The Infertility Diagnosis - Overview

The causes of infertility are numerous and complex. A precise diagnosis requires thorough and detailed examination. The encouraging news is that there are successful therapies for most male and female causes of infertility.

The initial consultation, with one of our infertility specialists, includes a detailed review of both partners' medical records and personal histories, as well as a complete physical examination of the female partner. Appropriate diagnostic tests are ordered for both as indicated, after a careful analysis of the couple’s clinical infertility needs.

Once a diagnosis is made, your physician will explain infertility treatment options, make specific recommendations and answer any questions you may have about the next steps in your care.

Basic Infertility Services

Many causes of male infertility and female infertility can be treated successfully with basic infertility procedures and treatments, including medication, hormonal therapy, or surgery. The most common are:

• Minimally Invasive Surgery (Laparoscopy, Hysteroscopy) – to correct or remove anatomical abnormalities that may affect a couple’s fertility.
  

• Ovulation Induction (OI) – the use of hormones to induce or regulate ovulation for the production of healthy eggs.
  

• Intrauterine Insemination (IUI) – often used in conjunction with OI, IUI is the preparation and placement of sperm directly into the uterus during ovulation, the precise time when fertilization is most likely to occur. Sperm washing, a technique employed prior to insertion, enhances sperm function and increases chances for successful conception.

Assisted Reproductive Technologies (ART)

When basic infertility treatments are not appropriate or they have been unsuccessful, your physician may recommend ART, sophisticated laboratory-based infertility techniques for couples who require advanced treatments to produce a pregnancy.

The most well known ART procedure, in vitro fertilization or IVF, relies on medication to stimulate the ovaries to produce multiple eggs. The eggs are then retrieved and united with sperm in the laboratory. If fertilization occurs, healthy embryos are transferred back into the uterus during the "fresh" IVF cycle. When more embryos are produced than needed for IVF, the extras can be frozen and transferred during a future cycle, known as frozen embryo transfer (FET).

Although IVF is highly effective for many couples, others may require additional procedures - known as micromanipulation - to assist fertilization and implantation. But even in these cases, Institute patients have a good chance for success. Institute scientists have either developed or contributed to the development of significant advances in reproductive science, including:

• ICSI (Intracytoplasmic Sperm Injection) – to promote fertilization, a single sperm is injected through the outer membrane of the egg. This method is very successful in overcoming problems related to male infertility.
  
• Assisted Hatching – to facilitate implantation, a small breach is made in the outer shell surrounding the egg, shortly before the embryo is placed in the uterus.
  
• Fragment Removal – to enhance development, so-called cell ‘fragments’ that may exist are removed from between the cells of an embryo.
  
• Ultrasound Guided Embryo Transfer – to allow direct visualization and optimal placement of embryos within the uterus, embryo transfer is assisted by ultrasound.
  
• Preimplantation Genetic Diagnosis – to identify genetic abnormalities in developing embryos, scientists remove and biopsy a single cell from the embryo and assess it for chromosomal abnormalities. Geneticists may also remove the polar body (a tiny cell genetically similar to the egg) before fertilization, a process called preconception genetic diagnosis. While affected embryos cannot be ‘cured,’ healthy ones can be selected for transfer.
  
• Cryopreservation – to preserve healthy embryos for future IVF cycles, couples may choose to have extra embryos frozen. This enables the woman to undergo a frozen embryo transfer (FET) cycle, which avoids additional hormonal treatments and the egg retrieval process.
  
• Single Sperm Freezing – to allow for cryopreservation of a single or a few sperm, they are placed inside a zona pellucida, the outer shell of an egg. This is used in cases where the male has no sperm in his semen, but a few can be retrieved surgically from testicular tissue. Inside the zona, the sperm can be safely frozen and quickly located after thaw, avoiding surgeries for subsequent cycles.

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