Treatment Options

Two different infertility programs or offices may vary tremendously in terms of their focus and these differences are often reflected in the treatment options that are presented and suggested to couples. For example, one program that focuses strongly on In Vitro Fertilization (IVF) may suggest this technologically advanced and very expensive treatment to most couples as a sort of panacea (universal cure) even when other reasonable and less expensive options are available. Another program may focus on other treatment options and suggest those procedures most of the time.

It is to your benefit to find an infertility office that offers the full range of infertility treatments and is willing to customize your management plan to best fit your own goals, desires, budget, insurance coverage, and schedule.

When a couple visits The NJ Center for Fertility and Reproductive Medicine for an infertility consultation, Dr. Eric Daiter reviews their history in detail. Information is collected on

ovulation, including

the menstrual cycle (regularity, duration, premenstrual symptoms) previous pregnancies and outcomes

previous techniques used to detect ovulation (basal body temperature charting, ovulation kits, luteal phase bloodwork, ultrasounds, endometrial biopsies)

prior hormone evaluations (assessment of the ovarian reserve, thyroid function tests, prolactin concentrations)
sperm, including

semen analyses (type of laboratory used, criteria for assessing the shape of the sperm, assessment of motility and/or forward progression)

previous pregnancies (in any relationship)

prior sperm function testing, urologic examination, hormone evaluation
the pelvic factor, including

history of pelvic pain with menses, intercourse or ovulation

history of abdominal surgery, pelvic infections, or IUD use

review of hysterosalpingogram report and films (if available)

postcoital test results

previous surgical treatment of gynecologic abnormalities

Initial testing of an infertile couple with no prior evaluation is to determine the occurrence of regular ovulation (usually a history of regular menses with premenstrual symptoms and biphasic basal temperature charting is adequate), the appearance of the sperm on semen analysis (Dr. Eric Daiter will often perform his own semen analysis if there is uncertainty with regard to prior semen testing), and the presence (or absence) of a pelvic factor using the less complex tests that are available (the postcoital test will determine if there is a sperm mucus interaction problem, the hysterosalpingogram can evaluate the shape of the uterine cavity and patency of the fallopian tubes). These tests can be completed within one menstrual cycle and may determine the cause of the fertility problem in 75-80% of infertile couples.

Infertility Treatments

Treating an ovulation dysfunction should be directed at correcting any identified hormonal cause (thyroid abnormality or excess circulating prolactin concentration). If no hormonal cause for an ovulation dysfunction is identified, use of fertility medications is often appropriate. Usually, a course of clomiphene citrate is initially attempted and if unsuccessful (at accomplishing ovulation) then controlled ovarian hyperstimulation (use of FSH containing medication to enhance the number of mature eggs per cycle) with intrauterine insemination (COH/IUI) is often recommended.

Treatment for an identified male factor varies with severity, IUI (or COH/IUI) is often effective for mild to moderate abnormalities and assisted fertilization (In Vitro Fertilization with IntraCytoplasmic Sperm Injection) results in good fertilization rates even when there is a severe abnormality.

Cervical mucus incompatibility (with sperm) is effectively bypassed with IUI. Proximal (fallopian) tubal occlusion can often be opened (treated) using selective catheterization under flouroscopy. Distal (fallopian) tubal occlusion or anatomic abnormalities identified within the uterine cavity (such as fibroids or endometrial polyps) often require surgical repair.

In the event that all of the initial testing is normal, or the couple has had a reasonable course of treatment for an identified problem without successfully achieving a pregnancy, Dr. Eric Daiter may suggest a pelvic evaluation (laparoscopy and hysteroscopy). These surgical procedures can be performed on an outpatient basis and may determine the majority (up to 75%) of the remaining fertility problems. Dr. Daiter attempts to repair any identified abnormality as it is found (endometriosis, pelvic adhesions and/or subtle problems within the uterine cavity) so that the woman does not need multiple surgical procedures. After surgical treatment of an identified pelvic factor, Dr. Daiter typically suggests 3-4 cycles of trying (timed intercourse) before moving to more aggressive management.

About 5-10% of infertile couples have no identified abnormality ("unexplained infertility") after this testing has been completed. Also, some couples do not become pregnant after all identified abnormalities have been appropriately treated. The two treatment options that have been shown to be useful for these couples are (1) controlled ovarian hyperstimulation (use of FSH containing medication to enhance the number of mature eggs per cycle) with intrauterine insemination (COH/IUI), and (2) In Vitro Fertilization (IVF). Generally, if 3-4 cycles of COH/IUI are unsuccessful then IVF is suggested.

For testimonials from patients and physicians who have worked with Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, click here.