Infertility Information

Assisted Reproduction, or IVF and Embryo Transfer

Although these “high-tech” infertility treatments sound very complex and new, they are actually now a routine and very successful part of modern practice. The process has been used in humans since 1978, and infertility since 1981 in the United States. IVF works whether a couple has a low sperm count, blocked fallopian tubes, endometriosis, unexplained infertility, or a combination of multiple problems.

Basically IVF makes sure that the sperm fertilizes the eggs. The sperm does not have to travel through the cervix, uterus, and tubes; the egg does not have to come out of the ovary and travel through the tube. In addition, an embryo does not have to find its way from the tube to the uterus. The IVF lab overcomes all those obstacles. The only thing an embryo has to do is implant. “IVF even allows the embryologist (the doctor who grows and takes care the embryos) to select the highest quality embryos, those most likely to result in pregnancy, from among a group.” Selection is important because humans of all ages produce many poor quality embryos. Even in nature, only 25% of all human embryos from young women have a chance of implanting and ending up as successful births. In IVF natural hormones simulate the ovaries to produce many eggs since only half or less of all embryos are likely to succeed. The natural selection process is allowed to occur and embryo transfer is often done at the blastocyst stage (5 days after fertilization) to keep success rates high and multiple pregnancy rates low. Each couple’s chance of pregnancy depends upon the characteristics of the individuals involved. Overall, pregnancy rates can provide only an overall picture. A patient needs to know her particular chances of achieving pregnancy which can be determined by a fertility evaluation in our office. The majority of women seeking pregnancy will ultimately succeed with the currently available treatments.

Embryos placed in the uterus at the blastocyst stage have improved the success and safety of IVF. The field of fertility treatment offers many avenues to success, some as new as IVF, others much simpler. Our goal is the same: making parenthood a reality with minimum medical treatment, maximum safety, and, as always, the compassionate care you deserve.

Adhesions and Tubal Problems

Internal scar tissue, or adhesions, is a primary cause for decreased fertility. Adhesions can form after pelvic infections, endometriosis, prior abdominal or pelvic surgeries, or other prior injuries. As internal organs and tissues try unsuccessfully to repair themselves, adhesions form between pelvic organs such as the ovary or tube, reducing fertility. Thus, multiple surgical attempts to remove scar tissue around a woman’s pelvic organs are usually unsuccessful. Laparoscopic adhesion removal, if feasible, is now considered preferable; several studies have shown that this particular type of surgery may cause fewer adhesions to occur or reccur. Our infertility practice is now investigating surgical adhesion removal with concomitant use of a barrier device to prevent organs from adhering to one another as healing occurs.

Tubal problems such as obstruction (“blockage”) in the first segment (nearest to the uterus) or at the end of the end of the tube (nearest to the ovary) are also common infertility factors. Blockage in the first segment of the tube can often be removed by inserting a catheter (tube) into this portion of the fallopian tube. As infertility specialists, we are specially trained to perform this type of surgery.

Tubal obstruction at the end of the tube is much harder to treat surgically with significant success. Usually such obstruction is due to prior pelvic infections or surgery, and concomitant adhesions are present. Subsequent surgical repair faces two big hurdles: one being the removal of the adhesions, and the other being the functional quality of the tube itself. As mentioned above, adhesions often reform, binding the tube down or causing the obstruction to reform. We use additional barrier devices to prevent the adhesions from forming again and a significant improvement.

Additionally, however the damage that caused the tubal obstruction usually affects the internal working of the tube. Pelvic infections usually, destroy the tiny hairs (“cilia”) along the inside of the tube that help the eggs and sperm move along the tube. This makes the surgical opening of the tube unfavorable since the tube still may not work normally afterwards. A patient may believe that her surgery will enable her to conceive when, in reality, the damage remains or the risk of (“ectopic”) pregnancy is very high. Patients that have damage to “cilia” in the tube will require IVF.

Polycystic Ovarian Syndrome (PCOS)

PCOS, which affects an estimated 6-10% of women, is the most common cause of irregular menses in reproductive women and is a leading cause of infertility. In addition to irregular menses and infertility, symptoms may include excess facial hair growth, acne or oily skin, thinning of the scalp hair, and obesity or difficulty in maintaining normal weight. Most women with PCOS are thought to have insulin resistance and may be at risk for developing such diseases as diabetes and high blood pressure. PCOS is treatable, but not curable, by a combination of medications and changes in diet and exercise. Infertility caused by PCOS is additionally treated by oral or injectable medications to induce ovulation, and resulting pregnancy rates are typically very good.

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