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Infertility Treatments
Fertility and Surgical Associates of California provides
comprehensive, state-of-the-art treatment for infertility. Each patient is
unique and we recommend treatment options following a thorough evaluation.
Here you will find descriptions of many of the treatment methods we use to treat
female infertility. We also offer testing and treatment for male
infertility.
Fertility medications
Sometimes treating infertility involves only
the administration of either oral or injectable medication,
many of which are designed to stimulate ovulation or cause a
woman to produce multiple eggs. Click here to learn
more about these medications.
Intrauterine Insemination (IUI)
Intrauterine
insemination, or IUI, refers to the placement of sperm
directly into the uterus. IUI is performed near the time of
ovulation and is a relatively simple procedure. Processed
sperm is placed directly into the uterus
using a small, flexible catheter. Infertility medications may
be recommended prior to insemination.
IUI is often recommended when the male has a low sperm count,
less than optimal sperm motility, or has erectile dysfunction
or some other medical condition that makes sexual intercourse
difficult. IUI may also be helpful if there is a problem with
a woman's cervical mucus and in some instances of unexplained
infertility.
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Stimulated High-Uterine/Transtubal Insemination (SHUTT)
We are pleased to announce continued
success with SHUTT, which was developed by Dr. Hubert at FSAC.
Instead of using standard insemination technique, a catheter
is introduced near the utero-tubal junction and sperm is
injected into each region where the fallopian tube joins the
uterus. This improves the likelihood of sperm-egg contact
and optimizes the timing for fertilization.
We have found that many patients conceive
following this modified insemination technique and do not
require IVF or GIFT. This technique does not have any increase
in side effects or cost beyond traditional insemination and
saves patients the time and expense of more elaborate
treatments.
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In-vitro
fertilization, embryo transfer (IVF-ET)
IVF-ET is a widely accepted treatment for
infertile couples that has been used worldwide since the early
1980s, with the first IVF baby born in England in 1978. The
staff at FSAC has had extensive training and success with
IVF-ET. Their research and clinical contributions to advances
in IVF-ET technologies have improved its successful use today.
IVF-ET involves the removal of human eggs, fertilization of
the eggs in the laboratory, and replacement of the fertilized
eggs (embryos) directly through the cervix into the uterine
cavity. The presence of functioning fallopian tubes is not a
requirement for IVF-ET and this technique was initially
designed for couples with tubal factor infertility. IVF-ET is
now also used for patients with endometriosis, unexplained
infertility, polycystic ovarian syndrome, and male
factor infertility.
More
about IVF >>
Gamete
Intrafallopian-Tube Transfer (GIFT) and Zygote
Intrafallopian-Tube Transfer (ZIFT)
Although uncommonly used
today, GIFT and ZIFT procedures may be the best option for
certain patients. In both cases, the woman
receives ovary stimulating medications prior to the
procedure. These procedures require laparoscopy and
anesthesia but they are done on an out-patient basis which
means the patient almost always goes home on the day of the
procedure. GIFT involves the placement of gametes (eggs and sperm) into the fallopian tube, where fertilization occurs naturally in the body.
GIFT requires normal fallopian tube function.
ZIFT can be thought of
as a cross between GIFT and IVF. Fertilization occurs in the
laboratory and the zygotes (fertilized eggs) are transferred back into the fallopian tubes. ZIFT is performed when documenting fertilization is critical, and where fallopian tube function is normal.
ZIFT involves the
placement of early cleavage stage embryos into the oviduct for
patients where a non-surgical cervical transfer is traumatic.
With the recent success
rates for IVF rivaling and surpassing GIFT or ZIFT, for most
patients GIFT or ZIFT is not necessary and they have the
simpler treatment of IVF which is lower cost and does not
require general anesthesia.
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Intracytoplasmic Sperm Injection (ICSI)
ICSI is a
micromanipulation technique whereby a single sperm is
injected into a mature egg. This is done to assist fertilization,
generally in cases of male factor infertility or prior poor
fertilization with standard IVF. Once fertilized, embryos
are cultures in the laboratory and subsequently transferred.
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Selective embryo transfer
Embryos produced under
laboratory conditions may be returned to the uterus on day
three, four, or five following egg retrieval. The day of
transfer is dependent on our ability to select the most viable
embryo(s). The number transferred is primarily dependent on
patient age, previous history, and patient
preference.
Serial embryo transfer
In serial embryo
transfer, the patient is implanted with two to four embryos on
day three, plus one or more on day five.
Blastocyst Transfer
Intended to increase the likelihood of
pregnancy and reduce the risk of a multiple
pregnancy, blastocyst culture and transfer may be recommended
for some patients. In this procedure,
the embryos grow in the lab for five days instead of three
days. This gives us additional time to evaluate the
embryos and implant only the ones most likely to result in a
viable pregnancy.
Assisted Hatching
A chemical procedure which erodes a small
opening in the protective coating (zona
pellucida) surrounding the embryos to assist the
hatching process prior to transfer on day three or four.
Embryo
Co-culture
Embryos are grown in the
presence of support cells obtained from the patient's own
follicle-granulosa
cells. Embryo Co-culture is performed in cases of poor embryo
development, or in patients who are poor responders to
fertility medication.
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Surgical Treatments
Often a first step is laparoscopy, a
minimally invasive procedure which allows the doctor to
visualize the reproductive system by inserting a scope through
a small abdominal incision. Laparoscopy can be
diagnostic (finding the problem) and/or therapeutic (treating
the problem). Endometriosis is one example of a condition that
can be treated during laparoscopy.
Infertility is frequently caused by blocked fallopian tubes
which keeps the sperm from meeting an egg. There are a number of surgical
procedures which may be recommended, depending on the location
of the blockage.
Hysteroscopy is used to diagnose
uterine abnormalities and remove uterine fibroids and
endometrial polyps, both of which can cause infertility.
Microsurgical tubal anastomosis is
performed to remove or repair a blocked or
damaged portion of the fallopian tube. If a portion of the
tube is removed, it is reattached (re-anastomosed) so that
eggs can travel from the ovary to the uterus. This procedure
is sometimes used to reverse a prior tubal ligation.
If a tube is blocked very close to the uterus
there is a non-surgical option available which is called tubal
cannulation. This is done using a combination of
hysteroscopy and x-ray to guide an instrument in an attempt to
unblock the area.
Pelvic
reconstructive surgery is done when a woman has anatomic
abnormalities which cannot be corrected using a laparoscopic
or microsurgical method.
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Other Services
Sonohysterography: Sometimes
called "fluid ultrasound," this diagnostic procedure
allows us to study the inside a woman's uterus by using a
small cervical catheter in conjunction with vaginal
ultrasound. The uterus is filled with sterile saline during
the procedure which allows good imaging and diagnosis of
uterine abnormalities.
In-vitro fertilization with coculture: Some embryos need a little
help to develop properly in the lab. These embryos are incubated
with a layer of support cells to more closely mimic the environment
of a fallopian tube. These special cells may secrete growth
factors to help embryos divide,
reduce embryo fragmentation, and improve the chance that
they will successfully implant in the uterus. This procedure
is beneficial for patients who have had prior unsuccessful IVF,
older patients, and those with less than ideal quality
embryos.
Sperm and Embryo Cryopreservation:
Embryo cryopreservation
(also known as embryo freezing) preserves embryos by cooling and storing them at
a very low temperature. These embryos can be thawed at a future date and
transferred to the uterus. Sperm may also be frozen
and stored for future use. This is sometimes called
"sperm banking" and is useful when a man has to
undergo chemotherapy or radiation therapy but would like to
retain the ability to have children in the future.
Anonymous donor banked sperm is also used for women whose
partners have no viable sperm or who wish to conceive on their
own.
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