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Diagnosis & Treatment

Diagnosis: The First Step

The first step in overcoming infertility is correctly diagnosising the cause of your infertility. Is ovulation occurring normally? Are your fallopian tubes open?  Are the sperm normal and functional?  Current statistics show there is a female problem in 40% of the cases, a male problem in 40% of the cases, a combined problem in 20% and in the remainder of the cases, the cause is termed “unexplained” because all tests results are normal.

Treatment options

Though causes of infertility are numerous and complex, both male and female factors can be successfully addressed with many of today’s technologies.  Our desire is to help you conceive as naturally as possible.  Therefore, once your diagnosis is made, we carefully move into the next steps after a thorough discussion of all applicable treatment options.  Treatment options may include ovarian induction to enhance the production of healthy eggs, minimally invasive surgery such as laparoscopy or hysteroscopy to correct or improve anatomical abnormalities, intrauterine insemination (IUI) with sperm washing to enhance sperm function, or more advanced care with assisted reproductive technologies (ARTs) such as IVF.

Ovulation Induction
Ovulation induction is one of the most commonly indicated treatments for many causes of infertility.  Ovulation induction medications or fertility drugs may be used to stimulate your ovaries to produce eggs during the treatment cycle.  Intercourse and /or intrauterine insemination (IUI) may then be scheduled around the time of ovulation to achieve a pregnancy.  To ensure the best chance for successful treatment, precise timing is required.  In most cases, your progress will be evaluated through monitoring including ultrasounds to visualize egg production and to ensure your uterus is ready to receive a fertilized egg and blood work to track your hormonal response to the medication.

Intrauterine Insemination (IUI)
Intrauterine insemination is often used in conjunction with ovulation induction.  Because sperm are placed in closer proximity to the eggs, IUI is an effective treatment for several infertility problems.  Intrauterine insemination bypasses the cervix, making it a useful treatment if there has been a problem with sperm reaching the egg(s).  Sometimes fertility medications such as clomiphene citrate (clomid) can actually change the viscosity of the cervical mucus preventing the sperm from swimming up to the uterus.  IUI is especially useful for the treatment of mild to moderate male factor, especially for those related to poor sperm function such as low count or motility.  To prepare for the IUI procedure, our onsite lab washes  and prepares the sperm so that the most motile and viable sperm are concentrated into a very small volume.  Next, they are loaded into a small catheter and injected into the uterine cavity.  This procedure is  performed in the office using the partner’s sperm or that of a donor.

Minimally Invasive Surgery
Laparoscopy is a surgical procedure performed in an operating room under general anesthesia.  A laparoscope, or telescope, is placed through a small incision (5 mm) in the umbilicus. One or two additional 5 mm incisions may be needed which are placed below the bikini line. Abdominal and pelvic organs can the be inspected and many abnormalities can be corrected or treated, such as endometriosis and ovarian cysts.

This procedure allows the doctor to inspect the inside of the uterus by inserting a hysteroscope ( a small telescope) ) through the vagina and cervix and into the uterus.  This procedure usually takes place in an operating room or in a doctor’s office.  Gas or liquid is placed into the uterus through the hysteroscope to separate the walls and allow inspection.  Fibroids, polyps, scarring, abnormal shape and malignancy may be seen.  Hysteroscopy is usually performed during the first half of your cycle to allow ideal visualization.


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