1. Health

Diagnosing and Treating Infertility

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Updated July 20, 2009

How is diagnosis made?

A standard infertility workup is included in INCIID's fact sheet Basic Infertility Testing. The short answer is that specific hormone tests are done on day three of a woman's cycle and again on the day of LH surge. Additional tests for the woman include a transvaginal ultrasound to confirm follicle development and release, a hysterosalpinogram to determine that the uterus is normal and fallopian tubes are clear and open, and possibly a laparoscopy in cases where endometriosis is suspected. For men, a full sperm work-up is essential before any treatment protocol is initiated for the woman.

In cases of recurrent pregnancy loss or known implantation failure (after two unsuccessful ivf transfers), the couple should have a complete immune work-up, which includes about 30 specific tests available at only a few labs in the U.S.

How long will it take after testing, before diagnosis is made and treatments begin?

There is no universal answer to this question except, "it depends." In some cases, surgery may be required---to remove endometrial lesions, to repair a septate uterus, to repair a man's varicocele. In other cases, treatment may begin the very next cycle. Couples can hasten the process by timing their first visit with a fertility expert to coincide with the woman's cycle. The first round of hormone tests should be done on day two or three of her cycle. If that first appointment is on day 10 of her cycle, she'll have to wait until the next cycle to complete the testing process.

What are the most common treatments for infertility? Please describe the treatment procedures.

Unfortunately, the most common treatment prescribed by non-experts is Clomid, or clomiphene citrate. This is unfortunate because there is a 12-cycle lifetime maximum recommended use of Clomid, and many physicians prescribe this drug without first testing the male partner. Further, failure to monitor the woman using Clomid often makes its use highly questionable. In fact, in about one third of women who use it, Clomid is counterproductive, causing hostile cervical mucus which can kill sperm on contact.

This is not to say that Clomid is not a wonderful and effective drug for many couples suffering from infertility. However, Clomid use should always be administered and monitored by a practitioner who is experienced at treating infertility patients.

Only about eight percent of couples with a barrier to pregnancy move to IVF as their treatment protocol. This means that more than 90 percent are assisted with other, lower tech and less expensive treatments. Such treatments range from ovulation induction drugs to IntraUterine Inseminations (IUIs) to combos of the two.

What are some less common treatments?

Immunotherapy with IntraVenous ImmunoGlobulin (IvIg) is a "less common" treatment that is becoming more recognized and utilized.

What is the cost of treatment?

The cost of treatment varies depending on the diagnosis and resulting treatment protocol. Clomid alone can be about $100 a month, plus another $150 for an ultrasound and $75 for a progesterone level blood test. InVitro Fertilization (IVF) with intracytoplasmic sperm injection (ICSI), including meds, can be anywhere from $12,000 to $15,000.

How effective are various treatments?

Effectiveness of each treatment depends on its appropriateness for your diagnosis. If you're being treated with Clomid and no one ever checked to see if your tubes are open, you will have zero effectiveness. The same is true if the woman is being treated and no one ever checked to see if the husband has any sperm whatsoever. Also, untold women are being treated with intrauterine inseminations (IUIs) that are timed so outrageously that their only chance of getting pregnant is if they have normal intercourse and get lucky! If you are the first couple for which the embryologist is trying ICSI, you're chance of success is dwarfed compared to an embryologist who's done 1,000 cycles of ICSI.

Also, if you have an undiagnosed immune problem, you can have failed IVF cycle after failed IVF cycle. So, IVF for couples with immune problems will be wholly ineffective, yet it is extremely successful for couples with tube problems.

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