Infertility Diagnosis and Treatment
Infertility is defined as an inability to conceive after a year of sexual intercourse without any form of contraception. It is a condition that affects nearly 15 percent of all people at some point in their lives. There are many causes of infertility, and most can be diagnosed and treated. However the woman’s age is the most important factor in determining a couple’s probability for a successful pregnancy after age 35, and evaluation should not be delayed for a year.
Most treatment options involve simple office procedures, X-ray, bloodwork, and oral medications. Occasionally an outpatient laser surgical procedure is required. The most effective treatment for infertility is In Vitro Fertilization (IVF). However, only 3% of infertility patients require this advance reproductive technology. A referral to a reproductive endocrinologist is required for these procedures.
Reproductive Endocrinologists have special expertise in this area because they have three years of fellowship training after completing four years of obstetrics and gynecology residency. However, most infertile patients can be helped with less involved treatment.
Texas Gynecology and Laser Surgery Center provide a complete basic work-up for infertility in the female and male patient. A comprehensive history and physician exam identifies risk factors for infertility including a male factor, tubal factor, infectious, endometriosis, diminished ovarian reserve, anovulation, uterine factor, and progesterone deficits. Most of the time an initial work-up will consist of an X-ray test, blood work, and a semen analysis.
Factors that may affect sperm quality include:
- Veneral disease
- Drug use
- Excessive exposure to heat (chronic hot-tub exposure)
Factors affecting female infertility include:
- Age greater than 35 years old
- Exposure to radiation
- Venereal disease
- Prior abdominal surgery (particularly for ectopic pregnancy or endometriosis)
- Uterine fibroids
Endometriosis is a particularly challenging disease which can result in severe pain (especially during menstruation) and infertility. Although many medical treatment options are available, surgical intervention is sometimes necessary especially when infertility is a concern. Surgery is extremely challenging because the endometrial implants often invade into vital pelvic organs including peritoneum, ureters, bladder, rectum, bowel, fallopian tubes, ovaries, and pelvic nerves and vessels. The surgical dissection must be extremely meticulous so that all of the endometriosis can be removed without injuring any of these vital structures. In contrast, many women who have had surgery for endometriosis only have a diagnostic biopsy, rather than a true surgical resection of disease which usually does NOT result in improvement in pain or infertility.
Dr. Farnam has specialty training in fertility preserving, minimally invasive laser surgery for endometriosis. He performs complete peritoneal endometriosis resection which occasionally involves resection of endometriosis of the bladder, bowel, and appendix. He can also evaluate the integrity and function of the uterine tubes by microscopic visualization and with a dyeing procedure called chromopertubation. Dr. Farnam performs laparoscopic laser fibroid removal (Myomectomy), microsurgery to fix damaged tubes and tubal ligation reversal.
Dr. Farnam performs a micro-surgical tubal ligation reversal using the da Vinci Robot. An office consultation and physical exam are required to determine if a patient is a candidate for tubal ligation reversal. It is most helpful if the operative note from the original tubal ligation surgery is available for review. The success rate for this procedure is 65-75%. The average total cost for this procedure is approximately $10,000.