The first step in treating infertility is to determine the cause.
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Whether a woman has never been able to become pregnant or has experienced miscarriages, our goal is to accurately assess each unique situation and then recommend appropriate treatment.
Your pregnancy success starts with an accurate diagnosis. At your initial consultation visit to FSAC, we will discuss your complete family and medical history, evaluate any medical records you may have brought with you (including any x-ray or ultrasound films from previous testing), and perform a thorough physical examination with ultrasound.
Some of our diagnostic procedures include:
[tab title=”Fertility Tests”]Depending on the findings and diagnosis, fertility testing may be recommended and some of these procedures include:
Female endocrine/hormone studies are performed to monitor the activity of the ovaries, pituitary, thyroid and adrenal glands by measuring hormone levels in the blood.
Hysterosalpingogram (HSG) is an x-ray of the reproductive system including the uterus, fallopian tubes, and surrounding anatomy. This test is useful in detecting blocked tubes and scarring which are common causes of infertility, both of which can usually be treated surgically.
Ultrasound is done transvaginal to evaluate the condition of the uterus, ovaries and surrounding structures.
Semen analysis involves the determination of sperm concentration, percent motility, and percent normality based on the strict assessment of size and shape of the sperm. In cases of severe low sperm numbers, an ICSI prep test is used to determine if any motile normal sperm are present in an ejaculate. This procedure may offset the need for a testicular biopsy.
Vaginal/cervical cultures are performed to indicate the presence of virus or bacteria that may be hindering conception.
Laparoscopy, a minimally invasive procedure, allows the doctor to visualize the reproductive system by inserting a scope through a small abdominal incision. This allows the doctor to see and treat possible causes of infertility.
Hysteroscopy uses a thin scope that is inserted through the cervix into the uterus to locate potential uterine abnormalities that may be affecting fertility.
Endometrial biopsy is a procedure where a small sample from the lining of the uterus is taken during an in-office procedure and then submitted to a reference laboratory for examination. Some minor abnormalities in the uterus lining can cause infertility and are treatable when detected.
LH surge testing may be performed mid-cycle. When an LH surge occurs, the ovary is instructed to release a mature egg. Patients monitor their urine at home to determine when an LH surge is occurring. This information is useful for timing intrauterine inseminations, timed intercourse or frozen embryo transfers.
Cervical mucus/post-coital testing to determine whether the cervical environment is optimum for sperm transport.
[tab title=”Infertility Treatments”]Embarking on fertility treatment can be daunting, but at FSAC, our complete, compassionate, and state-of-the-art treatment yields some of the best success rates available. Each of our patients receives highly individualized care, based on a thorough, in-depth medical evaluation that provides a roadmap to the optimal treatment methods. Below are descriptions of many of the methods we use to treat female infertility.
Intrauterine insemination (IUI) refers to the placement of sperm directly into the uterus via a small tube near the time of natural ovulation. IUI is often used when a low sperm count presents, when sperm have difficulty moving toward the egg, known as “low motility,” or when a man has erectile dysfunction or another medical condition that makes intercourse difficult. IUI also may be helpful if a woman’s cervical mucus makes it difficult for sperm to reach the egg.
At FSAC, many of our patients conceive using this combination of ovulation induction—a method used to encourage the ovaries to release eggs–and insemination. Our doctors inject sperm directly at the point where the fallopian tubes meet the uterus—which encourages contact between the sperm and egg. Patients save the time and expense of more complex treatments, with no greater side effects.
In Vitro Fertilization and Embryo Transfer (IVF-ET)
The doctors, nurses, and technicians of FSAC have extensive training and success with in vitro fertilization and embryo transfer. Their research and patient care have led to advances in making this technology successful for men and women throughout the world. With this method, eggs are removed from the woman’s ovaries, fertilized in a lab setting, and replaced directly into the uterus several days later. IVF-ET can be used even when a woman’s fallopian tubes do not function well—a common cause of infertility. It is also commonly used for patients with endometriosis, polycystic ovarian syndrome, and male infertility.
Gamete Intrafallopian Transfer (GIFT) and Zygote Intrafallopian Transfer (ZIFT)
Less common than IVF, GIFT and ZIFT are the best options for certain patients. In both cases, a woman first receives medication to stimulate her ovaries to increase egg production. Using the GIFT method, doctors place both eggs and sperm into the fallopian tube through small incisions in the abdomen (laparoscopy). Fertilization occurs naturally in the body. With the ZIFT technique, eggs are fertilized in the lab, thentransferred into the fallopian tubes instead of the uterus. ZIFT may be recommended in situations where it is not advisable for the eggs to be placed through the cervix. Patients undergo GIFT or ZIFT while under anesthesia but can return home the same day.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a type of in vitro fertilization in which a single sperm is injected into a single egg in a laboratory. This procedure is usually done when the man presents infertility problems or when efforts by a couple to become pregnant using standard IVF have not succeeded. As in IVF, once the egg is fertilized, the embryos are grown in a lab and then transferred directly into the woman’s uterus.
Alternate Types of Embryo Transfer Used with IVF
Selective Embryo Transfer
After embryos are fertilized in the lab, FSAC doctors may use this procedure to select those that are most likely to survive. Embryos are returned to the uterus on the third, fourth, or fifth day after removal, depending on when doctors are able to select the strongest candidates.
Serial Embryo Transfer
In this technique, 2 to 4 embryos are returned to the uterus on the third day after egg removal, and then one or more additional eggs are returned on the fifth day.
Blastocyst transfer gives embryos more time to grow before being placed in the uterus, allowing the doctors better opportunities to evaluate and choose those most likely to result in a successful pregnancy. This technique can improve the odds of pregnancy while reducing the chances of multiple births).
On around the fifth day after an embryo is fertilized, it normally bursts out of its protective coating—a process called “hatching.” With assisted hatching, doctors make a small opening in the protective coating to help this process along, before returning the embryos to the patient’s uterus.
Some embryos need help developing correctly in the lab. These embryos can grow together with a layer of support cells from the patient’s own body that generate an environment similar to that of a fallopian tube. This procedure, which strengthens the embryos, is beneficial for patients who have had unsuccessful IVF, older patients, and those whose embryos are not of ideal quality.
Laparoscopy: When doctors don’t know the cause of infertility, they may use laparoscopy—a procedure in which doctors make small incisions in the abdomen to photograph the reproductive system using a tiny camera—and often to correct the problemwithout delay . Blocked fallopian tubes and endometriosis—a condition in which uterine cells grow outside of the uterus—are two common conditions that can be treated this way.
The following are methods used to diagnose and treat conditions that can cause infertility:
• Hysteroscopy: A lighted device is used to see, and fix, abnormalities inside the uterus. Those include growths such as fibroids or polyps which can cause infertility.
• Tubal Anastomosis: This procedure to repair or remove a damaged section of the fallopian tube is used to improve the egg’s ability to travel from the ovary to the uterus. It is sometimes used to reverse a tubal ligation . A non-surgical alternative is Tubal Cannulation to help unblock fallopian tubes located close to the uterus.
• Pelvic Reconstructive Surgery: When a woman’s reproductive system has abnormalities that cannot be corrected using a one of the less invasive methods, pelvic surgery may be required.
Sonohysterography: Sometimes called “fluid ultrasound,” this procedure allows doctors to study and photograph the inside of a woman’s uterus.
Cryopreservation: FSAC offers patients the option to freeze embryos and preserve them for future use. Sperm also may be frozen and stored for future use—sometimes called “sperm banking.” This service is particularly important for men who must undergo chemotherapy or radiation therapy but would like to be able to have children.[/tab]
[tab title=”Medications”]After our doctors identify the cause of a woman’s infertility, medication is often the first step in treating it. Fertility drugs stimulate or copy the natural action of the brain, encouraging the ovaries to release eggs, helping the eggs to mature, and addressing other issues to improve the chances of a successful pregnancy.
At FSAC, doctors prescribe medications individually for each patient depending on her specific needs. Here is a list of some of the medications that we frequently prescribe. New medications are being researched all the time, all over the world, and our doctors evaluate each new drug as it becomes available and is found to be safe and effective.
Medications That Suppress Ovulation
Gonadotropin-releasing hormone, or GnRH, antagonist (Antagon, Cetratide): This hormone is prescribed to women whose bodies are preparing for in vitro fertilization (IVF) to keep them from ovulating too early in the process. These medicines have the opposite effect from hormones normally produced in the brain that cause a woman to ovulate.
Leuprolide (Lupron, Eligard): This medication can be used at varying points in the IVF cycle to control the timing of egg production.
Medications That Stimulate Egg Production or Growth
Clomiphene citrate (Clomid, Serophene): Similar to the body’s natural estrogen, clomiphene is often the first drug used for women who need help to ovulate.
Human menopausal gonadotropin or hMG (Pergonal, Metrodin, Repronex): This medication, given through a shot, stimulates the development of ovarian follicles—the sacs that contain a woman’s eggs. It is given to women who do not ovulate at all or who need to produce multiple eggs in order to become pregnant.
Follicle stimulating hormone or FSH (Fertinex, Gonal F, Follistim, Bravelle): This hormone, given through a shot, encourages ovarian follicles—and the eggs within them—to grow. FSH copies a hormone normally released by the brain to stimulate the growth and maturation of eggs.
Human chorionic gonadotropin or hCG (Profasi, Novarel): This medication is given to encourage the final state of egg maturation before eggs are retrieved for IVF.
Drugs That May Improve the Success of Fertility Treatment
Doxycycline (Adoxa, Doryx): An antibiotic, doxycycline is used during some fertility treatments to reduce the risk of infection.
Estradiol topical patches (Vivelle, Alora): These patches contain an estrogen hormone that helps prepare the uterus to receive fertilized embryos. They are often used by surrogate mothers, whose bodies have not produced the eggs that they will be receiving.
Methylprednisolone (Medrol): This medication increases the chance that an egg will be implanted successfully in the uterus during IVF. It works by changing a woman’s immune system slightly, for a short period of time, so that her body does not reject the embryos as foreign objects.
Progesterone (Prometrium): This medication helps to prepare and maintain the inner lining of the uterus to allow an embryo to become implanted.[/tab]