Enhancing Fertility
Fertility-enhancing treatments are used to help a person or persons achieve parenthood more often and more quickly. Fertility treatments may be sought after unsuccessful attempts at pregnancy but can also play an important role when gametes (egg and/or sperm) and/or critical organs (uterus, ovaries, etc.) are unavailable or some other aspect of your situation is not conducive to achieving natural pregnancy. If you desire pregnancy, have been trying to get pregnant, or want advice on parenthood, you should come in for a consultation. Some common fertility-enhancing treatment options are listed below.
Insemination (IUI) with or without Ovulation Induction (Superovulation)
Intrauterine insemination (IUI), also commonly referred to as artificial insemination, is offered when someone has unsuccessfully tried to get pregnant on their own, whether it be due to lack of ovulation, mild sperm deficiencies, advanced reproductive age (over age 35) or no definable cause. It is also used when an outside sperm source is required for a variety of reasons including lack of adequate quality (or any) sperm being available from a member of the parenting relationship. The latter could include, among others, a single or same-sex female couple, one involving transgender person(s) or one where a male partner doesn't desire his sperm be utilized. IUI is often combined with Ovulation Induction which involves approximately five days of pill medication or one week of injectable fertility medication (often administered as a subcutaneous shot) along with frequent ovarian-response monitoring, including blood tests and ultrasound exams. All monitoring takes place before many peoples' workday begins (7-9:30 AM) and daily instructions are chosen based on your body's response to medication.
In Vitro Fertilization (IVF)
IVF is an "assisted reproductive technology" (ART) used to help a person become pregnant in the setting of:
- Failure to achieve pregnancy naturally or after using ovulation induction and/or sperm insemination
- Suboptimally functioning fallopian tubes
- Prior ectopic pregnancy (meaning a pregnancy that implanted outside the uterus, usually in the fallopian tube)
- If there is a sperm-producing partner put semen parameters are suboptimal (low sperm count or sperm motility)
- Unexplained infertility
- Age >35 years
- Polycystic ovarian syndrome (PCOS) with associated ovulatory dysfunction
- Same-sex couples
- Gender-related situations
- Pregnancy carried by someone other than the intended parent(s) (Gestational Carrier)
IVF usually involves one or several weeks of injectable medications administered to cause multiple eggs to develop within the ovaries. It also requires frequent monitoring of the ensuing egg maturation through blood tests and sonogram exams. All monitoring takes place in the early part of the day, which for most people, occurs conveniently before the workday begins (7-9:30 AM). Daily medication and upcoming monitoring instructions are then provided later on in the same day based on the body's response to medication.
An egg harvest (retrieval) procedure is performed when the largest cohort of oocytes are deemed mature. The retrieval is usually accomplished under light intravenouly-administered anesthesia where the eggs are gently aspirated from the ovaries through the vagina (if possible and, if not - which is rare, transabdominally) using a thin needle. Embryos are created by combining sperm and individual eggs in petri dishes and allowing them to grow and divide in an incubator that mimics the conditions of the body. Several (most often 5) days later, embryos are either frozen for later usage or placed into the uterus through the vagina using a narrow, flexible plastic catheter. Embryo transfer is a relatively painless procedure for most people and ordinarily does not require sedation or other anesthesia. Prior to transfer or storage, embryos may be tested for chromosomal competence (PGT-A - aneuploidy) or for a specific genetic disorder (PGT-M - medical disease).
Reproductive Surgery (including congenital anomalies)
There are times when surgery is the appropriate next-step in the evaluation or treatment of infertility or whena person is getting ready for pregnancy. In general, surgery will be avoided when possible, but certain conditions warrant this modality:
- Fibroids, particularly those that involve the endometrial cavity or womb (the part of the uterus where pregnancy is carried) or those that cause significant symptoms, particularly bleeding
- Polyps in the endometrial cavity
- Dilated fallopian tubes, especially those large enough that they can be visualized on ultrasound examination
- Ovarian cysts of undetermined origin or those large enough to warrant surgical exploration
- Congenital uterine or vaginal abnormalities such as a uterine septum, bicornuate uterus, or vaginal hemi-septum
- Significant signs of endometriosis or pelvic adhesions
Surgery is accomplished through one of four approaches: laparoscopy, hysteroscopy, robotic or open abdominal surgery. The approach that allows the best outcome with the least amount of invasion to the body will be selected. (I am not a robotic surgeon.)
