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INFERTILITY

Definition: One year of unprotected intercourse without conception.
 
Approximately 10% of couples are affected by infertility
 
4 major causes of infertility: 1. Ovulatory Factors
                                             2. Tubal & Uterine Factors
                                             3. Male Factors
                                              4. Unknown
*A couple may be affected by more than one of the above factors.
 
 
Infertility Work-up
 

Test
When
Why
Where
Prep
Sonogram
Usually day 12
To check follicles, also rule out uterine or ovarian pathology
Office
None. Office will schedule
Bloodwork
Days 3 and 21
Check thyroid, prolactin, ovarian reserve, make sure ovulating
Lab (usually Suite 350, CNY Medical Center)
None. No appointment needed
HSG
Around Day 5
Make sure fallopian tubes are open, check for polyps, fibroids, or an abnormally shaped uterus
Crouse Radiology (2nd floor)
Take ibuprofen prior. Office will schedule
Semen Analysis
Anytime
Check sperm counts, volume, appearance, and motility
Andrology lab, 5th floor University Hospital
See paperwork
Laparoscopy
Anytime
Directly view uterus, tubes, and ovaries to look for scar tissue or endometriosis
Physicians Office Building
Given at surgical discussion appointment.

 
 
 
Infertility Treatments

Medication/Procedure
What is it
When
Side effects
Notes
Clomid
Oral medication, increases follicular maturation and ovulation
Usually days 3-7 or 5-9
Hot flashes, ovarian cysts, mood changes, 10% risk of multiple gestation
 
Ovidrel
Injected medication, induces ovulation
Around day 12-13, based on sonogram findings
Pain at injection site, abdominal pain, nausea, vomiting
Need to give self injection at home
Sonogram
Transvaginal ultrasound, checking for mature-appearing follicles
Usually day 12
Slight discomfort
 
IUI (Intrauterine insemination)
Either partner or donor prepared sperm is placed into the uterine cavity, via a speculum and catheter, done in the office
Usually day 14-15, depending on results of above
Cramping, possible spotting, slight chance of infection
Need to remain flat 30 minutes after insemination
Metformin
Medication use for diabetes, which can also help patients with Polycystic Ovary Syndrome to increase ovulation.
Three times a day continuously
Gastrointestinal upset: nausea, vomiting, diarrhea
 
Progesterone
Hormone to help develop the lining of the uterus
3 days after an IUI or ovulation
Fatigue, Bloating, Mood Changes
Can be given orally or vaginally

 
 
 
Sample Calendar

1
Call with menses to schedule HSG, sonogram, IUI
2
3
 
Day #3 labs
4
5
 
 
 
Clomid
6
 
HSG
 
Clomid
7
 
 
 
Clomid
8
 
Clomid
 
9
 
Clomid
10
11
12
 
Sonogram
13
14
 
Ovidrel
15
 
IUI
 
16
 
Start progesterone 3 days after IUI
17
18
19
20
21
 
Day #21 labs (not to be done the same month as Clomid)
22
 
 
 
23
24
25
26
27
28
29
 
 
 
30
 
Urine
pregnancy test
31
 
 
 
 

 
Tracking Ovulation
 
  1. BBT (Basal Body Temperature)-difficult to interpret but inexpensive and requires little effort. The patient takes her temperature at the same time each morning and records reading. Charts are available at our office.
  2. LH kits- At home urine tests for LH (a hormone that stimulates ovaries to release eggs). They are available over the counter and are more accurate than temperature charts.
  3. Progesterone- A blood test usually 7 days prior to menses.
  4. EMB (Endometrial Biopsy)-Measures effects of progesterone on uterine lining. (This test is not usually recommended)




739 Irving Avenue - Suite 530 Syracuse, NY 13210 Tel: 315-478-1158 - Fax: 315-478-3014

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