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Infertility Services – Introduction


This section explains:

  • What an infertility evaluation involves
  • Testing for infertility
  • Treatment options

Conception:


The process of becoming pregnant starts with ovulation, the release of an egg from a woman’s ovary. In an average 28-day menstrual cycle, ovulation occurs about 14 days after the first day of your last period. Once an egg is released, it can be fertilized for about 12-24 hours. Fertilization can occur if you have sex during or near the time you ovulate. When the man ejaculates during intercourse, his semen releases into the vagina. Semen is the fluid that carries the sperm. Sperm travel up through the woman’s cervix, uterus and out into the fallopian tubes. Sperm can live in the tubes for 3 days or more. If a sperm and egg join, fertilization occurs. The fertilized egg then moves through the fallopian tube into the uterus. It attaches there and begins to grow. All these events must take place for pregnancy to occur. If there is a problem in this chain of events, infertility may result.


Causes of Infertility:



Infertility may be caused by more than one factor. Some are easy to find and treat, while others are not. The factor may relate to the woman (40%) or the man (40%). In some cases, no cause can be found in either partner (10%).The couple’s age can be a factor. For healthy, young couples, the odds are about 20% that a woman will conceive in any one menstrual cycle. This figure starts to decline in a woman’s late 20s and early 30s and decreases even more after age 35 years. A man’s fertility also declines with age, but not as early. For this reason, older couples may not want to wait 6-12 months to seek care if they are having problems conceiving. Male factors most often involve problems with the amount or health of the sperm. Abnormal hormone levels may be a cause. Infection or scarring from a sexually transmitted disease (STD) also may be a cause. Female factors also may involve abnormal hormone levels. The ovaries may not produce enough eggs at the right time. Scarring or blockages in the cervix or tubes also may be a cause. Lifestyle factors, such as poor nutrition, anorexia, and obesity can play a part in infertility. Exposure to a drug called diethylstilbestrol (DES) can cause problems. This might be a concern if you were born in the United States before the late 1980s or in another country before the 1980s. Other health problems also can play a role.


Testing:


The decision to begin testing depends on a number of factors. They include your age and your partner’s age, as well as how long you have been trying to get pregnant. You and your partner will receive care as a couple. Testing involves an evaluation as follows: 1. Physical exam of both partners 2. Medical history, 3. Semen analysis, 4. Ovulation check, 5.Tests to check for a normal uterus and open fallopian tubes, 6. Discussion about how often and when you have sex. The basic workup of an infertility evaluation can be finished within 14 days from the start of the menstrual cycle . Please discuss with the Center about the costs involved and find out whether they are covered by your insurance.


Basic Workup for the Man:



A general physical examination and semen analysis is a key part of the basic workup for a man. Semen analysis may need to be done more than once. The semen sample is obtained by masturbation. Sometimes it can be obtained at home but usually it is obtained in our lab. Our staff will give you instructions. Our lab will study the sperm using specific criteria for:

  • Number
  • Shape
  • Movement
  • Signs of infection
  • Morphology

Based on the initial evaluation, further testing may be required in the Center, including genetic and chromosomal testing. It is recommended that the man abstain from ejaculation 3- 5 days before the semen test.


Common Tests for Infertility Evaluation:


There are many tests to see if ovulation occurs. Some are done by the woman, and others are done by the doctor.

  • Urine test. This test can be done by the woman at home with a kit. It is a way to predict ovulation. This test measures luteinizing hormone (LH), which is what makes ovulation occur. If the test result is positive, it means ovulation is about to occur. Sometimes these kits are used in conjunction with basal body temperature charts.
  • Basal body temperature. This test can be done by the woman at home. It is a way to tell that ovulation has occurred. After a woman ovulates, her body temperature increases a bit. To measure it, a woman takes her temperature by mouth every morning before she gets out of bed (basal temperature). She records it on a chart for two or three menstrual cycles.
  • Cycle day 3 hormone profile. This test helps to evaluate the different hormones involved in oocyte production and ovulation and also useful in evaluating ovarian reserve. They commonly include, FSH, LH, Estradiol, AMH, and Prolactin. Please go to the nearest lab (ie. LabCorp, Quest etc. ) on day 3 of your cycle to get the blood drawn in the morning. Please bring the blood request form with you. If the lab is not open you may draw the blood at the nearest hospital lab. If you are suspected to have PCOS you may be advised to do more blood tests after overnight fasting.

Other tests may be done, depending on a woman’s risk factors and symptoms.


Procedures:


Procedures are used to look at a woman’s reproductive organs. They check if the uterus is normal and the fallopian tubes are open. The tests you have depend on your factors and symptoms.




  • Trans-vaginal ultrasound/Sono-hysterogram. This test checks the ovaries and uterus by using sound waves to produce pictures of pelvic organs. First, a device (a transducer) shaped like a wand is lubricated and inserted into the vagina. A machine displays an image of the organs. In sono-hysterogram, a fine catheter is introduced into the uterus and the uterine cavity is instilled with saline solution, followed by ultrasound scan. This helps to visualize the cavity of the uterus. This test is commonly done on any day between day 2 and day 7 of your menstrual cycle. Since the Center does not know when you start your period, it is the patient’s responsibility to call and schedule these appointments. Please call the Center to make an appointment or click here and schedule appointment through the secure patient portal.



  • Hysteroscopy. This procedure lets the doctor look inside the uterus. A thin telescope-like device, called a hysteroscope, is placed through the cervix. The uterus may be filled with liquid to reveal more information. During this procedure, the doctor can correct minor problems or get a sample of tissue to study. The doctor also may decide other procedures are needed. This test is commonly done on any day between day 7 and day 14 of your menstrual cycle. Since the Center does not know when you start your period, it is the patient’s responsibility to call and schedule this appointment. Have your pharmacy information available so we may order pre-medication for this procedure at the time of your call.



  • Hysterosalpingography (HSG). This test is an X- ray that shows the inside of the uterus and fallopian tubes. In most cases, it is done right after a menstrual period. A small amount of dye is placed in the uterus through a thin tube inserted through the cervix. An X-ray is then taken. The dye outlines the inside of the uterus and fallopian tubes. If it spills from the tubes, it shows that the tubes are open. This test is commonly done on any day between day 10 and day 14 of your menstrual cycle. Please call the Center to schedule this appointment.
  • Laparoscopy. This procedure lets the doctor view the tubes, ovaries, and the outside of the uterus. It is usually performed in the hospital under anesthesia. A small telescope-like device, called a laparoscope, is inserted through a small cut (about 1 inch or less) at the lower edge of the navel. Fluid is placed in the uterus to see if it spills from the ends of the tubes. This shows if the tubes are open or blocked. The doctor also can look for pelvic problems, such as endometriosis or scar tissue.

You may be given pain medications for some of these procedures.


Post Testing Consultation:


After your basic testing as detailed above is completed, you and your partner will have a post testing consultation with the staff and the doctor. At this appointment, the results of all the tests performed are discussed in detail and a treatment plan is adopted. This may include just waiting for natural pregnancy, ovulation induction with clomid and or injectable medications, intrauterine insemination (IUI) or in-vitro fertilization (IVF). Men with very low sperm count may opt for ICSI procedure with IVF. Once a treatment plan is finalized a protocol is written up with dates and time of all appointments, when to take the medications, etc.


Treatment:


Infertility can be treated in many ways, including lifestyle changes, medication, surgery, and assisted reproductive technologies. After your initial evaluation at the Center, we will discuss with you the appropriate treatment options based on your medical condition, age, personal desires, religious beliefs and financial situation. The common Assisted Reproductive Technologies are:

  • Intrauterine insemination (IUI)
  • In-vitro fertilization and Embryo transfer (IVF-ET)
  • Intra cytoplasmic sperm injection (ICSI)
  • Microsurgical sperm extraction from the testes or epidydimis (MESA/TESA) and ICSI
  • Donor Oocyte program
  • Donor Embryo program
  • Gestational surrogacy program
The choice depends on the cause. After your evaluation, please discuss with the staff at the Center about the best treatment options for you and your partner. You also may choose adoption, foster parenting or other alternatives. Supporting you in whichever decision you make is our priority.

At The Center for Reproductive Medicine and Robotic Surgery(CRMRS) we provide private, professional and compassionate fertility care. Dr. Jacob and our reproductive team provide a very personalized approach, from diagnostic assessment and early intervention through high-tech procedures like In Vitro Fertilization (IVF), and Intracytoplasmic Sperm Insertion (ICSI), intrauterine insemination (IUI) and Pre-Implantation Genetic Testing – Aneuploidy (PGT-A).

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