Many couples find themselves hitting a bitter dead-end with their infertility care due to a lack of finances before conceiving a successful pregnancy. The steep cost of much of the care that is offered to them is based on an approach to care focused on In Vitro Fertilization/Assisted Reproductive Technologies (IVF/ART). However, there are other, very successful treatments offered by Reproductive Endocrinology and Infertility (REI) practices with excellent pregnancy rates that do not employ IVF/ART and are dramatically less costly. In so doing, couples that would otherwise be childless conceive successful pregnancies without the crushing financial burdens of IVF/ART.
Most infertility clinics offer treatment that is centered around their IVF/ART program. They offer services that are centered significantly or exclusively on treatment modalities involving these assisted reproductive technologies. One example is the emphasis on modalities such as sperm washing and intrauterine insemination (IUI) on all, routine cycles, even when there is no proven indication for this procedure. Many of the basic steps in evaluation and treatment of an infertile couple are rushed over so as to move the couple quickly into the IVF portion of their treatments. Patients are led to believe that these very expensive modalities, frequently costing more than $20,000 per monthly cycle, are their only options for achieving a healthy pregnancy. Desperate couples frequently expend great sums in terms of emotions, time and money, going deeply into debt in their quest for a child.
The traditional approach of a Reproductive Endocrinologist (REI) focuses on a thorough evaluation of the couple. Their fertility potential as a couple is evaluated, looking to identify the causes of their failure to conceive and then tailoring treatments to address the specific issues of each couple. This starts with a thorough review of the couples’ previous fertility records followed by an in-depth history and complete physical examination conducted by a knowledgeable REI. The results of these initial findings serve to guide in the ordering of further testing, including laboratory tests and radiologic studies.
Next, the three major causes of infertility, the male factor, the woman’s ovulations, and the woman’s anatomic condition, are each individually and simultaneously evaluated.
The woman’s ovulatory function is evaluated using a combination of basal body temperature charting, mid-cycle hormonal studies, ultrasounds, and post-coital testing to evaluate the maturity of the egg, the interaction between the woman’s cervical mucous and the man’s sperm, and the actual, mechanical release of an egg suitable for fertilization from the ovary. The adequacy of the hormones produced by the ovary after ovulation to sustain a pregnancy are then evaluated. Through serum progesterone levels, vaginal cytology and, ultimately, the maturity of the uterine lining on endometrial biopsy, the ability of that lining to nourish an early pregnancy is determined and assured. All these tests help to determine the quality and fertility of the egg that the woman develops each cycle. All can be addressed and improved.
The woman’s reproductive anatomic condition can also significantly impact her ability to conceive and carry a successful pregnancy. This evaluation begins with the initial physical examination and is followed up with either a hysterosalpingogram (an x-ray study where dye is injected through the vagina and cervix into the uterus and filling the fallopian tubes before spilling out into the abdominal cavity where it is quickly absorbed and filtered from the body through the kidneys) or a saline infusion sonogram (a vaginal ultrasound combined with sterile fluid being injected into the uterine cavity and spilling into the abdominal cavity). If there are abnormalities on either of these tests or if the woman’s history, symptoms, or physical findings would suggest that there may be endometriosis, pelvic adhesions, or uterine fibroids, then a diagnostic laparoscopy with operative capabilities would be performed to both diagnose and correct an abnormal anatomic condition.
The male factor, the third major area of investigation in the fertility evaluation of a couple, can initially be screened with either a semen analysis or a well-timed post-coital test (evaluating the presence of swimming sperm in the cervical mucous of the woman just prior to ovulation following timed intercourse). Depending on these findings, sperm washing and IUI may be indicated. When IUI is done routinely for all patients, the pregnancy rates increases minimally in each cycle. However, when done to specifically overcome an identified male factor or cervical mucous problem, the per cycle pregnancy rates increase dramatically (assuming that there are no other factors impeding pregnancy or, if there are, that they are corrected).
After these evaluations are completed, specific therapies that do not involve IVF/ART can be instituted. These treatments are tailored to the needs of the individual couples. Unlike IVF/ART, which is largely a “one size fits all” approach to fertility care, these therapeutic interventions are individualized with great success, depending on the condition, and significantly less expensive than the “one size fits all” approach of IVF/ART. These individualized therapies can include the treatment of hormonal imbalances that are adversely affect ovulatory function and ovulation induction tailored to the individual needs of each woman. Endometriosis, pelvic adhesions, and uterine fibroids can be treated by both surgical and non-surgical modalities. Male fertility issues can individually be optimized by medical treatments of the man and with sperm washing and IUI, when indicated.
Couples seeking this care want to look for physicians who are Reproductive Endocrinologists trained in and employing these classic fertility methods of diagnosis and treatment. The results of this approach, for many couples, are pregnancies that would never occur in the current IVF/ART fertility clinic.
If you have further questions, don’t hesitate to contact me via the e-mail link on this web page or calling my office at 856-429-2212.
Gerald V. Burke, M.D.