The most important prerequisite for treatment is proper diagnosis of the problem.  All the treatment in the world is of little use if it fails to correct the underlying cause.  Treatment modalities below are listed under headings of diagnosed problems

Ovulatory Dysfunction (Annovulation/Oligo-ovulation):

• Ovulation prediction kits:

An easy and inexpensive way to determine when or if you ovulate.  These may be obtained at or through most pharmacies or physicians offices....even online or by phone.  We recommend OvuQuick or OvuKit for it's ease of use and accuracy

• Clomiphene Citrate:

The least expensive medication used to induce ovulation.  An anti-estrogen it increases FSH and LH levels.  It is a prescription, oral, medication and will require monitoring by a physician.  This is the usual starting point for you and your primary care physician.

• Exogenous injectable gonadotropins:  

There are several of these medications. These are the 'big guns.' They are expensive and require instruction for injection.  They also require being prescribed by a trained physician and ultrasound monitoring. They are used after clomiphene citrate failure and specifically for ART

more info (password required; available only to ARC patients only)

• Ultrasound monitoring:

Seeing is believing.  Nothing demonstrates response or lack thereof, to treatment as does a ultrasound scan.  It may also detect other abnormalities and problems.  It is indispensable in the treatment of infertility and has been shown to be safe, even after repeated ultrasounds, by many medical studies 

Endometriosis:  

• Medications:

Currenlty there are two available medications for treating endometriosis; Danocrine and Lupron.  The side effects from Danocrine are so severe that it is little used.  Lupron is a monthly injection given usually for 6 months and sometimes as a precursor to surgery.

• Surgery (laser, etc)

 

Luteal Phase Defect:

• Progesterone Suppositories:

These are glycerin based vaginal suppositories containing progesterone in dosages of 100 mg mutliples. This is used to supplement endogenous progesterone in women whose established progesterone level is lower than 20 ng/ml. As you might guess these are rather messy

• Oral estrogen:

It is a simple equation: no estrogen no progesterone.  One way to insure adequate progesterone to supplement with estrogen (estradiol)

• Injectable Progesterone:

This is the nastiest shot you'll ever have, but nothing is as effective in delivering progesterone to the body and producing a good endometium

• Endometrial Biopsy:

Synchrony is the keyword.  The endometrium must be receptive when an embryo arrives.  This test takes a piece of the endometrial lining to determine if the timing is right. 

 

Fertilization:  MALE FACTOR INFERTILITY

• Semen Processing and Intrauterine Insemination:

First stop for patients with all but the poorest sperm quality.  Motile sperm are isolated from the semen and intrauterine (artificial) insemination is performed

• In-vitro fertilization (IVF):

If insemination has failed to produce results, or for patients whose sperm quality is too poor to be considered for processing for insemination, this is the next stop.  This is the 'big daddy' of procedures and carries the price tag to prove it. It is the most performed of the Advanced Reproductive Technologies or ART

• In-vitro fetilization with Intracytoplasmic sperm injection (ICSI):

The only meaningful advance in the treatment of male infertility in the last decade.  ICSI is the injection of a single sperm directly into an egg.  It has made possible the successful treatment of previously insurmountable male disorders. It adds to the price tag for IVF

• Donor semen:

A sperm substitution.  Though ICSI has caused a decline in it's use, it still  remains the only viable option for some patients.  For patients searching for reputable semen bank contact the American Association of Tissue Banks (AATB) at 703-827-9582

Tubal Transport:

• Hysterosalpinogram (HSG):

An x-ray (fluroscope) of the uterus and fallopian tubes.  If the track is blocked the train won't get through.  Sometimes the procedure itself can prove therapeutic, cleansing the cilia in the tube and breaking small intra-tubal or fimbrial adhesions.

• Hystersonogram:

Injection of saline into the uterus and tubes under ultrasound obervation.  Polyps, fibroids, septae, and other abnmormalities that an HSG may not detect

• Surgery (Tubal reconstruction)

Blockages and adhesions may be treated by surgery, both by laparoscopy and laparotomy.  Blocked tubes may also somtimes be restored by tubal cannualization or balloon tubo-plasty.

• In-vitro Fertilization

The final stop on the blocked tube special.  This may be of choice or by failure of all other measures to work.  IVF bypasses the blocked tracked and takes the embryo right to the station.

Implantation:

• Genetic screening

What we know about gene function has increased 100 fold over the lat decade due to the human genome project. Translocations, dysjunctions, deletions, to name just a few all may have significant impact on implantation and pregnancy.  For those with family history of congenital abnormalities this stop should be made sooner rather than later.

• E-tegrin Assay

Integrins are not new.  The ability to detect them is.  Repeated failure to achieve implantation (+pregnancy test) in light of no other unresolved problems calls for an integrin look. A piece of uterine tissue from an endometrial biopsy is submitted for this assay.

• Megadosing progsterone

For those with a negative integrin assay, large amounts of progesterone may be the answer

•  Surgery (Uterine)

Uterine myomas (benign tumors), septum, adhesions all can make the uterus a inhospitable place for embryos.  Surgical repair can make it 'home sweet home' again.

Endocrinopathies:

• Prolactin

A pituitary pregnancy hormone primarily responsible for breast milk production.  Elevated outside of pregnancy can induce annovulation and galactorrhea (leakage of milk from the breast).  Mostly caused by small tumors of the pituitary (microadenomas)  it can easily be treated by oral medication.  Parlodel and Dostinex are the most popular

• DHEA-S

 

• PCOS and hyperinsulinemia

Simple diagnosis being and inverted FSH/LH ratio (>1:2)  Its underlying cause is insulin resistance....much like and often a precusor to... diabetes.    Proper diagnosis and treatment is imperative for these patients and response can be dramatic, especially in the obese PCOS patient.  

• Hypogonadotropic hypogandism

In a word, the testes and ovaries (gonads) are not working.  In some cases the addition of gonadotrpins may correct this...in some it is an uncorrectable condition caused by degeneration of the gonadal tissues

• Age:

Barring other pathologies, the younger you are,the greater your chances of success

• Number of factors involved and severity:

The greater the number of factors influencing your fertility and as the severity of these factors increases, your chances for success diminish.

• Recent pregnancy in history:

In general, a recent pregnancy, successful or unsuccessful is the best indicator for your success--the more recent the better.

• Ovarian reserve:

Simply put, the number of good eggs left in your ovary(ies).  A depleted ovarian reserve does not bode well for success.