There are many valid approaches to the work up of a couple who have been unsuccessful in their attempts to become pregnant. While the angle of the approach to a fertility problem may vary from physician to physician, and from Center to Center, it is generally felt by us that there are certain “basics” to be investigated in nearly every couple with an infertility condition. These baseline studies may be slightly modified based on the initial history of the couple involved, but in general, the items presented here are considered very important to us in the study of nearly all couples.
There are a variety of viable techniques to working up a couple who have been unsuccessful in their attempts to conceive. While the approach to a reproductive problem may differ from doctor to doctor and centre to centre, we believe that there are certain “basics” that should be investigated in nearly every couple experiencing infertility. These baseline investigations may be slightly modified depending on the couple’s original history, but we consider the things described here to be very significant in the study of nearly all couples.
It’s vital to keep in mind that these are generic guidelines, and the studies described may not apply to every couple. These recommendations are based on the protocols in place at our Centers and are not intended to be used as a treatment plan. You should constantly try to acquire the best medical help possible and collaborate with your health care specialists to receive the best opinions on your workup. And, of course, if you choose to see us for a first evaluation, a second opinion, or after unsuccessful treatment elsewhere, we remain at your disposal at all times.
An Infertility Workup in Context
Prior having their first meeting at the Fertility Institutes, we require new patients to fill out a lengthy medical history questionnaire. These history forms are sent to patients ahead of time to give them enough time to fill them out at home and acquire the extremely extensive information required. We ask about the patient, the patient’s mother’s pregnancy (both husband and wife), the patient’s reproductive history, and the patient’s siblings, sisters, and immediate family members. We inquire about lifestyles and diets, as well as the history of “health food” consumption, vitamin history, and any previous usage of dietary supplements (herbs, etc.). There are also questions concerning probable occupational exposures to dangerous settings or substances, as well as high-stress situations. All of the aforementioned have been linked to possible negative impacts on fertility. A sexual history is gathered, and any misunderstandings or misinformation is addressed and cleared up.
We outline a rigorous, intensive diagnostic regimen after obtaining a complete history in order to arrive at a speedy diagnosis of the underlying reproductive problem. While numerous variations of the protocol are used to account for items discovered in the history, we always start with baseline investigations.
Treatment Options in Brief
Poor cervical mucus production due to previous cervical surgery (freezing, cone biopsy, LEEP), cervical antibodies developed against sperm, reduced sperm motility, and donor sperm implantation are some of the diseases that these procedures are used to cure. Intraperitoneal insemination (IPI) has a high pregnancy rate in certain women who have failed to conceive using other methods of insemination, and we always consider it before going on to more expensive and intrusive treatments. IPI involves injecting treated sperm directly into the pelvic cavity, where eggs are released, via the vaginal canal.
Inert density solutions are often used to prepare sperm for In Vitro Fertilization and associated procedures, and they have a high success rate. Though more expensive and time intensive than other sperm preparation procedures, it is the method used in nearly all of our conventional sperm preparations for artificial insemination. This approach yields a purer sperm sample with improved motility and fertilisation potential.
Our urologists and reproductive endocrinologists may successfully aspirate or extract sperm directly from various parts of the testicle, and then use that sperm to microinject (ICSI) a single sperm straight into the female’s retrieved eggs. Pregnancies and births can now be achieved using sperm from men who have had vasectomies, unsuccessful or failed vasectomy reversals, and men who lack the vas deferens, as well as those with extremely low sperm counts (less than 1 million), very poor motility (less than 2%), or, in some cases, no sperm motility or no sperm seen in the ejac. We provide detailed descriptions of these procedures over the phone, and you are welcome to contact for additional information. Electroejaculation techniques are also available for males who have ejaculatory dysfunction due to a variety of factors, including spinal cord injury. Disabled people have full access to all of our facilities. ADDITIONAL INFORMATION ON MESA, TESA, TESE, AND PESA
We are one of the largest users of native (natural) pulsatile infusion GnRH for the production of single healthy eggs in hypothalamic amenorrhea patients who do not ovulate on a regular basis. Very small dosages of fertility drugs can be supplied in small pulses around the clock using very small, portable automated infusion pumps. This procedure more closely resembles what happens in a “normal” cycle, and it virtually eliminates the possibility of multiple pregnancies.
Our programme is actively developing the harvest and culture of immature oocytes. We have yet to see any major positive outcomes from programmes that perform this approach. Our preliminary research has yielded promising results, but we will wait till further safety and outcome data is available before pursuing this treatment therapeutically. We regularly update our website and will keep you informed about new advances in the sector.
The Fertility Institutes have a track record of success when it comes to micromanipulation. In the Western United States, we had the first successful ICSI-derived pregnancy, as well as the first multiple pregnancy from entirely ICSI-derived embryos. Our ICSI success has been extended to males with sperm counts considerably below 1 million, as well as patients who had previously failed repeated IVF efforts with other programmes.
Through our affiliation with a prominent immunology laboratory, we can provide thorough pair tissue type compatibility testing. We collaborate closely with the country’s top immunologists and provide comprehensive laboratory testing, including preparation for and administration of paternal leukocyte immunisation, aspirin/heparin/prednisone protocols, and a variety of cutting-edge methods to both improve pregnancy outcomes and prevent pregnancy loss associated with advanced fertility procedures.