Infertility. A suggested Course of Treatments

The most appropriate treatment depends upon the cause(s) of a couple’s infertility. At SEMERT, each couple’s treatment is highly individualized. Contrary to what is portrayed by the media, assisted reproductive technologies, such as IVF are not the most commonly employed fertility treatments. In fact, most couples (>80%) will become pregnant using technologies such as fertility drugs and intrauterine insemination (IUI). It is estimated that less the 15% of couples seeking care from a reproductive endocrinologist, infertility specialist will eventually require IVF.

If the patient has reduced ovarian reserve (elevated FSH), then intrauterine insemination (IUI) after ovulation induction with FSH may be the treatment of choice. If irregular, “poor”, or no, ovulation is identified as a cause of infertility, treatment with Clomid may be an appropriate first choice. Clomid is usually administered from three to six ovulatory cycles, depending upon female age and other factors.

Diagnostic fertility tests such as day 3 hormones, androgen levels, prolactin levels, and others help determine the cause(s) of failed ovulation. If androgen levels are found to be elevated, the patient will be further evaluated for PCOS and if the disease is present Glucophage (metformin), or FSH may be the treatment of choice. PCOS patients must be managed by a fertility specialist because of their potential for exaggerated responses to FSH stimulation.

Some degree of male infertility is present in up to half of all infertile couples. For this reason, the semen analysis is mandatory before any treatment regimen begins. When mild male factor infertility is present, FSH stimulated IUI with washed and concentrated sperm may be the first treatment choice. When moderate to severe male factor is present in vitro fertilization employing the ICSI procedure is the treatment of first choice.

As with moderate to severe male factor infertility there are other conditions where IVF may be the treatment of first choice. When the fallopian tubes are blocked or damaged, IVF usually produces the best per cycle success rates.

Older women with mildly elevated FSH levels may attempt IVF depending upon their ovarian reserve. As women age, their eggs loose their ability to fertilize and develop properly and miscarriage rates increase. We encourage women with significantly reduced ovarian reserve, or ovarian failure, to enter our donor egg program. This is also true for women who fail the “Clomid Challenge Test”. IVF success rates using donor eggs are exceptionally good.

There may be large polyps or fibroids in the uterus in which case hysteroscopic or laparoscopic surgery are the treatments of first choice. There may also be uterine structural abnormalities that can be surgically corrected.

Endometriosis can attach to and penetrate the reproductive organs causing serious damage. The doctors can remove most endometrial implants surgically using the laparoscope and they often recommends therapy with Lupron.

Tests such as the ultrasound, or endometrial biopsy, may indicate that the lining of the uterus (endometrium) is not developing properly (in phase) to support a developing embryo. When this is the case, progesterone is often prescribed to stimulate endometrial development.

There can be many other causes of infertility and in most cases more than one defect is present. This is why it is important that your doctor should order a complete workup on both partners even if the cause of their infertility is suspected or known.

Intrauterine Insemination (IUI)

IUI is often considered a "first line treatment" for certain infertility conditions. At SEMERT in Tijuana, we offer the full spectrum of infertility procedures to help patients realize their dreams of creating families. These services include the fertility diagnostic evaluation, ovulation induction with gonadotropins for intrauterine insemination (IUI) and IVF, donor egg IVF, reproductive surgical procedures including tubal reversal surgery, specialized treatment of PCOS, and many others

IUI patients most often undergo ovulation induction with FSH (Follistim, Gonal-F, Repronex, etc.) to cause the recruitment and development of eggs within the ovarian follicles. Once the eggs are judged mature an injection of hCG is given and the IUI is scheduled at both 18 and 36 hours later.

The male’s sperm for IUI is obtained and specially washed and prepared for insemination into the female. All seminal plasma is removed and the sperm is concentrated. In the IUI procedure, a small catheter is used to pass the sperm sample through the vagina, cervix, and into the uterus in a painless procedure. This process bypasses problems such as poor cervical mucus. Unwashed sperm must never be placed into the uterus as serious painful reactions can occur.

IUI is used to treat infertility resulting from mild male infertility, cervical mucus insufficiency, hostile cervical mucus, some structural irregularities in women, as well as selected cases of unexplained infertility. In cases of moderate to severe male factor, IVF with intracytoplasmic sperm injection (ICSI) is usually recommended.

IUI cycles should be managed by a reproductive specialist thoroughly familiar with the use of injectable fertility medications.

When IUI is used in conjunction with an FSH ovulation induction protocol the probability of conception almost doubles than with other less aggressive methods. To find out if you are a good candidate for ovulation induction IUI contact our office.

Infertility Treatments
Male Factor Infertility
Infertility and Ovulation Induction FSH
Ovulation- PCOS- Metformin and Infertility
Male Factor Infertility
In Vitro Fertilization
ICSI
Donor Egg Program
Tubal Disease Infertility
Advanced Female Age and Infertility
Hormone Therapy, Thyroid, etc.
Bromocriptine- Hyperprolactinemia
PGD
Fertility Surgery
Laparoscopy, Hysteroscopy