Fertility challenges can arise at any point, even after a successful earlier pregnancy. Or maybe you have not yet experienced any fertility problems, but are planning for the future. Whatever your age, if you have been trying to get pregnant for six months to a year and have so far been unsuccessful, it may be time to begin fertility treatments. After an initial consultation and some testing, we will build a personalized fertility plan using some of these procedures.
Ovulation Tracking, Stimulation, and Induction
Ovulation tracking is an important first step in either identifying that normal ovulation is not occurring, or to recognize the best windows where you may be able to get pregnant.
Ovulation can be tracked in two ways:
- With at-home ovulation tests and trackers
- Using an ultrasound in our offices
Depending on your age, some additional testing and preparation may be recommended, such as mammograms or blood tests. If normal ovulation is not taking place, or not taking place regularly, you may then consider either intrauterine insemination (IUI) or in vitro fertilization technique (IVF) Ovarian stimulation and induction, will be an important part of the process.
We can analyze your semen sample for the presence of sperm, as well as sperm motility and morphology (shape). For some men, sperm is not identified with ejaculation. If this is the case, we can use a process called testicular sperm aspiration where sperm is extracted directly from the testicles.
Intrauterine Insemination (IUI)
Probably more commonly known as artificial insemination, intrauterine insemination is a procedure where sperm are directly transferred into the uterus. An IUI procedure is most often recommended for couples with unexplained infertility, male factor infertility – such as low sperm count or poor sperm motility – or for those using donor sperm.
The IUI procedure has 3 basic steps:
- Ovulation is tracked and a fertile period is identified (extra steps may be taken if ovulation is not occurring normally)
- Semen is collected and washed
- Sperm is inserted directly into the uterus
The final step is similar in many ways to a pap smear – a speculum is used to expand the vaginal walls, then a thin, flexible catheter is inserted through the cervix and the washed sperm is injected directly into the uterus. The washing process is important both to give the healthiest and most mobile sperm the best chance to reach the egg, and also because inserting semen directly into the uterus can cause cramping and pain.
IN VITRO FERTILIZATION (IVF)
In Vitro Fertilization, or IVF, is one of the oldest and most frequently used assisted reproductive technology (ART) procedures. IVF can be used to address complications in conceiving caused by everything from male factor infertility, to endometriosis, unexplained infertility, as well as fertilizing formerly frozen eggs.
The most common IVF procedure is divided into 4 major steps:
- Controlled ovarian hyperstimulation
- Retrieval of eggs
- Transfer of embryos to uterus
The body normally only matures and releases one egg at a time each month. To increase the chances for successful fertilization during the IVF process, the woman producing the eggs will be given certain medications to help the body produce more than one egg in this ovulation cycle.
The eggs are retrieved in our office under anesthesia and are then transferred to our lab for the next step: fertilization.
A semen sample that has been washed – removing all seminal fluid leaving only the most mobile and healthy sperm – is then mixed with the eggs. The eggs and sperm are carefully monitored for the next 18-24 hours to ensure that fertilization occurs.
Once several embryos have been created, we have the opportunity to run genetic testing before transferring them to the uterus. This is either pre-implantation genetic diagnosis (PGD) for patients with identifiable genetic defects – like cystic fibrosis, thalassemia, or sickle cell disease – or pre-implantation genetic screening (PGS) which may allow us to identify embryos with the right number of chromosomes and then transfer only those embryos with the best chance to implant successfully.
MINI IVF CYCLE
For patients in need of IVF but who are concerned about using high doses of hormones and other medications, or have concerns about the cost of a round of regular IVF, minimal stimulation IVF (Mini IVF) may be a good option.
Mini IVF cycles use smaller amounts of the injectable medications that cause the hyperstimulation of the ovaries. For Mini IVF patients we will also limit the monitoring of laboratory interventions to keep costs as low as possible.
While Mini IVF is not possible for every patient, we are happy to talk you through the various fertilization procedures and other treatment options that are available.
When the cause of infertility is not clear, we may recommend minimally invasive pelvic surgery.
Depending on what we need more information on, there are two types of surgery we might use:
- Laparoscopy, or
Laparoscopy provides a detailed view of the reproductive organs that ultrasound and other radiological procedures cannot show. Small incisions are made in the abdomen, and an endoscope – a small flexible camera – is inserted to directly examine the pelvic cavity, uterus, fallopian tubes, and ovaries. Laparoscopy is best used to examine and identify (and sometimes immediately treat) conditions like:
- Tubal blockage
- Pelvic adhesions (scarring)
When the only area that needs examination is the inside of the uterus, a hysteroscopy is used. The endoscope is inserted through the cervix to look for any abnormalities that could interfere with embryo implantation or that could be causing miscarriages. Hysteroscopy can also identify:
- Uterine Septum
- Uterine Scarring
Treating these conditions may improve your chances of becoming pregnant.
The technique of freezing eggs for later reproductive use has been around for decades, with the first human birth from a frozen egg reported in 1986. Continuing to develop new techniques for extraction and freezing has improved survival and pregnancy rates. By removing the “experimental” label in 2013, the American Society of Reproductive Medicine recognized egg freezing as a valid option to preserve the reproductive potential in women of childbearing age.
There are several reasons that you might be interested in egg freezing, including:
- Preserving eggs if you are facing cancer treatments
- Medical conditions that may require the surgical removal of the ovaries
- Genetic conditions that may cause ovarian failure
- For those uncomfortable with freezing embryos for religious or personal reasons
- Planning for future pregnancy
The initial steps in the egg freezing process are similar to the beginning of IVF. One of our fertility specialists will review your medical history and perform a physical exam which may include blood tests that help to predict the number of eggs that could be obtained. At this point, you will begin hormonal injections to stimulate the growth of multiple eggs in one cycle. We’ll monitor the growth of the eggs and once they are mature we will extract them and bring them to the laboratory to be frozen.
At Laurel Fertility Care, we use the vitrification – or fast freezing – technique to freeze eggs (as well as embryos). As soon as the eggs are extracted they are:
- Transferred to the laboratory
- Exposed to a cryoprotectant solution to help survive freezing
- Plunged into liquid nitrogen for incredibly fast freezing
This fast freezing technique eliminates ice crystal formation, which can damage the egg, and leads to improved survival and pregnancy rates.