Friday, March 29, 2024
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We aim to make dreams of parenthood
a reality for couples.

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Patient Evaluation

General
Before starting ART therapy, certain tests should be performed to ensure that conditions for successful pregnancy are optimal. You should have a complete physical exam, including breast exam and Pap smear, within one year. You should also start taking prenatal vitamins, which may reduce the risk of spine abnormalities (neural tube defects) in the baby. Women 40 and older should have a mammogram prior to ART therapy.

Blood Tests
General
We confirm the woman's blood type and screen for antibodies that could affect the health of a fetus. Documentation of immunity to rubella (German measles) and varicella (chickenpox) may also require a blood test. Rubella during pregnancy can cause serious harm to the fetus. We require blood tests for hepatitis and HIV (AIDS) for both the patient and her partner. We also require that patients be tested for syphilis (RPR). We also recommend testing for Cystic Fibrosis, a serious inherited disease affecting the respiratory system. Other genetic tests may be requested depending on your genetic background and history.

Ovarian Reserve Testing
A woman’s reproductive potential declines with age. This is reflected in the decreased ability to conceive (become pregnant) and an increase in the rate of spontaneous abortions (miscarriages). Although fecundity (the ability to achieve a pregnancy which results in a live birth) decreases in all women as they age, the precise age when a women can no longer conceive varies between individuals. Approximately one-third of couples in which the female partner is age 35 or older will have problems with fertility. It is estimated that two-thirds of women will not be able to get pregnant spontaneously by the age of 40. Several tests may be useful in assessing fertility potential in older patients. For those patients with poor fertility potential predictions, the use of donor eggs or embryos can be considered.

1) Day 3 Levels of FSH, LH, and Estradiol. The determination of blood concentrations of follicle stimulating hormone (FSH) and estradiol levels on menstrual cycle day 3 has been used to estimate fertility potential. Women with elevated levels of FSH and/or estradiol measurements on cycle day 3 have very poor pregnancy rates with both ovulation induction and assisted reproductive technologies (ART) such as in vitro fertilization (IVF). More recently, it has been shown that women with elevated blood levels of luteinizing hormone (LH) on cycle day 3 also have poor pregnancy outcomes with fertility therapy.

2) Clomiphene Citrate Challenge Test. This test entails the oral (by mouth) administration of 100 milligrams of clomiphene citrate on menstrual cycle days 5-9. Blood levels of FSH are measured on cycle day 3 and again on cycle day 10. Elevated blood levels of FSH on cycle day 3 or cycle day 10 are associated with very low pregnancy rates with both ovulation induction therapy and ART.

Semen
A complex semen analysis should be performed within one year of ART. Changes in sperm quality may occur over time that could affect ART therapy. The complex semen analysis checks for sperm number, shape, swimming ability, survival, significant infection, and antisperm antibodies. In some cases, additional semen testing may be recommended.

Uterus
We evaluate the anatomy of the uterus prior to ART. We may suggest an x-ray procedure (hysterosalpingogram - "HSG") ultrasound procedure (sonohysterogram or SIS), or hysteroscopy. An HSG is performed by injecting a special liquid through the cervix into the uterus. The liquid is visible on x-ray films and outlines the anatomy of the uterus and tubes. This is performed in a radiology suite and requires no anesthesia. An SIS is performed by injecting fluid into the uterus during transvaginal sonography. This procedure is performed in the office without anesthesia. Hysteroscopy involves insertion of a small telescope and light source through the cervix into the uterus to look for abnormalities. We may perform this procedure in the office using local anesthesia or in the operating room.
Prior to IVF/ET we also perform a uterine measurement called a trial transfer. The purpose of this procedure is to determine the length and direction of the uterine cavity. This enables us to guide the embryo transfer catheter into the proper position for the actual embryo transfer. Uterine measurement is similar to a pelvic exam or intrauterine insemination. Your physician will place a speculum in the vaginal and insert a thin, flexible plastic catheter through the cervix into the uterus. You may experience a small amount of cramping when the catheter goes through the cervix and again when the tip of the catheter touches the top of the uterine cavity. This cramping, which is similar to a mild menstrual cramp, should resolve within 30-60 seconds.