Fertility Service Overview
Infertility affects over 15% of couples at some time during their reproductive lives. This means that three couples out of every twenty will experience infertility, making it a common condition. It is defined as the inability to become pregnant after one year of unprotected intercourse in young and healthy couples. Since there is strong decline in fertility as a woman ages, women 35 and older should seek care from a fertility specialist after 6 months of regular intercourse without conception.

The keys to successful treatment of infertility are accurate diagnosis and identification of the most appropriate course of treatment. This begins with an in-depth physician consultation and evaluation, which includes a detailed history, a physical exam and a pelvic ultrasound to assess the health of the woman’s pelvis, including the uterus and the ovaries. A semen analysis is commonly performed as a part of the initial evaluation to examine potential male factor that could be contributing to infertility. The semen sample is assessed for volume, concentration of sperm, total sperm count, motility, and morphology. The medical and reproductive histories often reveal issues that could direct the physician to perform additional tests.

Common diagnostic tests include a hysterosalpingogram (HSG), which is an X-ray test where a dye is run through a woman’s uterus and fallopian tubes and gives information on the patency and health of the tubes. Other tests include blood tests to assess a woman’s ovarian reserve, ovulatory status, thyroid function, and prolactin levels. Ovarian reserve testing is performed on the third day of a woman’s cycle to test for serum follicle stimulating hormone (FSH) and estrogen.

The information gathered from the initial consultation and examinations may indicate a condition that may require a minor surgical procedure. A hysteroscopy is a procedure where a physician inserts a small camera in the uterine cavity to evaluate for the presence of polyps, adhesions or fibroids, which can interfere with fertility. If encountered, they can easily be removed with small instruments under direct visualization. A laparoscopy is a surgical procedure where a small camera is inserted through a small incision below the umbilicus to assess the pelvis for adhesions, tubal blockage or damage, endometriosis or other conditions.

If amendable to correction, the physician can take care of the abnormality during the same procedure. Treatment of infertility varies for all couples depending on the information gathered from the consultation and the diagnostic testing. Common treatments include ovulation induction, which could be done with clomid, a medication taken orally for five days in the beginning of a woman’s cycle. If appropriate, ovulation induction could also be done with gonadotropins, which are hormonal medications delivered through small injection shots. An intrauterine insemination (IUI) may also be recommended depending on the semen parameters. An IUI is performed by collecting a semen sample and washing it in order to select the best quality sperm and inserting them in the uterine cavity through a small catheter. This is done near the time of ovulation in order to increase the chances of conception.

If an intrauterine insemination is not an option due to female and/or male factors, the next option for treatment would be in-vitro fertilization (IVF). In-vitro fertilization offers the highest percentage of success rate as it is capable of overcoming multiple infertility factors. Every protocol is individualized to address the specific needs of the patient.

In cases with strong male factor, intracytoplasmic sperm injection (ICSI) may be performed to fertilize the eggs. This procedure involves directly placing a sperm in the egg to increase the chances of fertilization. To further assist the embryo in implantation, a procedure called assisted hatching may be performed by the embryologist.

Unfortunately, not every patient is a candidate for intrauterine insemination and/or in-vitro fertilization, but you can trust that the CHA team will thoroughly evaluate each and every patient to ensure that the proper treatment is implemented.

CHA Fertility Center works with all third party agencies to assist couples who are in need of an oocyte (egg) donor and/or surrogate. We will help our couples in their decision to either move onto egg donation and/or surrogacy or perhaps consider adoption.

It is important to remember that the keys to successful treatment of infertility are accurate diagnosis and identification of the most appropriate course of treatment.