When having a difficult time becoming pregnant we always recommend that our patients take all the recommended steps to have a natural conception for at least 6 months before we perform any procedure. You could go to our blog for more tips on how to become pregnant naturally. After 6 months of trying and still not seeing any results, then it”s time to go over your treatment options.
It takes two to make a baby so we usually try to work up both potential parents to see where the problem may lie.
We need to do test to see if the woman is ovulating, passing an egg, every month correctly. That the hormonal milieu around the woman’s cycle is working normally. This includes thyroid, pituitary and ovarian hormonal function testing. We can do these things with blood test, sonograms and/or through endometrial testing (a biopsy of the uterine lining)
We need to know that enough sperm, usually around 70 million per ejaculate are being produced. They need to be motile, have normal forms and that there are no incompatibilities between the couple (allergies). We usually ask the man for a semen analysis and a lab test
Artificial insemination is a procedure where the man’s ejaculate is processed, washed, concentrated and the most motile sperm selected, and injected into the woman’s reproductive system.
This procedure is often selected when there is a male –factor identified in a couple’s fertility problem. There are two types of insemination:
- ICI – intra cervical placement of the insemination
- IUI – intra uterine placement of the insemination, the more common type offered.
Think of an artificial insemination as providing a short cut for the sperm to reach their target – the fertilization of an ovum.
Success rates for artificial insemination vary depending on a number of factors and the initial reason for the fertility problem but it will range around 20 – 30% per cycle.
Factors that lessen the chance of getting pregnant with the procedure include:
- Woman’s age over 40
- Lower end of acceptable for insemination sperm count or motility
- Severe endometriosis
- If the fallopian tubes are very damaged by disease even if they’re not completely blocked.
The procedure is safe with little health risk for the woman. I have personally seen many women achieve pregnancy with the aid of an artificial insemination. Once the patient is pregnant, the insemination per say, does not increase risk during the pregnancy or afterwards in the child’s life.
If in – vitro is not selected or an artificial insemination has not been successful a sperm bank is also an option. There are large banks that offer cryo – preserved specimens ready for insemination. Donors are tested for sexually transmitted diseases in the manner that blood donations are also screened and are considered safe. Donors are listed and available as to their ethnicity, physical characteristics, education etc.
Ovulation induction is the stimulation of the ovary to produce an egg (egg) using drugs that increase fertility. When is it recommended to use medication to stimulate ovulation?
When the woman is not ovulating and is presenting infertility we would then offer this treatment. Besides not getting pregnant, some symptoms might include
- Irregular periods, very short or very long cycles between periods.
- Periods lasting several days or a few days with a small number are also common symptoms.
Sometimes there are no other symptoms other than the couple failing to become pregnant, even with monthly menses. This is especially common in women after age 35, when fertility starts to decrease.
In other conditions such as polycystic ovary syndrome, the woman does not produce a mature egg without the aid of medication to induce ovulation. Women with this condition will have at least two of the following symptoms:
- Ovaries on an ultrasound will have small black nodules present.
- Increased body hair or increase in blood testosterone levels.
- Irregular periods
How is ovulation induction done?
There are four types of medication that are used to promote ovulation.
- Clomid / Serophene / clomiphene citrate
- Femara / letrozole
- Bromocriptina / Parlodel / Dostinex
- Gonadotropinas / FSH
Ovulation induction can be used as one tool to solve problems of infertility or in conjunction with other methods of assisted reproduction. Depending on the cause of infertility, a treatment plan will be formulated specific to the problem of the couple.
Obstruction between ovum and sperm maybe present, causing the problem. The biggest culprits are previous infections, surgeries, endometriosis or anatomical abnormalities such as fibroid.
Ultrasound evaluation or a special dye evaluation of the reproductive organs, a hysterosalpingogram, may be ordered to check out the possibility of an obstructed passageway.
Sometimes we order a blood test that raises the suspicion of endometriosis being present. Endometriosis is a condition where even if obstruction is not present, it may be affecting the ability of sperm and egg to travel adequately through the passageway and create problems anyways.
Usually the last step we perform would be a laparoscopy if completely necessary. This is an invasive surgical procedure. Performed under general anesthesia, usually in a go-home the same day type of setting.
It may be used to evaluate a woman’s reproductive organs more directly, but is usually reserved for when treatment of a problem is anticipated. For example, when endometriosis is suspected and needs to be removed. Also, in the case of obstruction of the passageway due to adhesion or fibroid which also need to be resolved for fertility to be restored.