Infertility Diagnosis and Treatment

What to expect….

If you are at a point where you feel you should seek help, at first, it may feel overwhelming. Certainly, this is not something anyone expected to go through. Treatment varies from simple intervention to more advanced therapies. However, if you follow instructions and focus on doing your part, you will find that it is not as scary as it looks at first! This statement is an observation from Terry and Eddie’s personal journey, and Mandell’s 25+ years servicing fertility patients. At Mandell’s, we will work closely with your physician’s office to achieve the mutual goal of making this process as seamless as possible and ensuring that you have access to a trained professional 24/7 to help answer any questions and address any concerns.

At first, your physician will conduct a detailed consultation to document your medical history. It is important to be open and honest with your RE so that they have a clear picture of your particular condition. Depending on your history, age and other factors, your physician will then order blood work and tests.

Blood work will help determine any hormonal issues that you may have. Other tests that your doctor may consider may include a hysterosalpingoram, hysteroscopy, laparoscopy and/or a sonogram. An endometrial biopsy is another possibility. The male patient will undergo a semen analysis to identify any male factor issues.

Throughout your treatment, make sure to ask questions so that you understand all of your options. We have found that the well informed patient who takes an active role in her treatment and is well organized and prepared usually experiences less stress, which is an important factor. If you have any questions about your medication, make sure to contact your doctor, nurse or Mandell’s before administration. We are available 24/7 and would prefer to advise you before administration so that you are certain and confident during your treatment. Never hesitate to call us, we are here and always available to help!!

Your physician will determine whether you need a simple Clomid cycle, IUI, IVF or other treatment and will discuss your options with you.

Procedure Options

Intrauterine Insemination (IUI)

IUI is a procedure in which the sperm is introduced directly into the uterus at the right time in your cycle. This is the least invasive treatment and depending on your diagnosis and age, may be tried several times if pregnancy is not achieved right away.

Ovulation Induction

Ovulation induction involves stimulation of your ovaries to produce egg follicles by prescribing either clomiphene citrate or an injectable gonadotropin in order to stimulate your eggs to produce follicles.

Typically, a “trigger shot”, usually HCG, will facilitate ovulation approximately 34 hours after administration.

These patients are then either artificially inseminated or instructed to have sexual relations within a certain time frame in the hope of achieving a pregnancy.

In-Vitro Fertilization (IVF)

In-Vitro Fertilization involves the joining of egg and sperm outside of the body to create embryos which are then implanted, or “transferred” into the uterus. This treatment involves controlled ovarian hyperstimulation using injectable gonadotropins. The patient is very closely monitored during the entire cycle to determine egg development, as well as identify any complications that may arise from the use of these medications. A possible complication could be hyperstimulation. Ovarian Hyperstimulation Syndrome (OHSS) can occur when the medication causes enlargement of the ovaries due to an excessive amount of liquid in the ovaries. This is why during your cycle you will need frequent blood work and vaginal sonograms to monitor the size and progress of your ovaries and prevent complications. Your physician will adjust your dose of medication accordingly in order to prevent this condition. However, it can occur. Some symptoms of OHHS are nausea, vomiting, bloating, pain around the ovaries and diarrhea. If OHHS occurs, most cases are mild. In severe cases, the patient may, in addition, experience rapid weight gain of 5-10 pounds in one or 3 days. If you experience any of these symptoms, mild or severe, you should contact your physician immediately. If your symptoms are severe, you should seek immediate medical attention.

When your physician determines that the patient is ready to have her follicles retrieved, a “trigger” shot is administered to trigger ovulation in approximately 34 hours. The procedure is scheduled and the eggs are then removed from the ovaries in order to mix with the sperm. The patient begins to inject progesterone at this point in order to maintain the lining of the uterus. After 3-5 days, the embryos are implanted into the uterus and the waiting for results begins! In our experience, many patients report that this is actually the most difficult time of the entire treatment because of the emotional anticipation of the results.

Natural Cycle IVF – This type of IVF relies on the natural menstrual cycle, with little or no use of medications.   It is “natural” because it relies on the body’s own hormone regulation and often results in a single egg, which is then retrieved and treated in the same manner as IVF above.

Third Party Reproduction – This means, quite literally, that there is a “third party” directly involved in one or more steps of the IVF process –  most commonly this general term relates to egg donation, embryo donation, surrogacy and gestational carrier treatments.

Egg Donor Cycles

Patients who do not have the ovarian reserve or egg quality to yield a viable embryo may opt to use an egg from a young, healthy donor as a viable option. Patients who use a donor egg are referred to as the “recipient”. Egg donors are carefully screened and can be matched to a recipient by physical features, educational preferences, ethnic background and psychological profile. The donor may be anonymous or a person known to the recipient.

Treatment involves ovulation induction for the donor. The cycle of the donor and the recipient are synchronized so that the recipient takes medication to prepare the uterine lining to receive the embryo created by the donor, who undergoes ovulation induction. The donor egg and sperm are united to create an embryo which is then implanted into the recipient.

Using donor eggs has allowed thousands of couples to achieve their dream of creating a family.

Sperm Donation Cycles – Sperm donation is primarily used in two ways.  If there is no male partner present, sperm donation is used as a means of obtaining the male contribution of sperm to the creation of an embryo.  In other cases, there may be a male partner present but his sperm does not have the necessary quality to produce a viable embryo.

Gestational Carrier/Surrogacy – Gestational carriers are women who carry and deliver a baby for someone else.  The intended-parents are involved with the pregnancy, delivery and become the child’s parents once he or she is born.   Depending on the circumstances, the child’s can be genetically related to both, one or neither intended-parent.