Treatment

We favor treatment plans that are time efficient and cost effective. Depending on the cause of infertility, treatment can begin with the most basic or the most advanced. For practical purpose treatment can be divided into three levels:

1. Ovulation Induction using Oral Medications such as clomiphene (Clomid, Serophene) or letrozole (Femara) with or without intrauterine insemination (IUI).
2. Super Ovulation Induction using Injectable Medications such as FSH (Bravelle, Follistim, Gonal-f) or HMG (Pergonal, Repronex) usually in combination with IUI.
3. Advanced Reproductive Technologies such as IVF and ICSI using autologous eggs or donor eggs.

At ARCC the Fertility Algorithm is as followed:

 

For couples who have severe male factor, stage 3 or 4 endometriosis, pelvic adhesions, or tubal damage as the cause of their infertility, IVF is the treatment of choice. Surgery to repair male factor (varicocele repair) or to open diseased tubes (tuboplasty) has very limited value, especially when the female partner is 35 or older. In our experience, the IVF option yields a higher rate of pregnancy and is more cost effective in these instances.

Operative laparoscopy is helpful in cases of suspected endometriosis. Endometriosis implants have been shown to secrete substances that can damage the integrity of the egg and sperm and impair the ability of the tubes to pick up the egg. Removal of endometriosis can increase the pregnancy rate during the first 6 to 8 months after surgery. In cases of hydrosalpinx (fluid-filled tubes), laparoscopic removal of the damaged tubes should be performed before IVF to prevent the toxic fluid from flowing into the uterus.

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