ABCS of DIAGNOSIS AND TREATMENT

Diagnoisis and Treatment of fertility issues

"AS I’VE STRESSED BEFORE, CONSULTING A SPECIALIST IS AN EXCELLENT FIRST STEP IF YOU SUSPECT YOU NEED HELP GETTING PREGNANT."

Diagnosis

Three simple tests help us evaluate what treatment will be best for you:

  1. A hysterogram (also sometimes called a hysterosalpingogram or an HSG) is an x-ray that checks to see if your uterus is normally shaped and if your tubes are open.
  2. A day-three blood test for FSH and Estrogen to test your ovarian function.
  3. A semen analysis to see if the sperm count is high enough.

Based on these tests, your age and your history, we develop a plan for treatment.

You may not need treatment at all, some patients get pregnant on their own. If you have been trying for at least 1 year, your odds are now 3% per month (they were 20% when you first started trying). All of the treatments involve different ways we can increase your chances.

Treatment

The basic outline of treatment options includes:

1. Clomid plus insemination: Clomid is a pill that causes or improves ovulation. It’s taken for five days and insemination takes place about five days later. Insemination means washing the sperm in our lab and placing it into the uterus around the time of ovulation. Insemination allows more sperm to reach the eggs. Many times we recommend “monitoring” once or twice to help time the insemination. Monitoring is a quick office visit for a blood test and ultrasound.

How it can help: Clomid with insemination increases our chances to about 8% per try. That means in three tries, we see about 20% of our patients conceiving. Clomid is not appropriate for most women in their 40s.

2. FSH: We teach you to give yourself injections of FSH (sometimes mixed with LH), a more powerful medication than Clomid. Our nurse will show you how–it’s really a much “smaller deal” than most people anticipate. You take the injections for seven to nine days and come to our offices occasionally for monitoring. We can track the size of your follicles, and when the time is right we perform the insemination.

How it can help: FSH injections with insemination can give you a 20%
chance of pregnancy per try. Women in their 40s have a much lower rate, but in some cases this treatment is still appropriate.

3. IVF or In Vitro Fertilization: In an IVF cycle, you give injections to yourself everyday for about two weeks. We monitor your progress with blood tests and ultrasounds in our office every one to three days.

Then you have a “retrieval”. In our offices while you’re asleep under anesthesia, we retrieve the eggs through your vagina using a needle and ultrasound. You wake up right away and go home about an hour later.

On the same day we get a sperm sample and combine the eggs and sperm. Three, five or six days after your retrieval, we transfer the embryos back into you with a very short procedure like an insemination.

Patients entering an IVF cycle are invited to an orientation class. A nurse reviews IVF details in a relaxed and private setting with lots of time to ask questions.

How it can help: Our success rates at New York University Fertility Center are consistently among the best in the nation. Take this opportunity to view our success rates.

(Pregnancy rates are important! My site offers easy instructions for checking out your doctor’s pregnancy rates).

Patients have a higher success with IVF than with insemination, but not everyone is a candidate for IVF. IVF patients must have normal day 3 blood tests and have enough eggs (usually about 5) to make the retrieval worthwhile. The odds decline with age.

4. Surgery I am an experienced infertility surgeon. You can read about my approach to surgery. Here are brief descriptions of the most common infertility procedures:

    • Laparoscopy—surgery through your navel to check for tubal problems or to treat endometriosis, cysts or scar tissue.
    • Hysteroscopy—surgery that uses a small scope to check inside the uterus. Abnormalities such as polyps, fibroids and septums can be removed.
    • Myomectomy—surgery with an abdominal incision to remove a larger fibroid.

    Together we will decide on the appropriate treatment plan for you. I hope this small compendium helps in the process. We proceed together. My staff and I are here to take care of you along the way.