Once your initial evaluation has been completed, Dr. Zeringue will meet with you to discuss the findings and make individual recommendations. Since there is tremendous variability in the exact treatment that individuals receive, this section will be divided into generalized treatment categories. Below is a brief description of the different types of treatment. Click on the title to go to the page of interest where you will find more specific information.
Some couples complete their testing without any abnormalities identified. While this may be frustrating to be diagnosed as unexplained infertility, all hope is not lost. This simply means you have reached a point in your evaluation that the more common causes of infertility have been ruled out and the best course of action is to begin a coordinated attempt at pregnancy rather than continue to look for reasons why you are not pregnant. Without identified abnormalities during your evaluation you will likely have a very good chance of becoming pregnant.
Ovulation induction refers to the process of using medications to produce an egg or multiple eggs for the purpose of increasing a woman's chances of becoming pregnant. There are several techniques for stimulating the production of eggs. The main approaches to growing follicles include Clomiphene citrate, or Clomid, Injectable medications, or gonadotropins, and on occasion , letrozole, or Femara. Once the eggs are ready, there are several options for helping the sperm and egg get together. These options include intercourse, intrauterine insemination (IUI), and in vitro fertilization (IVF).
Clomid is an oral medication taken for 5 days that indirectly stimulates follicular development. This treatment requires the fallopian tubes be open as well as relatively good sperm parameters. This type of ovarian stimulation can be combined with home intercourse, cervical cup insemination, or intrauterine insemination. Donor sperm may be used also. Ovulation is usually triggered with HCG based on ultrasound monitoring though Clomid can be used without monitoring. A progesterone level may be drawn on cycle day 21 (or 7 days after suspected ovulation) as an indicator of ovulation if monitoring is not done. [More Information]
Controlled Ovarian Hyperstimulation (COH)
Technically Clomiphene citrate is a form of COH, however, the term COH is commonly used to mean ovarian stimulation with gonadotropins combined with ultrasound monitoring of the ovarian response. COH also involves the timed release of the oocytes based on ultrasound parameters. Since the oocytes are not retrieved in a COH cycle the fallopian tubes need to be open and the sperm parameters need to be adequate. COH can be combined with home intercourse, donor sperm insemination, or intrauterine insemination. [More Information]
After the preparation of the eggs, sperm must be introduced by one of several means. Intercourse offers the most natural way of fertilizing eggs but is usually associated with the lowest chance of a pregnancy. Intrauterine insemination, sometimes called artificial insemination, would be the next most effective treatment followed by in vitro fertilization. Additional information on each treatment can be found by clicking the bold title below.
Intrauterine Insemination (IUI)
IUI involves the preparation of the sperm for injection directly into the uterus. This allows the sperm to be concentrated to allow more sperm to enter the uterine cavity than happens normally. The sperm preparation process, or sperm washing, is designed to remove any debris or chemicals that would not normally enter the uterus. An IUI would also bypass any problems with abnormal cervical mucous, vaginal pH, or cervical stenosis (closed cervix). There is much concern about the environment of a woman's vagina killing the sperm though there is not a lot of evidence to support these concerns. Inseminations would bypass any of these factors if they were present. [more information]
In vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI)
IVF involves the stimulation of follicles with gonadotropins combined with ultrasound monitoring. HCG is used to prepare the oocytes for retrieval. Retrieval is performed by transvaginal needle aspiration before the oocytes are released into the abdomen. The oocytes are then combined with the sperm so that fertilization may occur. Techniques such as ICSI and assisted hatching require the IVF process. Patients with tubal factor infertility or male factor infertility will need IVF if the abnormalities are severe enough to preclude COH. Also, patients that have failed other therapies such as COH may be referred for IVF.
- In vitro Fertilization (IVF) [More Information]
- Intracytoplasmic sperm injection (ICSI) [More Information]
Donor Oocytes (eggs)
The donor oocyte program offers and alternative for patients who are unable to use their own oocytes to achieve pregnancy. This process requires the IVF procedure as described above as the egg donor must undergo the procedure to have her eggs collected. Oocyte donors receive compensation for their generosity. More detailed information is provided for both oocyte donors [here] and oocyte recipients [here].
Donor sperm is obtained from a sperm bank and used with IUI or IVF described above. Directed sperm donation from a friend can be used but is not advised due to legal concerns about parental rights. We can help you understand the process of finding a sperm bank and selecting a sperm donor during your initial visit. Donor sperm is an excellent option for single women or lesbian couples as well as couples where the man was found to have abnormal sperm counts, motility or morphology (shape of the sperm). [more information]
Fertility treatments are not always successful. As one of the alternatives to becoming pregnant, adoption can be very rewarding. There are many options available, including embryo adoption. Here you will find several links to resources on the internet. Please send your links to sites you have found useful and informative. [Adoption information and resources for California Patients including embryo adoption]
Child Free Living
If you have been unable to become pregnant and do not feel adoption is the alternative for you, there are many others like you that have found happiness. There are many organizations on the internet that can provide information about this option as well as helping you locate support groups. Be certain to fully understand your options for fertility treatments and adoption. Choosing child free living should be an active decision.
Selecting a Treatment
You will need an evaluation into the possible causes of infertility as well as an individualized assessment by an experienced infertility specialist. Our doctors will review your history and available treatment options in detail. Often there will be more than one option available. You will need to take into account the success of the infertility treatment, length of time it may take to achieve a pregnancy, and the estimated cost of the treatment. You can find out more about the costs associated with infertility treatments as well as insurance options here.