Fertility Treatments

Ovulation induction is often the first line of treatment for women who are not ovulating regularly (known as ovulatory dysfunction) which typically presents as irregular or absent periods. This treatment involves using oral or injectable medications to stimulate the ovaries to release one or more eggs.The most commonly used medications for ovulation induction are Clomiphene Citrate (Clomid) and Letrozole (Femara), which help recruit a dominant follicle for ovulation.
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‍How It Works:
Administration of ovulation medications being on cycle day 3-5 and are most often taken for a duration of 5 days. This is followed by ultrasound monitoring to ensure there is at least one dominant follicle that has been recruited. Once the follicle(s) reaches a mature size, a medication known as a “trigger shot” is used to reinforce ovulation followed and intercourse or intrauterine insemination (IUI) is timed accordingly.

Who is it for?

• Women with polycystic ovary syndrome (PCOS)
• Women with unexplained infertility (in combination with IUI)
• Women with ovulatory dysfunction

Intrauterine insemination (IUI), also known as artificial insemination, involves placing sperm directly into the uterus during the most fertile time of the woman’s cycle. This procedure increases the chances of sperm reaching the egg.

‍How It Works: Sperm is collected and washed in an embryology lab and placed in a syringe. Sperm is then inserted into the uterus using a thin catheter. This can be done with or without ovulation-inducing medications.

‍Who is it for?

• Couples with mild male factor infertility (mildly low sperm count or motility)
• Couples with unexplained infertility (in combination with superovulation)
• Women with mild endometriosis or cervical issues
• Same-sex female couples or single women using donor sperm

In vitro fertilization (IVF) is the most effective fertility treatment there is (with few exceptions of course). It involves retrieving eggs from the ovaries (after stimulating them), fertilizing the eggs with sperm in a lab, and transferring the resulting embryo(s) into the uterus.

Process (simplified):

• Ovarian Stimulation: Hormonal injectable medications are used to stimulate the ovaries to help grow the available cohort of follicles for that cycle.
• Egg Retrieval: Eggs are retrieved from the ovaries via a minimally invasive procedure using a needle to aspirate the content of each follicle under ultrasound guidance
• Fertilization: The eggs are fertilized with sperm in the lab (either via standard insemination or intracytoplasmic sperm injection- ICSI, where a single sperm is injected directly into the egg).
• Embryo Transfer: One or more embryos are transferred into the uterus either 3-5 days after retrieval or in a subsequent cycle after embryos have been frozen. Frozen embryo transfers are more commonly done over fresh embryo transfers, while awaiting genetic testing results for the embryos (called preimplantation genetic testing- PGT).

IVF success rates vary by age, with younger women typically experiencing higher success. It is also influenced by factors such as egg quality, sperm quality, whether or not there is uterine factor infertility and the lab used for treatment.

‍Who is it for?

• Couples with severe male factor infertility
• Women with blocked or damaged fallopian tubes
• Couples with unexplained infertility
• Women with endometriosis or recurrent pregnancy loss
• Women with advanced maternal age or diminished ovarian reserve
• Reciprocal IVF for same sex female couples
• Couples using third party reproduction (such as using a gestational carrier)

ICSI is a technique used in assisted reproductive technology (ART) to help increase fertilization rates. It was initially used to overcome severe male infertility. In this procedure, a single sperm is injected directly into an egg. It is now more commonly used routinely for most patients undergoing IVF.

How It Works: After egg retrieval, a highly skilled embryologist selects a single healthy appearing sperm and injects it into the egg. ICSI is especially useful when the sperm count or motility is low.

‍Who is it for?

• Men with low sperm count or poor sperm motility
• Couples with previously unsuccessful IVF cycles
• Men with sperm obtained surgically due to severe oligospermia or azoospermia (little to no sperm in the ejaculate)
• Previously frozen eggs being thawed