TREATMENT OPTIONS: OVERVIEW
Treatment is based on the findings from a diagnostic workup. If there is an identifiable cause of infertility, therapy should be aimed at correcting the reversible causes. The couple should also be counseled on lifestyle modification, such as weight loss, smoking cessation, reducing caffeine and alcohol consumption, and appropriate time and frequency of coitus.
TREATMENT OPTIONS: SURGERY
There are many surgical options that can help restore fertility. These include surgeries to remove endometriosis, fibroids, ovarian cysts, or other abnormal growths, as well as reconstructive surgery to repair a damaged uterus, tubes, or ovaries.
You can read about surgery success stories on our patient testimonials page.
TREATMENT OPTIONS: IVF OR SURGERY OR BOTH?
As mentioned, several studies suggest that women with untreated endometriosis have significantly higher IVF failure rates. This is true even for women with very mild cases of endometriosis. Before you mortgage your house for multiple rounds of IVF, you may want to obtain a second opinion from an experienced endometriosis specialist to see whether it may be more beneficial to have your endometriosis surgically removed before pursuing IVF. In many cases, IVF is no longer necessary as many patients are able to conceive naturally after such surgeries.
Please see the following articles for more on this still controversial subject:
– Wall Street Journal article: What You Should Know Before You Start IVF
– Fertility & Sterility Article: Laparoscopic treatment of endometriosis patients with failed in vitro fertilization cycles
– Stanford University Study: Surgery before IVF may prove more successful
TREATMENT OPTIONS: SURGERY: OVARIAN DRILLING
A surgical procedure called ovarian drilling, where small holes are made in the ovary, can increase the chances of conception, especially in women with PCOS. While it is not well understood why this is an effective treatment, the medical literature shows that there is indeed a measurable improvement in pregnancy rates after this procedure.
The following articles provide excellent overviews on the subject of ovarian drilling:
– Pregnancy rates increased after ovarian drilling
– Fertility drugs failed? Ovarian drilling correlated to high rate of successful outcomes
– Ovarian drilling helps patients with polycystic ovarian syndrome
– New Minimally Invasive Technique for Irregular Ovulation
Peer-reviewed ovarian drilling – article on pubmed
TREATMENT OPTIONS: TUBAL REVERSAL
Tubal reversal is a procedure in which the previously tied or blocked fallopian tubes are repaired and restored to be functional and open. This means that women can again have the chance to conceive naturally every month.
Dr. Nezhat performs the procedure on an outpatient basis and with minimally invasive surgery. His patients may return home the same day and resume regular activities within a week, compared to two or more days of hospital stay and four to six weeks of recovery after conventional (open) abdominal surgery.
Factors that influence success include age, coexisting infertility factors, as well as length and degree of previously damaged fallopian tubes. Around 70% of Dr. Nezhat’s patients may become pregnant within one year after the procedure.
TREATMENT OPTIONS: UTERINE RECONSTRUCTION
For patients with a uterine septum or intrauterine adhesions, surgery can be done to correct these. As mentioned, hysteroscopy, where a camera is placed inside the uterus, is used to visualize the septum or adhesions and remove them. This can increase chances of implantation. The procedure is done on an outpatient basis and patients can go home the same day.
TREATMENT OPTIONS: REPRODUCTIVE ENDOCRINOLOGY/HORMONE TREATMENTS
For patients who have ovulatory problems, there are many medications that can be used to stimulate the ovaries. Some are hormones themselves and others are aimed at getting the body to produce its own natural hormones. Medications include Clomid, aromatase inhibitors, and gonadotropins. Each of these medications is aimed at helping ovulation. These medications can be used to help with natural insemination, intrauterine insemination, or in vitro fertilization.
TREATMENT OPTIONS: IUI (INTRAUTERINE INSEMINATION)
Intrauterine insemination (IUI) is the placing of sperm into a woman’s uterus when she is ovulating. This procedure is commonly used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems.
The timing of IUI is crucial, as the insemination must be performed at the time of ovulation, which is usually within 24-36 hours after the LH surge is detected, or after the “trigger” injection of hCG (human chorionic gonadotropin) is administered.
If injectable ovulation stimulating drugs are used in an IUI cycle, careful monitoring is essential. Monitoring includes periodic blood tests and ultrasounds beginning around day 6 of the woman’s cycle. Results of these tests will indicate when eggs are mature, prompting the hCG shot.
Special procedures are also performed to ensure that sperm are in optimal condition. For example, the sperm undergo a process called washing. This involves cleansing the sperm of potentially toxic chemicals, which may cause adverse reactions in the uterus. Sperm separation is also performed. Separation selects out motile sperm from the man’s ejaculate and concentrates them into a small volume.
After these procedures are performed, the sperm is then deposited directly into the uterus using a small, soft catheter, which is passed through a speculum directly into the woman’s uterus.
IUI is a relatively quick and inexpensive procedure and is performed in the doctor’s office without any anesthesia. While many experience no pain, some women do report mild discomfort.
TREATMENT OPTIONS: IN-VITRO FERTILIZATION (IVF)
Dr. Nezhat can also help guide you through all of the IVF options available today. Please note that our center does not provide the entire range of IVF services. Therefore, be sure to let us know which IVF services you are interested in so that we can help direct you to the appropriate provider or institute.
Please see the below-listed for great overviews describing how even mild endometriosis can cause infertility:
TREATMENT OPTIONS: ALTERNATIVE-THERAPIES
A current trend in infertility treatment is to combine alternative therapies like yoga, acupuncture, hypnosis, and herbal supplements, with traditional medicine. While there are no well-designed studies that show these have a proven effect on fertility, yoga, acupuncture and hypnosis have been proven to help in relaxation and stress relief, which may provide some benefit. Herbal remedies are not recommended as they are not regulated by the FDA, can have unpredictable side effects, and actually interfere with some fertility treatments. Please consult your doctor before starting any alternative therapy.
SEND US YOUR QUESTIONS
To really understand what’s going on with your fertility health, a thorough in-office evaluation is necessary. Please take a look at the Getting Started section where we have outlined what to expect at your first in-person consultation.
However, if you just have a few general questions, please email us at firstname.lastname@example.org or call us at (650) 327-8778 (M-F, 8.30 AM – 5.00 PM) and we will try to answer as many questions over email as possible.