost all multiple pregnancies are delivered surgically posing risks of bleeding, infection and anesthesia for mom. The risk of multiple pregnancy have been greatly reduced by the transfer of a single day five or day six embryo. At the Florida Institute for Reproductive Medicine the great majority of our transfers are single day five blast embryos that have been genetically tested providing high pregnancy rates, i.e., comparable to the transfer of two untested blast embryos. There has been criticism of the accuracy of pre-embryo genetic testing, but in the great majority of cases this technology is accurate. Pre-embryo genetic testing, while a significant cost, has proven to be cost effective in the sense that couples are not storing abnormal embryos and coming back for repeated transfers of chromosomally abnormal embryos.
In short, IVF is a safe procedure, if performed with up-to-date optimal protocols.
The Florida Institute for Reproductive Medicine would like to announce the opening of our new state of the art IVF center in the One Call Tower anticipated to open November 1st. This facility will encompass the latest technology to support our IVF program. It will include an outpatient surgery center, andrology lab, endocrine lab and sperm storage. Patients will enjoy views of the St. John’s River.
Given current Florida law, the Florida Institute for Reproductive Medicine (FIRM) does not anticipate the recent overturn of Roe vs. Wade to pose any changes to treatment options regarding your cryopreserved embryos, pre-embryos, eggs or sperm. If in the future treatment rights are in any way affected, FIRM will facilitate the transfer of your reproductive materials to the state and program of your choice.
This June marks the 30th anniversary of the Florida Institute for Reproductive Medicine (FIRM). This time period has been very exciting with some monumental advancements in reproductive medicine technologies. Intracytoplasmic sperm injection (ICSI), whereby a single sperm can be injected into an egg producing a healthy ongoing pregnancy – has largely eliminated male factor infertility. Egg cryopreservation, whereby women faced with potential sterilizing therapies or delayed child bearing can freeze their eggs and have a family at the time of their choosing. Pre-embryo genetic testing, whereby embryos created in the lab can be checked for potentially life-threatening genetic diseases has been a major advance in preventing birth defects and recurrent pregnancy loss. Over the last 30 years the Florida Institute for Reproductive Medicine has been on the forefront of all these technologies. We have grown from a practice of one to a practice of six board certified physicians providing the most comprehensive reproductive medicine to North Florida/South Georgia.
FIRM comprehensive care includes:
In-house surgical sperm extraction – a huge advantage in terms of using non-frozen sperm to fertilize eggs.
Performing in-house pre-embryo genetic testing.
A staff of three PhD embryologists and one masters level embryologist allow us to perform IVF year round, i.e., on the patient’s schedule.
In-house egg, embryo, sperm storage eliminating the need to constantly mail eggs, sperm, embryos to and from a storage facility – expensive and potentially dangerous.
An egg bank as well as embryo bank.
Gestational surrogate IVF.
Physician highly experienced in robotic surgery.
Apart from our technologic expertise what I believe most distinguishes FIRM is our personalized care. When you come to the Florida Institute for Reproductive Medicine you will see a board certified reproductive medicine specialist who will provide essentially all your care. We have a team of 12 RNs averaging over 6 years of experience in reproductive medicine.
This high tech, high touch philosophy of care combined with some of the most competitive pricing in the Southeast has made the Florida Institute for Reproductive Medicine the largest program in North Florida/South Georgia. We continue to strive to stay on the forefront of new reproductive technology advances and to provide the most personal care possible.
June 11th, 2020by
Kari Sproul von Goeben, M.D.Blogs
Regular menstrual cycles each month are the result of regular ovulation. If a female is having irregular cycles, out of the range of every 21-35 days, or not having cycles at all, her ovulation is either irregular or not happening at all. In a normal cycle, at the start of each month, there is a group of eggs that are ready to be chosen from. In women who are ovulating regularly, one egg is chosen from that group and all of the others die off. If one is not chosen from that group because the patient is not ovulating, that group of eggs still dies off.
Ovulation induction is the process by which medications are given in order to help a women ovulate or to regulate her ovulation. This is done so that patients know when to time intercourse in an effort to conceive. In patients with irregular or no ovulation, depending on the cause of the irregularity, we can use lifestyle modifications, medications, either oral pills like clomiphene citrate or letrozole, or injections, called gonadotropins, to stimulate the development of a single follicle and subsequent ovulation of a single egg. We are not depleting a woman’s supply of eggs more rapidly, we are just growing one from that group that would have died off anyway.
Depending upon the particular patient, one of several treatments may be recommended. In women who do not ovulate, oral medications, rather than injection medications, are often recommended as the initial treatment. Some of the advantages of oral medications compared to injections include the ease of oral administration, fewer side effects, lower cost (of the medication itself, as well as the monitoring), lower risk of multiple pregnancies, and a reduced time commitment (related to monitoring during treatment). If the woman has tried oral medications or if oral medications are unlikely to be helpful, the next step is often to try ovulation induction with injection medications. Oral or injection medications may be used along with timed intercourse (TIC), intrauterine insemination (IUI), and/or in vitro fertilization.
When initiating treatment for ovulation induction, in most cases, one will have a baseline ultrasound to assess the ovaries at their “resting” state. If the ovaries look as they should, the patient will take the oral medication or give an injection once per day, for a number of days. The pill is taken by mouth and the injection can typically be given under the skin. After taking the medication for an allotted time period, the patient may be asked to have a pelvic ultrasound to measure follicle growth, and possibly a blood test to measure hormone levels. Depending upon the results of these tests, the dose of the medication may be increased or decreased. Blood testing and pelvic ultrasound may be repeated more times during a cycle. For women who do not ovulate on their own, the goal is to have one follicle that is at least 18 mm in size. If more than one follicle develops, depending on the number, the cycle may be cancelled due to a higher risk of becoming pregnant with twins, triplets, or more. In rare cases, the cycle may be converted to an in vitro fertilization cycle, so that the clinician can ultimately control the number of embryos that are transferred in the uterus.
The side effects of both oral and injection medications are usually minimal. With oral medications, there are side effects of hot flashes and night sweats as well as headaches to name a few. While these side effects are less likely with injection medications, patients can feel more emotional on all of the medications. Because the ovaries grow during treatment, a patient can have abdominal discomfort, and in more severe cases, nausea and vomiting. The most serious risks of oral and injection medication therapy are the development of ovarian hyperstimulation syndrome (OHSS) and conceiving a multiple pregnancy. OHSS is a condition in which the ovaries become enlarged and in severe cases, the woman may develop severe abdominal pain, vomiting, and blood clots. However, severe OHSS occurs in less than 2 percent of women undergoing treatment with injections and less than 1 percent of women undergoing treatment with oral medications.
The take home point is that if your menstrual cycles are irregular or you are not having a menstrual cycle at all, ovulation induction is the process that can help to regulate ovulation! Once ovulation is regulated, one can understand when to time either intercourse or an intrauterine insemination so they have a better chance of conceiving!
Going to the fertility clinic is scary enough even when you understand all the terms. It’s even harder when it feels like you are reading alphabet soup. Here is a list of common abbreviations used in the clinic.
ART—Assisted Reproductive Technology include advanced fertility techniques such as in vitro fertilization where an embryology lab is required to help fertilize an egg
ECS—Expanded Carrier Screening may be offered to couples planning to have a baby. There are many illnesses that have a genetic cause and require genes from both parents. If a person is a carrier of any of these conditions, they won’t be affected but if they conceive with someone who also is a carrier of these genes, there is a ¼ chance their child could have the condition.
FET—Frozen Embryo Transfer is when an embryo grown in the lab is transferred into the woman’s uterus after having been cryogenically preserved (frozen) for some period of time.
HSG—A HysteroSalpingoGram is a procedure where fluid is placed into the uterus and x-ray is taken of the uterus and tubes to see the shape of the uterus and/or to see if the tubes are open
ICSI—Sometimes, advanced techniques are needed to fertilize an egg. IntraCytoplasmic Sperm Injection is where a single sperm is placed directly into an egg to increase fertilization
IUI—IntraUterine Insemination is the process where sperm is concentrated and placed into the woman’s uterus.
IVF—In Vitro Fertilization is the process where eggs are retrieved from a woman’s body and fertilized in the laboratory with a man’s sperm to create an embryo. Embryos are then placed in the woman’s uterus.
OHSS—Ovarian Hyperstimulation Syndrome is a condition that sometimes happens when ovaries have been stimulated to make more than one egg. Sometimes it is serious and requires medical intervention.
PCOS—PolyCystic Ovarian Syndrome is a condition where women don’t ovulate (release eggs) regularly. The ovaries have a particular appearance on ultrasound and some women have higher than normal levels of androgens (masculine hormones). There are other conditions that may cause these symptoms that should be evaluated and ruled out before the diagnosis is made.
PGT—Preimpantation Diagnostic Testing is a laboratory procedure where cells are removed from the developing embryo and tested for genetic conditions
SET—Single Embryo Transfer is when one embryo is placed into a woman’s uterus. eSET is an elective SET and means there was more than one embryo available and the woman chose to have only one embryo transferred. Other embryos may be stored for later.
SIS—Saline Infusion Sonography is a procedure where salt water is placed into the uterus while ultrasound is being performed. This gives a very detailed look at the inside shape and lining of the uterus
TVOR—Transvaginal Oocyte Retrieval is the procedure where eggs are removed from a woman’s ovaries with ultrasound guidance. This is done by a needle attached to an internal (vaginal) ultrasound probe. Women are often sedated for this procedure.
A more contemporary way to perform a cryo (frozen) embryo transfer is the modified natural embryo transfer protocol. The concept behind this is to simply perform a frozen embryo transfer at the proper time point during a natural ovulatory menstrual cycle to allow for embryo implantation and development. During such a treatment cycle, the patient’s natural follicle development is followed by ultrasound and blood work. At the time that it is expected that the woman would ovulate, a trigger shot of hCG is typically given to cause ovulation and promote good corpus luteal function, thereby maintaining proper progesterone levels. The day following the follicular trigger shot, a minimal form of Progesterone administration is typically begun. During the natural cycle no supplemental Estrogen is typically required. The advantage to such a cycle is that there is little need for hormonal support and implantation is ultimately allowed to occur in an environment very closely replicating a natural ovulation. Disadvantages to such a transfer cycle mainly focus on our inability to time the cycle to possibly desired calendar days for transfer, as we are simply following along the natural follicle development. Not all women will be candidates for a modified natural embryo transfer cycle. Those patients would include women with irregular menstrual cycles, history of recurrent pregnancy loss, gestational carrier cycles, and others. Better suited candidates are women who have had prior spontaneous successful pregnancies and now have infertility issues due to tubal factor or severe male factor. If such a frozen embryo transfer cycle interests you, please consider discussing this with your physician at the F.I.R.M.
Most people are assigned a sex at birth (boy vs. girl) based on their external genitalia. For some people, that “boy” or “girl” label may not feel right. For example, someone born and labeled female may feel that they are really a male. Conversely, someone born and labeled male may feel that they are really a female. Transgender is a term used to describe people who may feel this way.
Others may feel that they belong to neither gender or to both genders. Terms used to describe this setting may include “gender fluid,” “gender queer,” “gender neutral,” and “gender nonconforming.”
Members of the transgender or queer community may decide to change how they dress, change their name and change their preferred pronouns. Some may even choose to take hormones or to have surgery so that their bodies more closely match their gender identity. Others do not. There is no “correct” way to be a transgender person.
Do I need permission for a medical transition?
In most places in the United States, you will need permission from your parent or guardian to do a hormonal or surgical transition before you are 18 years old. You also will need to talk with a mental health professional and get a letter of support before starting treatment. This may involve multiple counseling sessions.
How do hormonal treatments work?
Hormonal treatments are usually managed by a pediatric or medical endocrinologist.
One way that hormones can be used for a medical transition is to block or delay puberty. These medications can stop menstrual periods, breast growth, facial hair growth and deepening of the voice. You may need to wait until you have started the early stages of puberty before taking puberty blockers. Most effects of puberty blockers are reversible.
Another way that hormones can be used is to help you look or sound more masculine or feminine. This also may be called gender-affirming hormone therapy. Depending on the treatment, these medications can help you develop desired characteristics, such as: deepening your voice, growing facial hair, developing breasts, changing your body shape. Most of these changes cannot be reversed.
What fertility treatments are available for transgender patients?
Some kinds of hormone treatments may make it harder for you to have a baby in the future. Some kinds of surgery may make it impossible. Talk about this with your doctor before you have treatment. Prior to initiating any hormonal or surgical treatment, it is advisable to meet with a reproductive endocrinologist to review future reproductive treatment options which may include:
Freezing your eggs or sperm
Intrauterine Insemination
In Vitro Fertilization
Freezing Embryo(s)
Using donated eggs or donated sperm to achieve a family
Using the help of a gestational carrier to help you achieve a family
Adoption
If you have questions about your gender identity:
If you have questions about your gender identity it may be helpful to talk with your parents, a teacher, counselor, doctor, or other health care professional. It’s a good idea to ask about what can be kept private before you talk with an adult.
There are websites and hotlines where you can be anonymous if you need information. These websites also can help you educate your parents, family, and friends about the transgender community.
Resources
Centerlink (954) 765-6024 www.lgbtcenters.org Directory of community centers for LGBT people.
Transgender Care Listings www.transcaresite.org Directory of trans-friendly health care professionals.
Trans Youth Equality Foundation www.transyouthequality.org Resources for transgender teens and young adults.
Campus Pride www.campuspride.org Resources for LGBTQ college students.
PFLAG (202) 467-8180 www.pflag.org Network of communities for LGBTQ people, parents, and friends.
Gender Spectrum 510-788-4412 www.genderspectrum.org Organization that supports gender expansive children, teens, and their families.
Hotlines
Trevor Lifeline Toll-free: 866-4-U-TREVOR (866-488-7386) Hours: 7 days a week, 24 hours a day www.thetrevorproject.org Confidential suicide and crisis counseling for LGBTQ teens and young adults. Text and instant messaging options are available on the website.
Trans Lifeline Toll-free: 877-565-8860 Hours: 7 am–1 am PST / 9 am–3 am CST / 10 am–4 am EST www.translifeline.org Peer support hotline that is run by and for trans people.
LGBT National Youth Talkline 800-246-PRIDE (800-246-7743) Hours: Monday–Friday 1 pm–9 pm PST / 4 pm–12 am EST, Saturday 9 am–2 pm PST / 12 pm–5 pm EST [email protected] www.glbthotline.org/youth-talkline.html Peer support and resources for LGBTQ teens and young adults.
More and more babies are being born after using assisted reproductive technologies (ART). This mainly includes babies being born after in vitro fertilization (IVF) when a woman’s eggs are fertilized with a man’s sperm inside a dish in a laboratory. However other techniques that are under the umbrella of ART are procedures like egg donation, surrogacy and egg freezing. At our annual meeting in the fall of 2016, an estimated 5 million children were born after ART technologies in the previous six years! This increase is thought to be due to increasing access in developing countries and increasing insurance coverage in many locations. According to the Centers for Disease Control and Prevention, about 1% of babies born in the United States each year, so about 60,000, are conceived through ART.
Kari Sproul von Goeben, M.D.
friends of F.I.R.M.
Dr. Winslow, What a blessing you are – You have truly been AMAZING! Our journey to achieve a pregnancy has not been easy, but you and your staff have treated us with such kindness and compassion! God has a way of placing special people in your life when you need them the most, and I’m […]
