Our Services

Consultation and Diagnosis

When you come in to see us for the first time, Dr Witten will meet with you in his office. We ask that you send us any previous records ahead of time, so he will have gone over your history and any previous treatment. He will discuss your options and explain the course of action he thinks you should take. Dr. Witten will take the time to explain each step and answer any questions you may have. Any procedures necessary to help with the diagnosis are performed by Dr. Witten so he is right there to see the results and discuss them with you.

Next, you will meet with one of our nurses, Mickey or Carolyn. They will give you a packet of information to help you through this journey and schedule you for the next step of the process, which will vary according to your individual situation. We realize that this is a stressful time in your life and we strive to be available to you. Please know that you are not alone in your journey.

Infertility affects approximately 10 to 12 percent of couples at some time in their reproductive lives and the percentage increases as the female ages. A reproductively healthy couple having regular intercourse has about a 20% chance of conceiving each cycle. If the female is under the age of 35, a couple is usually considered infertile if pregnancy has not occurred after one year of unprotected, well-timed intercourse. Over the age of 35, the period is shortened to six months. A board certified reproductive endocrinologist is specially trained to recognize the causes of infertility that may be missed by someone who does not specialize in infertility treatment.

Some of the common causes of infertility are:

• Ovulatory Dysfunction: Failure to ovulate on a regular cycle
• Tubal Disease: Blockage or impairment of the fallopian tubes.
• Endometriosis: A condition where tissue similar to the lining of the uterus is found elsewhere in the body. Endometriosis lesions can be found anywhere in the pelvic cavity and can cause obstruction or blockage of the reproductive organs.
• Polycystic Ovary Syndrome (PCO): an endocrine disorder that may affect up to 10% of women and is a common cause of infertility. Symptoms may include lack of regular ovulation and/or menstruation, weight problems, extra hair on the face and body, acne, and thinning hair.
• Cervical Factor: Abnormal cervical mucous can prevent sperm from reaching the egg.
• Uterine Factors: Absent or malformed uterus, fibroids, polyps, and scar tissue can interfere with normal uterine function.
• Male Factor: Sperm defects are a contributing factor in approximately 47% of infertility cases.
• Unexplained Infertility: In some cases, the cause of infertility cannot be determined. IVF is often the preferred treatment because it allows observation and control of the fertilization process.

Ovulation Induction

Occasionally, a woman’s body does not produce mature eggs on its own during a monthly cycle. It may be necessary to use medication to help stimulate the maturation of one or more eggs. This is referred to as ovulation induction. Ovulation induction may be achieved by taking pills for several days during a cycle or may require alternate medication in the form of injections.

Intrauterine Insemination

Intrauterine Insemination is an office procedure where washed sperm are delivered directly into the uterus using a small catheter that is passed through the cervix. The procedure is relatively quick with very minimal discomfort. The cervical mucus, which can sometimes be hostile to the sperm, is completely bypassed. All of the sperm in the ejaculation are placed in the uterus as compared to the 1% (approximately) that make it during natural intercourse.

Artificial Insemination with Donor Sperm

Success in achieving a pregnancy depends on the quality of both the female egg and the male sperm. In some cases, treatment for male factor infertility is unsuccessful. Donor sperm from an approved sperm bank may be used in conjunction with intrauterine insemination (IUI). The sperm bank provides profiles on various proven sperm donors and a donor can be selected based upon his genetic and physical factors.

Assisted Reproductive Technologies (including IVF)

In vitro fertilization involves both the female and the male partners. Eggs are retrieved from the ovaries and are placed with the male partner’s sperm in a petri dish in a laboratory, where fertilization occurs to produce embryos. After the embryos have matured for several days in the laboratory, they are placed into the uterus for implantation and a pregnancy should result.

At the proper time in her cycle, the female partner is given hormone medication that should produce multiple eggs in each ovary. Egg production is monitored by a series of vaginal ultrasounds and blood tests. When the eggs are ready, the patient is sedated in the office, and the eggs are retrieved using an ultrasound guided needle through the vagina. The needle is advanced into the ovarian follicle and the eggs are aspirated into a test tube for transport to the lab. After the retrieval procedure, the patient spends a short time recovering and can then go home. Limited activity is recommended for a time.

Just prior to egg retrieval, the male partner’s sperm is obtained and processed. A suspension of the best population of sperm is added to the eggs for fertilization. If the quality of the sperm is very poor, ICSI (intracytoplasmic sperm injection) can be performed. When ICSI is used, a single sperm is captured in a needle-like pipet and is then injected directly into the egg to facilitate fertilization.

The eggs and sperm are monitored regularly to assess fertilization and the production of embryos. Embryos are allowed to mature for several days until they reach the blastocyst stage.

When the embryos are ready, 2 or 3 are transferred into the uterus using a small catheter threaded through the cervix. No sedation is required; the transfer takes approximately 10 minutes. After a short rest period, the patient can go home. Again, limited activity is recommended for a time. Any remaining embryos can be cryopreserved, or frozen, for possible use with another cycle.

Intracytoplasmic Sperm Injection

ICSI (Intracytoplasmic Sperm Injection) is performed in the laboratory when the quality or concentration of the sperm is very low and the possibility of fertilization of the eggs is unlikely. When the eggs are retrieved, one sperm is captured in a needle-like pipet. Using a microscope for viewing, the sperm is then directly injected into the egg. ICSI can be used to treat several sperm issues including low motility, low concentration, antisperm antibodies, prior failure to fertilize in IVF, and use of frozen sperm collected prior to cancer treatment. Although ICSI is very successful, the process may damage some eggs.

Preimplantation Genetic Diagnosis

PGD (Preimplantation Genetic Diagnosis) is a clinical diagnostic procedure used with IVF for testing human embryos for the presence of genetic abnormalities (inherited diseases), before transfer to the uterus and pregnancy. Only embryos that are shown to be free of the genetic disorders are transferred to the uterus. PGD is a major advance in treating infertility in couples who may have a genetic disorder.

Comparative Genomic Hybridization (CGH)

A genetic process that analyzes the chromosomal integrity of the egg or embryo prior to it being transferred to a woman’s uterus in the course of In Vitro Fertilization. CGH reveals whether an egg or embryo has the correct number of chromosomes. Too many or too few (referred to as “aneuploidy”) will result in either a non-viable embryo, a miscarriage or, if implanted and carried to term, a birth defect. Because aneuploidy is the most common cause of IVF failure, identifying viable embryos for transfer to the uterus can significantly boost birthrates for IVF.

Donor Egg

In some cases, disease or ovarian failure (including menopause) may diminish the ability to produce a fertilizable egg. Egg donation offers a realistic opportunity for pregnancy. Egg donation involves retrieving eggs from one woman (the donor), fertilizing them in the laboratory, and transferring the resulting embryos into the uterus of the recipient, who will carry the baby to term.

Hysteroscopy

The uterine cavity can be visualized by inserting a small optical tube called a hysteroscope, through the vagina and cervix. The uterus is filled with saline to enhance visualization. The physician can evaluate the size and depth of the uterus, the presence of abnormalities inside the uterus, the presence of polyps or adhesions, and the quality of the endometrium. The procedure is usually performed in the early half of a woman’s cycle and can be done in the office. It takes approximately 20 minutes.

Hysterosalpingogram

A hysterosalpingogram (HSG) is a procedure used to x-ray the uterine cavity and fallopian tubes. It is performed in the x-ray department and takes approximately 15 minutes. The patient is allowed to go home after the procedure. A thin catheter is passed through the cervix into the uterus. The uterine cavity and fallopian tubes are then flushed with an x-ray contrast dye (through the catheter). There may be some cramping associated with the injection of the dye. The movement of the dye is observed as it makes its way through the uterus into the fallopian tubes and spills into the pelvic area. An HSG can detect: an abnormally shaped uterine cavity, fibroid tumors, polyps, scar tissue, partially or completely blocked fallopian tubes, and normally shaped uterine cavity and tubes.

Follicular Cyst Aspiration

Typically, ovarian cysts are not disease related and disappear on their own. During ovulation, a follicle grows but fails to rupture and release an egg. It retains fluid and becomes a cyst. Ovarian cysts can cause a variety of symptoms including abnormal uterine bleeding, pelvic pain, and nausea and vomiting. An ovarian cyst can be drained in the office using a needle with ultrasound guidance. The procedure takes approximately 15 minutes.

Tubal Catheterization

When a blocked fallopian tube is discovered with a hysterosalpingogram (HSG), a tubal catheterization can be performed to correct the blockage. The procedure is performed in the x-ray department and takes approximately 20 minutes. The patient can go home after the procedure. Under fluoroscopic guidance, a thin balloon catheter is threaded through the cervix, uterus and into the affected fallopian tube. At the site of the blockage, the balloon is inflated, correcting the obstruction. The area is then flushed with an x-ray contrast dye to verify results. There is an 85 – 90% chance that a blocked tube will be opened. About 60% of those will still be open after 6 months, and 30 – 40 % will conceive.

Embryo Cryopreservation

Often, an IVF cycle will result in more embryos than can be used for that cycle. Extra embryos can be cryopreserved, or frozen, in liquid nitrogen at an extremely low temperature. They can then be saved for possible use in another otherwise natural cycle, sparing the patient from undergoing ovulation induction, egg retrieval, etc. Approximately 50% of frozen embryos will survive the thawing process.

Sperm Cryopreservation

Like embryos, sperm can also be cryopreserved, or frozen, in liquid nitrogen at an extremely low temperature where they can remain viable indefinitely. This can be useful for patients with poor sperm quality who are undergoing IVF. Several semen samples can be processed and added together to provide a specimen with a larger population of higher quality sperm. Patients undergoing cancer therapy or vasectomy may also choose sperm cryopreservation prior to their treatments.

Follicle Study Ultrasound

Each cycle, eggs mature in the ovaries within small sacs called follicles. It is important to monitor the formation of the follicles during the first half of the monthly cycle as the amount and size of the follicles tell the physician how many eggs are being produced by the body. Adjusting medication can regulate the number of eggs produced. A slender wand attached to an ultrasound machine is introduced into the vagina and directed towards the ovaries. The ovaries and follicles can be seen on a screen. Follicles are counted and measured and medication is adjusted accordingly. The procedure takes approximately 15 minutes in the office and causes very minimal discomfort.

Post-Coital Test

The post-coital test is used to assess the function of the sperm within the cervical mucus and is usually scheduled 1-2 days prior to ovulation. Several hours after the patient has intercourse, a small sample of the cervical mucus is examined under the microscope. The amount of sperm seen in the mucus and the quality of motility are evaluated. Cervical mucus that has an adverse effect on the function of the sperm can be associated with infertility.

Cultures

Occasionally a microorganism harbored in the reproductive tract can be the cause of infertility. Culture swabs of the area can give your physician valuable information regarding any unusual organisms.

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