Infertility Treatment Overview
Women with ovulatory dysfunction may fail to ovulate (anovulation) or have disordered/sporadic ovulation (oligo-ovulation). When an egg is not released from the ovary, natural fertilization and conception is not possible. If ovulation is reduced or irregular, opportunities for conception are also diminished, resulting in infertility.
When menstrual cycles are irregular (shorter than 21 days, or longer than 35 days), or if menses are skipped or absent, ovulatory dysfunction is diagnosed. Occasionally, women with regular monthly menses may also fail to ovulate, which can be confirmed using ultrasound examinations, ovulation prediction kits, and blood testing.
Establishing the exact cause for ovulatory dysfunction may prove to be a difficult task. There are many different factors which can lead to anovulation or disordered ovulation. Such factors may include generalized stress/anxiety, hormonal imbalance, eating disorders (anorexia/bulimia), excessive exercise, central nervous system abnormalities, cancer therapy, genetic disorders, polycystic ovary syndrome (PCOS), obesity, and unexplained factors, among others. A careful history and physical examination can often establish the diagnosis and suggest a specific cause, which often requires additional testing for confirmation (blood work, imaging studies…).
Establishing a specific cause for ovulatory dysfunction is important in order to determine a customized treatment protocol. Occasionally, simple interventions such as behavioral changes or the correction of a specific hormonal imbalance can lead to resumption in normal ovulatory cycles. Sometimes, specific diagnoses require ovulation induction with various orally ingested medications (Clomiphene citrate, Tamoxifen, aromatase inhibitors, Metformin…) or, if needed, injectable hormones, often with excellent results.
The California Center for Reproductive Health specializes in diagnosing and treating anovulation/oligo-ovulation. After a comprehensive work-up, simple treatments are initially employed to achieve ovulation and pregnancy.
FAQ
Reproductive endocrinology and Infertility is a sub-specialty of Obstetrics and Gynecology. In addition to managing medical and surgical treatment of disorders of the female reproductive tract, reproductive endocrinologist and infertility (REI) specialists undergo additional years of training to provide fertility treatments using assisted reproductive technology (ART) such as in vitro fertilization.
Reproductive endocrinologists receive board certification by the American Board of Obstetrics and Gynecology in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
In general, patients should consider consulting with an REI specialist after one year of trying unsuccessfully to achieve pregnancy. The chance of conceiving every month is around 20%, therefore after a full year of trying approximately 15% of couples will still not have achieved a pregnancy.
However, if a woman is over the age of 35 it would be reasonable to see a fertility specialist earlier, typically after 6 months of trying.
Other candidates to seek earlier treatment are women who have irregular menses, endometriosis, fibroids, polycystic ovary syndrome (PCOS), women who have had 2 or more miscarriages, or problems with the fallopian tubes (prior ectopic pregnancy).
Approximately 1/3 of the time cause for infertility is a female factor, 1/3 of the time a male factor, and the remaining 1/3 a couples’ factor.
At CCRH, we emphasize the importance of establishing a correct diagnosis. Both partners undergo a comprehensive evaluation including a medical history and physical exam.
Furthremore, the woman’s ovarian reserve is assessed with a pelvic ultrasound and a hormonal profile. A hysterosalpingogram (HSG) will confirm fallopian tube patency and the uterine cavity is free of intracavitary lesions. A semen analysis is also obtained to evaluate for concentration, motility, and morphology of the sperm.
Additional work up is then individualized to direct the best possible treatment option for each couple.
In vitro fertilization (IVF) is the process that involves fertilization of an egg outside of a woman’s body.
The process starts with fertility drugs prescribed to help stimulate egg development. In your natural cycle, your body is only able to grow one dominant egg, but with stimulation medication we can recruit multiple eggs to continue to grow. After about 8-10 days of stimulation, the eggs are surgically retrieved and then fertilized with sperm in a specialized laboratory. Fertilized eggs are then cultured under a strictly controlled environment within specialized incubators in the IVF laboratory for 3-5 days while they develop as embryos. Finally, embryos (or an embryo) are transferred into the uterine cavity for implantation.
Before deciding if IVF is the right choice, it’s important to sit down with an REI specialist to discuss available treatment options. For some people, other methods such as fertility drugs, intrauterine insemination (IUI) may be the best first choice treatment. At CCRH, we believe each individual couple is unique and not everyone needs IVF.
While not painful, the fertility medications may some side effects including headaches, hot flashes, mood swings, and bloating. The injection sites may also bruise.
Unfortunately, no. Many people think once they start IVF it’s a matter of time that they will be pregnant and have a baby. But according to national statistics per the Society of Assisted Reproduction (SART), on average 40% of assisted reproduction cycles achieve live births in women under age 35. The chances of success then continue to decrease with advancing age.
At CCRH, we employ only evidence-based interventions to ensure patient safety and optimal outcome. While we cannot guarantee a baby, we guarantee that you will receive the best, most advanced, personalized care to help you maximize your chance of a baby.
The average IVF success rate (success measured in live birth rate) using one’s own eggs begins to drop around age 35 and then rapidly after age 40. This is due to the decline in egg quantity and egg quality as a woman ages.
Our clinic’s success rate consistently beats the national average year after year.
Individual insurance plans often do not have any coverage for infertility treatments. If you have a group plan, you can call members services to see if they have coverage for infertility (including consultation/workup and IVF).
After your consultation with our REI specialist, one of our dedicated account managers with sit with you to go over the cost of treatment.