Unexplained Infertility
Unexplained infertility" does not mean
undiagnosed infertility.
Unexplained infertility means that all known
diagnoses have been eliminated.
When a couple is diagnosed with
"unexplained infertility", a careful review is conducted of their entire
infertility
evaluation.
Each test is examined to ensure it was
performed correctly and is technically sound. The interpretation and/or
conclusion drawn from the results is also examined. Tests with questionable
results may be repeated. Further investigation of one or more questionable
factors may be conducted. If a thorough review still provides no clues or
leads, the next treatment strategy is empirical therapy.
Empirical
therapy is treatment based on observation or experience with other
infertile couples, rather than on conclusive evidence of what is wrong. The
justification for empirical therapy is that it frequently works. Through the
use of "Assisted Reproductive Technology" or ART, we join hormonal
therapy with a form of artificial insemination (i.e. intrauterine
insemination) or IVF.
The
purpose of ART is to enhance or bypass as many fertility factors as
possible. Sometimes these ART techniques are used to overcome known
deficiencies, such as using IVF to circumvent damaged fallopian tubes.
The
following are the diffferent levels of treatment based on your age as well as
prior history. Each level of treatment involves more time time commitment on
your part, but is also associated with a higher probability of preganancy.
There are Three Levels of Empirical
Therapy Treatments
Level 1 includes up to three cycles
of clomiphene combined with intrauterine insemination, using 100mg/day for 5
days starting on cycle day 5. Transvaginal ultrasound monitoring will be
performed. Usually there will be two or three follicles seen. Follicles are
fluid filled sacs which contain the eggs. Once the largest follicle is = 18 mm,
hCG is given as a single injection and intrauterine insemination with specially
prepared sperm is performed 24 to 36 hours later. It is also possible to
schedule the timing of the IUI based on urinary ovulation predictor kits.
Level 2 includes up to three cycles of gonadotropins combined with
intrauterine insemination. Gonadotropins (Gonal-F, Follistim, Bravelle,
Menopur, Repronex) are started on cycle day 3 and administered daily as
injections. Transvaginal ultrasound monitoring is begun after five days of
treatment and repeated every 1-2 days until 3-6 follicles reach a size of = 18
mm. hCG is given as an injection to induce ovulation and then intrauterine
insemination with prepared sperm is performed 24 to 36 hours later. The sperm
preparation is done at the Presbyterian ARTS facility and then brought to our
office for insemination.
Level 3 involves the use of IVF.
Gonadotropins are administered as in level 2, but with the addition of Lupron
injections. Transvaginal ultrasound and blood estradiol measurements are
done according to protocol, with hCG being administered when mature follicles
are detected. Transvaginal ultrasound-guided follicle aspiration is performed
36 hours later. The eggs from the follicles are fertilized with the husband's
sperm in the laboratory. This creates embryos which are then transferred into
the uterus 3-5 days later. With IVF, further diagnostic
information will be obtained, as we are able to observe the fertilization
ability of the sperm, and the embryo development prior to transfer. This
information may provide clues to a prior undiagnosed infertility factor.
|  | Fertility Specialists of
Dallas
Phone: 214.750.5500
Presbyterian Hospital of
Dallas
8230 Walnut Hill Lane Suite 300
Dallas, TX 75231
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Directions
Presbyterian Hospital of Plano
6300 W.
Parker Rd
Bldg II, Suite 424
Plano, TX 75093
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Texarkana Satellite
1002 Texas Blvd Suite 401
Texarkana, TX 75503
903.793.5500
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