Fertility Treatments - Step by Step
Almost 60% of couples are able to conceive with these types of Fertility treatments suggesting that the majority of couples are able to conceive with basic fertility treatment interventions.
The majority of couples who receive an infertility diagnosis will have one or more factors identified. The rest will be diagnosed with unexplained infertility. The sooner fertility treatments are given, the better the chance of success. This gives more opportunity for success.
The likelihood of achieving a pregnancy depends upon the specific reasons for infertility. Certain diagnoses respond to fertility treatments better than others. Individualized fertility treatments are developed using a team approach between you and your physician. Infertility options vary from one couple to the next. It is our desire to help you add to or start a family. We realize the physical, emotional, and financial impact of going through infertility treatment.
Fertility Treatments may include: procedures, fertility drugs, IUI (insemination), IVF, or donor egg.
The Reproductive Medicine Group offers a wide range of fertility treatments. Our clinic provides from minor and minimally invasive, like medication and IUI to state of the art scientific techniques which are considered advanced, like IVF.
First, from all the testing performed, our doctors will determine if an outpatient procedure is necessary to improve the chances of pregnancy. Then, your doctor will develop an individual care plan, which is a fertility treatment plan. This plan will be based on your unique infertility factors which affect you as a couple. This is specific to what your exact needs are, in order to achieve pregnancy.
Basic fertility treatments include interventions aimed at correcting the identified cause for infertility as well as treatments to enhance fertility in couples with unexplained infertility. Think of this as a step by step approach to treating infertility.
Basic fertility treatments, like fertility drugs and IUI (insemination) are the foundation of fertility treatments.
IUI in combination with fertility drugs (both oral and injectable), ultrasound monitoring and HCG injection to trigger ovulation increases the chances of the egg and sperm interacting improving pregnancy rates significantly for many infertile couples. These types of fertility treatments allow the sperm and egg to unite naturally within the woman’s body.
These fertility procedures do not allow us to confirm if the egg is actually fertilized by the sperm, if the cells divide to form an embryo, if the embryo enters the uterus or if the embryo implants into the uterus. However, almost 60% of couples are able to conceive with these types of treatments suggesting that the majority of couples are able to conceive with basic infertility options.
Of the remaining 40% of couples who do not conceive with basic treatments or in whom basic fertility treatments would not be appropriate, the vast majority are able to become parents through in vitro fertilization either using their own eggs and their husband’s sperm if egg health is acceptable and viable sperm are produced within the testes or with donor egg IVF if ovarian function or egg quality is poor.
Advanced fertility treatments (ART) involve the use of injectable fertility medicine to increase the number of eggs produced, removing the eggs directly from the ovaries under sedation and uniting the eggs and sperm in a petri dish outside of the body. Fertilization and cell division are confirmed before the embryos are replaced directly into the uterus. Pregnancy rates correlate to the woman’s age and embryo grade.
The Reproductive Medicine Group doesn’t “correct” male infertility. We can, however, use fertility treatments to overcome male fertility issues. With these treatments available, male infertility can virtually disappear.
Procedures to Improve Fertility
Laparoscopy is a same day surgical procedure allowing visualization of the pelvic organs. It is performed under general anesthesia, most frequently at the end of the infertility evaluation. In most cases, it is done as an outpatient procedure – either in our surgery center or a hospital. Two small incisions, less than the size of your thumbnail, are made in your abdomen, one in your belly button area and one above the pubic hairline. Through these incisions, instruments are inserted which enable your physician to observe the pelvic organs.
During a laparoscopy, your physician is able to determine if your fallopian tubes are open and detect abnormalities on the surface of the uterus, and pelvis such as adhesions or endometriosis. Laparoscopy is a same day surgical procedure allowing visualization of the pelvic organs. It is performed under general anesthesia, most frequently at the end of the infertility evaluation. In most cases, it is done as an outpatient procedure – either in our surgery center or a hospital.
Two small incisions, less than the size of your thumbnail, are made in your abdomen, one in your belly button area and one above the pubic hairline. Through these incisions, instruments are inserted which enable your physician to observe the pelvic organs. During a laparoscopy, your physician is able to determine if your fallopian tubes are open and detect abnormalities on the surface of the uterus, and pelvis such as adhesions or endometriosis.
Hysteroscopy is a surgical technique in which an instrument, similar to a telescope, is used to inspect the interior of the uterus. It is performed as an outpatient procedure, usually under intravenous sedation, either in our surgery center or at the hospital.
After adequate anesthesia is achieved, the telescope is passed through the cervical opening into the uterus. The uterine cavity is distended (expanded) using a fluid solution. Polyps, fibroids, scar tissue or a septum within the uterine cavity may be resected/removed from the cavity during the procedure. As the procedure is performed under sedation, you will feel no discomfort. You may have light bleeding or mild cramping following the procedure. If you experience bleeding heavier than a menses, severe pain or temperature greater than 100.4, please call the office.
Male fertility treatments can involve surgical procedures.
Surgical removal of sperm (MESA/TESE)
Even when no sperm is present on a semen analysis, viable sperm may be produced but remain within the testes. Men who have under gone a vasectomy or are born without a vas deferens will almost always have sperm production within the testes that is has not been released due to an obstruction that was created or exists from birth. The majority of men who do not have any sperm found on semen analysis do not have an obstruction but instead produce an insufficient amount of sperm to be present in the ejaculate or the sperm maturation process is interrupted and does not reach the level of maturity to be released. Although in some cases no sperm is produced by the testes, in many cases sufficient numbers of healthy sperm can be extracted directly from the tests to allow for fertilization of the egg during IVF with ICSI. The techniques involved with MESA/TESE are remarkable because in these cases, men who could not have fathered children naturally are now able to become a biologic parent. The sperm extraction procedure is performed under general anesthesia and must be performed by a skilled urologic surgeon with special training in testicular surgical sperm extraction techniques in a facility where the sperm can be identified and then processed appropriately, all of which is available at the RMG/IVF and Surgery Center.
The Reproductive Medicine Group is pleased to announce affiliation with Dr. Howard Heidenberg, a board-certified urologist with specialized training in male infertility. He trained at Walter Reed Army Medical Center, and operates a private practice in Tampa. In addition to general urology, Dr. Heidenberg is trained in the evaluation and treatment of male infertility including: vasectomy reversal, varicocele repair, and testicular biopsy and aspiration procedures for TESE and MESA.
Fertility Medications (Fertility Drugs)
Fertility medications can be used alone or combined with other fertility treatments.
Some patients will conceive by using medication alone, depending upon their diagnosis and age. Other couples will need to use more advanced fertility treatments in combination with medication, such as IUI (insemination) or IVF.
Several fertility medicines are available to enhance the chances for conception in couples experiencing fertility problems. The medications prescribed are determined by the results of couple’s medical history and evaluation phase.
Fertility medications are used to enhance quality of ovulation, regulate the menstrual and ovulatory cycle or to increase the number of eggs released in each cycle.
The most common prescribed fertility medications include clomiphene citrate (Clomid, Serophene), letrozole (Femara), gonadotropins (Bravelle, Follistim, Gonal F, Menapur), human chorionic Gonadotropin (hCG, Ovidrel), progesterone, GnRH agonists (Lupron, leuprolide acetate) and GnRH antagonists (Cetritide, Ganerelix).
IUI - Intrauterine Insemination (Artificial Insemination)
Intrauterine insemination (IUI) is commonly used procedure in fertility treatments. It can be used in cases where the male has a low sperm count, there is unexplained infertility, or when the female is not ovulating regularly. Ovulation inducing drugs are usually used as well. In cases where there is no male partner, donor sperm is used with IUI treatments and medication. Using a sperm donor for insemination is also called artificial insemination.
In this technique, semen is collected into a sterile cup by masturbation or into a special condom sheath used during intercourse and then brought to the office laboratory. It is prepared in special media, similar to that used for IVF. The objective of IUI is to insert a concentrated quantity of sperm directly into the uterus bypassing the cervix. Since IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract, the sperm function of the male must be reasonable and the fallopian tube(s) must be healthy and functional. Sperm function includes sperm number, shape and movement. The sperm wash takes about 45 minutes to 2 hours depending on the technique utilized. An IUI takes approximately 10-15 minutes to complete.
Timing of the insemination to coincide with ovulation is critical. In order to ensure this occurs, timing of ovulation is monitored by urinary hormone tracking methods or sonogram. Urinary LH ovulation predictor kits indicate that ovulation will occur within a 24 to 48 hour window. The urinary tracking method is performed at home, generally in the late afternoon or early evening. When the test is “positive”, insemination is performed 24 to 36 hours later. Another method used to time ovulation is ultrasound/sonography. The development of the follicle and impending release of the egg can be timed by serial ultrasounds performed in the office. Sonograms to time IUI’s are usually used when the patients are taking oral or injectable fertility medications. Patients generally use an hCG injection to further ensure release of the egg.
IUI success rates are best when reviewed cumulatively, and it is an affordable fertility treatment option, if appropriate.
ART therapies, the most common of which is in vitro fertilization (IVF), assist couples in overcoming fertility issues through the joining of the sperm and eggs outside the body and then transferring the resulting embryo into the uterus. The ART program is comprised of dedicated physicians, nurses, embryologists and andrologists. Our ART Laboratory is located adjacent to our Surgery Center in North Tampa.