The Center for Advanced Reproductive Medicine offers several therapies to help infertile couples have children. Treatment options for infertility are as varied as the sources of the problem itself. Each couple is unique in their circumstances and reasons for seeking assistance in getting pregnant. Dr. Burns offers insight to couples who have made the decision to seek medical help in conceiving. Patient history must be taken into account to determine eligibility for fertility therapy. For many women, in particular, getting pregnant is a central component of life. It is assumed that when she is ready to have a child, she will be able to do so. When consulting with a patient, he gives them a realistic assessment of their chances for success, outlining not only the course of treatment itself, but also the physical and emotional stresses that come with it.
Eighty-five to 90 percent of infertility cases can be treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. Sometimes surgery can be done to repair damage to a woman's ovaries, fallopian tubes or uterus if the damage is not severe. Likewise, male infertility may be corrected by surgery. Recent advancements in some fertility treatments, such as more oral drugs and an increased understanding of the role obesity plays in ovarian dysfunction, have helped to make treatment more accessible and effective.
Clomiphene citrate (Clomid, Serophene) is a relatively inexpensive drug which increases the stimulation of the ovary to begin production of a mature egg. The drug is taken by mouth for five days each month. Clomiphene therapy is initiated so that the woman ovulates around day 12-20 of a regular 26-35 day cycle. Ovulation can be timed with intercourse or intrauterine insemination (IUI). For an IUI, a sperm specimen is washed in order to recover all motile, normal sperm cells. These sperm cells are then placed in the uterine cavity using a small catheter at the time of ovulation, fertilization and embryo growth inside the body. For women whose only fertility problem is irregular or no ovulation at all, about 40 percent will become pregnant within six months of clomiphene treatments.
Cabell Huntington Hospital has a special in vitro fertilization laboratory in which the staff performs microscopic procedures such as sperm preparation for oocyte (egg) retrieval, embryo transfers and cryo-preservation of sperm and embryos. Two other special procedures to assist couples who are trying to have a baby include intracytoplasmic sperm injections for low sperm counts and assisted hatching, in which the egg shell is softened so it will implant in the uterus more easily.
In 1978, the world’s first “test tube baby” was born through the process now called in vitro fertilization. IVF is the most complicated and expensive form of infertility therapy. The procedure is often used when other simpler treatments have failed, in cases where there is severe tubal damage or male infertility.
In preparation for IVF, a woman follows a specific drug protocol. Typically she is put on birth control for 30 days to suppress her hormones. After approximately 10 days, she then receives daily injections for 10-20 days. During this period of time, she makes 4-6 office visits for ultrasound examination and blood testing. When testing indicates that the eggs are optimally developed, the eggs are removed from the woman's ovaries and placed in a culture dish with the man's sperm for fertilization. The eggs are examined the next day to see if they have become fertilized by the sperm and are properly dividing. These fertilized eggs (embryos) are then placed in the woman's uterus through a soft plastic catheter. The embryos may be transferred at two different times of development; on day 3, in which the embryo has 8 cells or day 5 when the embryo has 120 cells. Based on the patient’s age and medical history, the physician and embryologist will consult with the patient to determine the number of fertilized eggs to be transferred to the woman’s uterus. In vitro fertilization has the highest success rate per cycle of treatment of any fertility procedure.
This relatively new and highly effective treatment specifically addresses male infertility issues and is performed in a laboratory setting. Following a cycle of fertility drugs that are given to the woman to help produce multiple eggs, the eggs are removed. In the laboratory, a cluster of cells surrounding each egg is removed, allowing for better viewing and assessment of the egg’s maturity. ICSI involves the injection of a single sperm into an egg.
Treatment with In Vitro Fertilization is effective. However, there is always the chance that it may take more than one cycle to achieve pregnancy.
It is a goal of the Center to provide a level of service to any woman who wants to get pregnant. Fertility treatments can be expensive, with IVF utilizing injections as described above, ranking at the top at $12,000 per cycle. With fertility treatments becoming more common and as the options and techniques are improved, insurance coverage has improved in some cases. Each patient should check with her insurance carrier to determine which costs are covered.