Infertility is a common problem for couples. Advanced Reproductive Medicine (ARM) is proud to offer a full spectrum of infertility services to meet the needs of our patients. Our clinical staff practice evidence-based medicine, meaning we base our recommendations for testing and therapy on the best available research evidence and what works best for an individual problem. We strive to avoid unnecessary tests and treatments. It is our belief that simple approaches such as medication treatment and/or insemination therapy are often successful. The staff works with patients and couples to try to find the simplest and most affordable treatment that will lead to a successful pregnancy.
Our infertility diagnosis and treatment plans are individually based after extensive discussion with the patients regarding the expected outcomes. We help patients find the “recipe” for them, rather than fit them into our recipe. We are up front with our patients regarding their chances of success, but are willing to give patients with limited success an opportunity to try treatment if the expected benefits outweigh the risks.
Even though our nursing and technical staff are outstanding, we do not leave the day-to-day management of your care to them. This is likely to be quite different from experiences at other clinics. We offer a full set of services, including services for single women and patients needing oocyte or sperm donation. With our university affiliation, we often treat patients and couples with very complex and difficult issues such as cancer or major medical problems. If needed, our clinical staff has immediate access to all the consultative services of other university physicians, such as maternal fetal medicine, cardiology, oncology, etc. Additionally, The Center for Integrative Medicine, located in the same building as ARM is closely affiliated with our practice – offering acupuncture and other treatments as needed or desired by our patients.
We understand that infertility testing and treatment can be emotionally draining and many infertile patients need support or benefit from counseling regarding infertility related decision-making. We recommend considering seeing one of our psychologists who specialize in support of individuals going through infertility treatment, and also offer participation in an infertility support group.
Sometimes a referral for outside counseling or psychotherapy is needed and we can help with this as well. We have two experienced Ph.D. psychologists on our staff. They are well versed in the different aspects of the fertility experience and can guide women and couples through the process.
Infertility Diagnosis & Testing
Infertility is a common problem for couples: diagnostic tests include both male and female components.
Our clinical staff practice evidence-based medicine, meaning we base our recommendations for testing and therapy on the best available research evidence and what works best for an individual problem.
With our university affiliation, we often treat patients and couples with very complex and difficult issues such as cancer or major medical problems.
Many infertile patients need support or benefit from counseling regarding infertility related decision making.
The first step in determining male infertility is to evaluate the sperm for numbers, movement, appearance and shape. Sperm problems can be caused by deficient production, blocked sperm ducts, hormone abnormalities, testicular trauma, and birth defects.
Ovarian Reserve Test
As part of a fertility evaluation, ovarian reserve tests check FSH, estradiol, anti-mullerian hormone and ovarian antral follicle count levels.
Testing the Uterus
A basic infertility evaluation should include an assessment of the uterus to check for irregularities such as uterine fibroids or polyps.
Blocked Fallopian Tubes and Tubal Factor Infertility
Blocked fallopian tubes are a common cause of infertility and an assessment for damage to discover this can be done through a hysterosalpingogram (HSG).
Hysterosalpingogram (HSG) Test
A hysterosalpingogram (HSG) test is an x-ray using special contrast liquid to determine if the uterine cavity has a normal shape and if the fallopian tubes are open.
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is an assisted reproduction technique that combines a man’s sperm and a woman’s egg outside of the body in a laboratory; then the resulting embryos are implanted back into the uterus. IVF has very high success rates and is used for many fertility issues.
This involves the use of mechanical or chemical thinning of the zona pellucida (outer shell) of the embryo. It is believed this outer shell becomes thicker and hardened with the aging of the oocyte. Assisted hatching is performed before transfer and may be beneficial for women older than 38, for women with thicker zona pellucidas, or for a couple with poor quality embryos. Assisted hatching may also be utilized for couples that have failed to achieve pregnancy after multiple IVF attempts.
Preimplantation Genetic Diagnosis (PGD)
PGD is a process to evaluate embryos for genetic disorders prior to implantation of the embryos in the uterus. The embryos are typically biopsied, a process in which one or two cells are removed at the eight-cell stage. These cells are then tested for specific genetic defects. The remaining portion of the embryo if free of disease is transferred to the uterus, typically on Day 5.
Intracytoplasmic sperm injection (ICSI)
ICSI is a procedure in which a single sperm is injected directly into the oocyte (egg). ICSI may be used for male factor infertility, poor quality oocytes, or unexplained infertility.
Donor Oocyte (egg)
Some women for a variety of reasons may not be able to use their own oocytes (eggs) for the IVF process. In these cases, oocytes donated from another woman (typically younger than 32 years old) may be an option. Candidates for oocyte donation include:
- women with premature menopause or ovarian failure
- congenital absence of the ovaries from birth (ovarian agenesis or dysgenesis)
- previous chemotherapy
- carriers of genetic disorders
- inadequate response to fertility drugs
- poor oocyte quality
- advanced age
Donor oocytes can be used for women age 50 or younger.
Some couples may choose to achieve pregnancy using embryos donated from other couples. The waiting process for donor embryos is often very long. We can refer you to agencies handling embryo donors.
Donor Sperm Insemination
The use of donor sperm to achieve pregnancy. Often used by single women or in married couples whose husband has no sperm, or who has a genetic disorder.
Intrauterine Insemination (IUI)/Artificial Insemination
Artificial insemination is often a highly effective means of bypassing infertility issues. The most common procedure used today is intrauterine insemination (IUI), which injects sperm directly into the woman’s uterus where they have easier access to the egg.
For IUI to succeed, the woman’s ovaries must be producing viable eggs and the fallopian tubes must be unblocked so that the injected sperm can reach and fertilize the egg.
Sperm retrieval surgical procedures can be used by some men to retrieve sperm when they have no sperm in their ejaculate.
Reproductive surgical procedures are utilized to increase fertility, decrease risk of miscarriage or correct congenital malformations or acquired diseases of the reproductive tract.
Ovulation induction uses fertility drugs to produce oocytes (eggs) and induce ovulation. Commonly, clomiphene citrate or gonadotropins are utilized.
Blastocyst Embryo Cultures
This is the growth of embryo to the blastocyst stage, usually Day 5.
Single Embryo Transfer
During IVF, only one embryo is transferred, typically at the blastocyst stage. This may be advisable for couples at risk of multiple births.
Menopause Evaluation and Treatment
Patients are evaluated for signs and symptoms of menopause or perimenopause. After evaluation, the physician will make recommendations for therapy. Options may include medication (such as hormone replacement therapy), alternative medicinal therapy, herbal therapy, bioidentical hormone therapy, or observation. The decision of which therapy to use is based on the patient’s individual needs and risk factors.
Endometriosis Diagnosis and Treatment
Endometriosis is a common cause of female infertility. Tissue that normally lines the inside of the uterus spreads to the abdominal cavity, often attaching itself to the reproductive organs within the woman’s pelvis. Patients with endometriosis are evaluated and treated with medical or surgical therapy. UCARM is involved in numerous research studies, which are trying new therapies for woman who have not had good success with conventional medical therapy.
Fibroids: Surgical and Non-surgical Management
Uterine fibroids are noncancerous growths in the uterus that can cause heavy bleeding and infertility if inside or very close to the uterine cavity. Fibroids can also grow very large inside the uterus, causing the cavity to be distorted. Fibroid treatment options available to women, such as hysteroscopy, can be discussed with patients.