Testing and Treatment Options

► Consultation – Facing a new doctor for the first time can be an intimidating experience, but the reproductive endocrinologists at the Fertility Center welcome the opportunity to meet you. You'll quickly feel at ease with their warm and open approach to understanding your medical history as well as your current concerns as they begin to explore what may bring you better health and reproductive success in the future. Sometimes nature just needs a little “push,” but in-depth options may be necessary. Your doctor will most likely advise tests and procedures to help him make a diagnosis and recommend a treatment plan. Because infertility strikes both men and women alike, the Fertility Center strongly encourages couples to visit our office together. 

► Unexplained Infertility – One out of every five couples with fertility challenges won’t be given any medical explanation why conception hasn't happened. Partners with unexplained infertility usually have normal ovulation, open fallopian tubes, no pelvic adhesions or endometriosis, high sperm counts, and frequent intercourse for a year or longer. Behind the scenes, though, egg or sperm quality could be poor, embryos may not be attaching to the uterine wall for implantation, hormones might be out of balance, or hidden infections could be impeding fertility. All these factors can be difficult to diagnosis, especially if conditions are intermittent. Finding a reproductive specialist is an important step in fighting back against unexplained infertility and understanding tests and approaches to targeting atypical fertility conditions. For many with unexplained infertility, in vitro fertilization is one way to eliminate a variety of conception variables – either with known or unknown fertility issues. When eggs and sperm are retrieved and combined in a laboratory outside the body, some of the steps of natural conception are eliminated or bypassed. Fertilization can be observed and confirmed. A developing embryo is evaluated for several days before being transferred to hopefully implant in the uterus and continue growing as a viable pregnancy.

► Recurrent Pregnancy Loss – One-third of women who conceive experience repeated miscarriages (also known as habitual or spontaneous abortions) of a fetus before 20 weeks of gestation. Contributing factors can be uterine malformation, cervical incompetence, chromosomal disorders, thyroid imbalances, diabetes, polycystic ovary syndrome, clotting issues, immune conditions, decreasing egg quality and progesterone deficiencies as well as lifestyle factors and infections.  While some cases continue to be a mystery, many are treatable. The Fertility Center's medical professionals are skilled at uncovering known roadblocks and finding alternative approaches, such as preimplantation genetic diagnosis and anticoagulant medications, to help women carry pregnancies to term. 

► Endometriosis and Polycystic Ovary Syndrome (PCOS) Therapy – Conditions that involve abnormal production of uterine tissue (or endometriosis) can cause painful, irregular periods and impede fertility. Another obstacle to conception can be changes in hormone levels that lead to the production of cysts on the ovaries (or polycystic ovaries). Recommended treatments used by our doctors involve lifestyle changes, anti-inflammatory drugs and other medications, birth control pills, hormone therapy and surgery. For more information about PCOS, click here.

► Semen Analysis – Information about sperm helps ensure that the most beneficial assisted reproduction steps are done at the proper time to help achieve fertilization of the eggs. About 40 percent of infertility issues are linked to sperm, so one of the first steps that doctors and specialists recommend is a semen analysis to explore the volume, count, movement and shape of the sperm. Many semen analyses are considered diagnostic tests and may be covered by insurance. The cost is typically less than $200 in the Chattanooga and Knoxville areas. A semen sample needs to be collected by masturbation into a sterile specimen container, and results are available within two weeks. Sperm is analyzed in two steps. A basic semen analysis shows how many total sperm are present (for example, 25 million), how many sperm are moving (motility), and how fast they are moving (speed). A strict criteria morphology semen analysis determines how many sperm are shaped normally. Additional semen tests sometimes are ordered if male-factor fertility issues become evident. For more information on semen analysis, click here.

► Hysterosalpingogram – Early on in the process of evaluating a woman's fertility, the possibility of blocked or malformed fallopian tubes is explored. If eggs do not travel through and exit the tubes, they cannot reach the sperm to be fertilized. The HSG method involves injecting dye into the uterus by means of a tiny catheter threaded through the cervix. Under x-ray, radio-opaque dye is observed filling the uterus and the tubes to see if the dye spills out the ends of the tubes. Any irregularities or scarring in the lining of the uterus also may be seen. The HSG procedure is done at a radiology surgery center near the Fertility Center. The best timing for the procedure is after a menstrual period ends but before ovulation begins. This test is optional for patients who will use in vitro fertilization procedures, which bypass the fallopian tubes.

► FemVue – FemVue is the first procedure for fallopian tube evaluation that can be performed in a physician’s office. A non-allergenic mixture of saline and air is introduced into the fallopian tubes and observed under ultrasound, allowing immediate feedback of tubal status. For women with difficulties becoming pregnant, the test can show whether or not the uterine cavity is normal and whether or not the fallopian tubes are open. It also will give a general picture of the condition of the tubes. For women with abnormal menstrual bleeding, structural problems in the uterus such as fibroids, polyps or scar tissue often can be identified. The procedure is done at the Fertility Center during the first half of the menstrual cycle.

► Saline-Infused Ultrasound – Another uterine evaluation procedure involves injecting saline solution into the womb via a tiny catheter placed through the cervix. The filling of the uterus is observed on ultrasound to confirm smooth walls and to identify any irregularities (such as fibroids, polyps or septums) that could hinder embryo implantation or pregnancy. The SIUS procedure is done at the Fertility Center and is relatively painless, but some patients report mild cramping. The best timing for the procedure is after a menstrual period ends but before ovulation begins. 

► Ovarian Stimulation – Ovulation problems are a common cause of female infertility and usually are related to hormone imbalances. Medications can be taken either by mouth or by needle injections to cause the ovaries to produce egg follicles and then release those follicles into the uterus. Also referred to as a “super ovulation cycle,” this fertility approach gives the body’s natural systems a “jump start” or push in the right direction. Patients are monitored closely with blood work and ultrasound scans throughout treatment to avoid overstimulation. Following stimulation, some couples attempt to conceive on their own through timed intercourse while others take the next assisted reproduction steps of intrauterine insemination or egg retrieval and in vitro fertilization.

► Myomectomy – The surgical removal of fibroids from the uterus allows the womb to be left in place and preserves fertility. A myomectomy can be done by three methods: a hysteroscopy through the vagina and into the uterus; a laparoscopy with one or more small incisions in the abdomen; or laparotomy with a larger incision in the abdomen. The size, location and number of fibroids dictate the appropriate method of removal.

► Tubal Reversal – A laparotomy procedure, which is typically done through an abdominal incision, sometimes can reverse a tubal ligation or repair a portion of the fallopian tube damaged by disease. The blocked or diseased portion of the tube is removed, and the two healthy ends of the tube are then joined. Other tubal procedures include: removing part of a fallopian tube that has developed a buildup of fluid; creating a new opening close to the ovary when the end of the fallopian tube is blocked by a buildup of fluid; and rebuilding the fringed ends of a tube that is partially blocked or has scar tissue preventing normal egg pickup. For more information on tubal reversal, cllck here.

► Intrauterine Insemination (IUI) – Sperm is collected manually, processed to increase concentration and activity, and transferred into the uterus by catheter near the time of ovulation, bypassing mucus and other possible barriers at the uterine entrance. From this point, the sperm is on its own to find and fertilize the eggs that are produced and released, either naturally or through medicated stimulation. This procedure is sometimes referred to as artificial insemination.

► In Vitro Fertilization (IVF) – Following ovarian stimulation, a woman’s eggs are retrieved under anesthesia. In the lab, the eggs are combined with sperm and observed to see if fertilization occurs to make an embryo (or embryos). The embryos stay under incubation for five or six days to allow for the natural selection process to show which embryos are the strongest and most healthy. One or more of the growing and dividing blastocycts may be transferred to the woman’s womb to hopefully implant (or attach to the uterine wall), resulting in a pregnancy. Progesterone supplements typically are used throughout the first trimester. To decrease the chances for a pregnancy with multiples, remaining embryos may be cryogenically preserved (or frozen) for use in subsequent cycles. Because IVF uterine transfer success rates typically exceed intrafallopian transfer results, the Fertility Center no longer performs GIFT (gamete) and ZIFT (zygote) procedures. For more information on IVF cycles, click here.

► Testicular Sperm Extraction – For men who have had a vasectomy or who have no living sperm evident in their ejaculate, viable sperm sometimes can be retrieved from the testes through aspiration or a testicular biopsy. In most cases, fertilization can be achieved through intracytoplasmic sperm injection prior to in vitro fertilization, but the quantity of sperm retrieved from an extraction is not sufficient for an intrauterine insemination. These extraction procedures include percutaneous epididymal sperm aspiration (PESA) and testicular epididymal sperm aspiration (TESA), both of which are performed by a urologist while a patient is under anesthesia

► Intracytoplasmic Sperm Injection (ICSI) – A single sperm is injected into each mature egg to assist or “force” fertilization. To learn more about micromanipulation, click here.

► Gender Selection – The Fertility Center recognizes the controversial nature of choosing a specific gender for pregnancy attempts or embryo cryopreservation. The doctors and staff respect each patient's right to make that choice and neither encourage nor discourage the use of sex-selection procedures in the laboratory for couples needing either family balancing or screening for chromosome-related diseases. Embryo genders are identified through the process of preimplantation genetic diagnosis (PGD) whether sex selection is needed or not.

► Preimplantation Genetic Diagnosis (PGD) – While in culture in the laboratory, a cell is removed from an embryo to determine genetic normality. For single-gene disorders, the cell can be used to test for one of more than 200 abnormalities such as sickle cell anemia and cystic fibrosis. Aneuploidy testing looks at nine out of 23 sets of chromosomes to check for abnormal numbers; those nine are linked to the majority of early miscarriages and to the most common birth defects including Down and Edward's syndromes. As a result, a couple undergoing IVF can ensure that transferred embryos are free of any identifiable and inheritable life-threatening or debilitating diseases. For more information about micromanipulation, click here.

► Assisted Hatching – When embryos have a thick zona (or outer protective layer), a small opening is created under a microscope to help the embryo break out and implant in the uterus after being transferred. For more information about micromanipulation, click here.

 ► Sexual Dysfunction Treatment – Physical and psychological causes of sexual dysfunction in both men and women can be identified, addressed and most often eliminated with counseling, medications, hormone therapy or injections, among other methods.

► Fertility Preservation – Young people as well as adults planning to undergo treatments for cancer or other conditions can have their eggs or sperm retrieved and cryogenically frozen and stored at the Fertility Center. For more information on egg freezing, click here. For details on sperm preservation, click here.