Infertility is defined as the inability to conceive following one year of unprotected intercourse. Infertility investigations are usually begun then, but can be initiated earlier under certain circumstances, such as in cases of advanced maternal age (35 years of age or greater), if there is a history of previous pelvic inflammatory disease (PID), a history of major abdominal surgery, or a history of irregular menstrual cycles.
The initial consultation visit is with the female patient and her husband or partner. During this visit, the doctor will review medical and genetic history and discuss diagnosis, prognosis and future plans. At this time, scheduling can be done for further diagnostic testing that has never been performed and possibly repeat tests in which results may be outdated. Blood work may be obtained during this initial visit. The couple should check with their insurance company to determine if a specific laboratory or referral needs to be used. Follow-up visits will be arranged with Dr. Padilla or Dr. Bass depending on the physicians' availability the day of the next appointment.
A semen analysis is done by our andrology laboratory. The male partner is required to have one to three days of abstinence prior to the day the analysis is to be done. The male partner collects the specimen in a private room adjacent to the laboratory. The specimen can be collected at home in a sterile container only if he cannot collect in the laboratory. Semen cultures for bacteria and Ureaplasma are taken since there is a possibility these microorganisms play a role in infertility. The cultures are sent to an outside laboratory who will send a bill to the insurance company. Again let us know if your insurance company requires the use of a specific laboratory. If these microorganisms are present, treatment of one or both partners is recommended. Candidates for in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and intrauterine insemination (IUI) will have another test performed which involves separating the more active sperm. This is called a sperm wash. Out-of-town patients can schedule a semen analysis ahead of time to be done the day of the initial consultation. We recommend 1-3 days of abstinence prior to the semen analysis.
A postcoital test may be performed around the time of ovulation. Within 12 hours after intercourse, the cervix is checked for the quality of mucus and the number of motile sperm. Normal sperm are capable of surviving there for 48-72 hours. Factors involved in poor postcoital tests include poor mucus, inflammation, previous surgeries, antisperm antibodies and poor sperm quality. Medications and/or inseminations can improve the situation.
Ultrasonography is a diagnostic test used to evaluate the uterus and measure the size and number of ovarian follicles, small "cysts", which contain the eggs. It allows accurate detection of ovulation disorders and exact timing of the ovulation process. Some of these ultrasounds are done by an ultrasound technician with extensive experience and then reviewed by the doctors. The lining of the uterus can be evaluated for polyps and/or fibroids by injecting saline through the cervix under ultrasound guidance. This is called sono-hysterography.
Hysterosalpingography (HSG) involves the use of an x-ray contrast solution which is injected through the cervical canal. The solution fills the uterus, passes through the tubes and spills into the abdominal cavity where it is absorbed by the body. X-rays are taken of the solution's progress. The purpose of the test is to evaluate the shape of the uterus and patency of the tubes. Patients may take Advil or Motrin one hour before the procedure to reduce the cramping. If you are very apprehensive, the doctors may prescribe a stronger medicine for the discomfort. The results of the test are immediately available and will be discussed with you. Although the radiation exposure is minimal, you need to avoid pregnancy during that cycle. A radiologist assists during the procedure and you will be receiving a bill from us and from the radiologist.
An endometrial biopsy is done to diagnose progesterone deficiency or chronic infection (endometritis). The endometrium is the lining of your uterus where the early embryo will implant. Two to four days before the expected date of menses, a small piece of endometrial tissue is obtained and sent to a pathologist for evaluation. You should avoid pregnancy this cycle. The procedure takes 30 seconds and causes brief discomfort.You may take Advil or Motrin one hour before the procedure. Since we consult a pathologist, you will receive a bill from us and from the pathologist.
Hysteroscopy is direct visualization of the inner lining of the uterus with an endoscope. Intrauterine adhesions (scars), polyps, fibroids and other abnormalities can be diagnosed and often treated at the same time. In some cases, blocked tubes can be opened by inserting a catheter during this procedure. The recovery period after a hysteroscopy is two to three days.
Laparoscopy (pelviscopy) is a surgical procedure which involves inserting a telescope (laparoscope) into the abdomen to visualize the abdominal and pelvic organs and any possible abnormalities. Findings may include scar tissue, endometriosis, fibroids and tubal abnormalities. The laparoscope is passed through a small incision in the umbilicus. Sometimes treatment is performed through additional small punctures in the lower abdomen at the hairline. Laparoscopy is usually performed in an outpatient surgery center with general anesthesia. The recovery period after a laparoscopy is three to five days.
Medications, such as clomiphene citrate (Clomid, Serophene) or human menopausal gonadotropins (Repronex, Menopur) or follicle stimulating hormone (Follistim or Gonal-F) are used to help induce ovulation. Some of these are administered orally while others are delivered into the body by needle injection. Ovulation induction can be monitored with temperature charts, ultrasounds and blood work.
INTRAUTERINE INSEMINATION (IUI)
IUI is used for male factors, cervical mucus problems and unexplained infertility. IUI requires careful timing so that it is done close to ovulation. An injection of human chorionic gonadotropin (HCG) may be used to trigger ovulation and time the insemination. The husband collects the sperm sample in the andrology laboratory 2- 2.5 hours prior to the actual insemination. The sperm are delivered to the uterus by means of a small catheter. No pain medication is required.
ADVANCED OPERATIVE LAPAROSCOPY
Patients who have endometriosis, pelvic adhesions (scar tissue), fibroids or blocked tubes can undergo advanced operative laparoscopy. New instrumentation allow surgical repair of tubal conditions as an outpatient procedure, where several years ago they required major operations and hospitalization.
TUBAL OR UTERINE MICROSURGERY
Patients with blocked tubes due to scar tissue can undergo microsurgery. In cases of uterine anomalies or fibroid tumors that may cause recurrent miscarriage or premature labor, the uterus can be repaired using these techniques.
ARTIFICIAL INSEMINATION WITH DONOR SPERM (AID)
Donor sperm insemination may be the only alternative for some couples with male factor infertility unresponsive to other treatment methods. Although we do have an established history with a few donor banks, patients may choose donor sperm from any certified sperm bank in the country. The donors from these banks have been screened for several hereditary and infectious diseases. Donor and patient identities are confidential. AID can also be done for single women who do not have a male partner.
REVERSAL OF TUBAL LIGATION
Tubal ligation can be reversed. It involves making an incision to remove the obstructed pieces of tube and reuniting both ends using a microscope. This is usually a major surgical procedure requiring an abdominal incision and a brief post-operative hospital stay. In general, tubal ligation reversal is not recommended for women 37 years of age or older. In this case, IVF is usually a better option.
IN VITRO FERTILIZATION (IVF)
Involves the union of sperm and eggs in a dish in the laboratory with transfer of the resulting embryo(s) directly to the uterus. We do not recommend IVF or ICSI (see below) when the woman is older than 43 years of age. Other treatments, especially IVF with donated eggs, may be a better alternative.
INTRACYTOPLASMIC SPERM INJECTION (ICSI)
Assists couples with very low sperm counts and/or motility or a history of poor fertilization with IVF. ICSI involves an embryologist physically injecting a single sperm into an egg.
We offer discount global fee programs, as well as patient refund programs. The recommended number of eggs to freeze rises with age. For a woman 37 years old or younger, we recommend freezing at least 15 eggs. For women 38 and older, we recommend at least 20 eggs. Although this can be achieved with one cycle, most of the time we recommend that you plan on doing two egg freezing cycles. For additional cost information, feel free to click on the above programs or call our Benefits Department at 410-296-6400.
Allows storage of fertilized eggs for future transfer, improving the pregnancy rate and lowering the risk of multiple pregnancy.
ASSISTED HATCHING (AH)
Involves an embryologist placing a microscopic hole in the shell/zona of the embryo. This process may be used to help an embryo implant in the woman's uterus. AH is often used on thawed embryos or in cases where couples have had multiple transfers with no positive pregnancy test.
ADVANCED EMBRYO (BLASTOCYST) TRANSFER
The latest IVF technique available. This may also be referred to as a day 5 or day 6 embryo transfer.
DONOR EGG AND DONOR SPERM
Programs are available for patients who have poor or absent egg or sperm production. Donors undergo extensive screening according to established national guidelines. While many couples choose anonymous donors, it is possible to use a known donor.
GESTATIONAL CARRIER PROGRAM
This program is available for patients who have abnormalities of the uterus or do not have a uterus (hysterectomy) but still have their ovaries. It can also be done for women with other medical contraindications to pregnancy. This procedure involves IVF or ICSI and the use of eggs and sperm from the couple. Resulting embryos are then transferred to the uterus of the gestational carrier.