What Tests and Treatments Are Best Done Through My Fertility Specialist?

These tests are best done through your Reproductive Endocrinologist (fertility specialist):

• Strict sperm morphology Strict morphology is a very specific method of evaluating the shape of sperm. Most laboratories do not use strict criteria thus potentially missing a sperm problem. Our laboratory is staffed with embryologists trained to analyze sperm with these strict criteria.
• Evaluation of ovarian reserve
• Ultrasound A pelvic ultrasound is a very useful test when it is done at the appropriate time in the menstrual cycle. A few days prior to ovulation an ultrasound can evaluate ovulation, follicle growth, endometrial thickness and pattern, polyps, and fibroids. During menses is the best time to evaluate the ovary for cysts and endometriosis.
• Genetic testing Genetic testing is important in women with premature menopause and multiple miscarriages and men with very low sperm counts. Patients with a family history of a genetic disease can use genetic testing to determine if they are carriers of the disease. Universal genetic testing (Counsyl, www.counsyl.com) can be used to assess risk for certain genetic illnesses that run in families. If detected, Preimplantation Genetic Diagnosis (PGD) can help prevent genetic illness in your child.
• Insulin Women who have irregular periods and have been told they have Polycystic Ovary Syndrome (PCOS) should be evaluated by an REI. Testing can lead to more effective treatment.

Treatments by a fertility specialist The advanced training of an REI is helpful to provide the most successful treatments for infertility. Some of these treatments include:

• In vitro fertilization with embryo transfer (IVF, or IVF/ET),
• Fertility preservation
• Egg freezing
• Intracytoplasmic sperm injection (ICSI)
• Preimplantation genetic diagnosis (PGD)
• Ovulation induction
• Intrauterine insemination

A specialist is able to evaluate simpler treatments and finely tune them to make them more effective. For example, a specialist can monitor ovulation induction with clomiphene (Clomid) with ultrasound and blood tests. The vaginal ultrasound can be used to assess follicle development and endometrial pattern and thickness. Intrauterine inseminations can be done to bypass hostile mucus caused by clomiphene. The specialist can also help decide when to stop a particular treatment and/or proceed with more. Alternative medications like letrozole (Femara) are just as effective as clomiphene but have fewer side effects. Since letrozole is not approved by the FDA for marketing for fertility use, its use is generally restricted to specialty clinics, that is, REIs. Gonadotropins, the injectable drugs, for example Follistim, Gonal-F, Bravelle, and Menopur, are potent stimulants to the ovary. They are designed to produce multiple follicles, in order to improve pregnancy rates. Due to the risk of multiple pregnancy and overstimulation of the ovaries, the medications should be used only by experts in the field. Most of these treatments are performed by REIs in the United States. At Pacific Fertility Center, we bring a complete team of specialists together to focus on your fertility situation. With extensive backgrounds as REI specialists, embryologists, nurses, marriage and family therapists and financial counselors, we develop a single, integrated solution to your medical, psychological and financial needs. Please use our Ask the Experts resource if you have further questions. -- Philip Chenette, MD

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