Joliet, IL
815/730-1100
1515 Essington Road

 

 

Melrose Park, IL
708/681-7390
675 W. North Ave., Suite #212

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Infertility Treatment
Patient Education Resource

User ID: 730110001

Password: rhs815

Providing the highest
quality infertility treatment in a warm & friendly environment.

Dr. Marek Piekos
Dr. Anthony J. Caruso
Board Certified OB/GYN - Reproductive Endocrinologist

 

Fully Accredited by the College of American Pathologists (CAP) & the Clinical Laboratory Inspection Agency (CLIA)

Infertility is a problem that affects approximately 5 million people in the United States, or 10% of people of reproductive age.  The inability to conceive children can be devastating for a couple, but with new treatment options, many infertile couples can have children and complete their family.

 A couple is said to be infertile if they have been unable to conceive after one year of unprotected intercourse.  Infertility is caused by disease of the reproductive system, which interferes with conception.  About 40% of infertility may be attributed to a female factor, 40% to a male factor, and 20% is caused by a combination of problems.

Pregnancy Puzzle

Reproduction involves many factors, including healthy reproductive organs and a complex interplay of reproductive hormones.  The failure to ovulate and irregular ovulation account for about 30% of female infertility.  Other common causes are:

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Endocrine Problems
The ovaries, pituitary, hypothalamus, thyroid or adrenal glands fail to secrete specific hormones at the proper times.

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Structural Problems
Fallopian tubes may be blocked or damaged due to scarring from pelvic inflammatory disease, surgery or sexually transmitted diseases.

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Endometriosis or PCOS
(polycystic disease)

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Congenital malformations of the
reproductive organs

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Fibroid tumors of the
uterus

The most common male factor is the production of low-quantity or poor-quality sperm.  If the sperm arenít sufficiently motile, they wonít be able to move up the fallopian tubes.  

In some cases, the sperm lack receptors and canít bind to the egg.  In others, they lack an enzyme needed to break into the egg.  In others, the sperm may contain abnormal genetic material.  A semen analysis can reveal most abnormalities. 

An ART-ful Conception



Before the development of currently practiced assisted reproductive technologies (ART), infertile couples relied on adoption or the rare spontaneous pregnancy.  Today, thanks to modern science, two-thirds of all infertile couples that seek medical intervention eventually give birth. 

Treatment options for infertility vary and depend mostly on the diagnosis.  A basic infertility evaluation begins with a thorough medical history of the couple.  Both partners are interviewed together, and a physical examination is routinely done. 

Specific testing may be done, including blood tests for hormone levels, an ultrasound of the reproductive organs, an X-ray examination of the uterus and fallopian tubes and semen analysis.  A surgical technique called a laparoscopy which allows the surgeon to view the pelvic organs may also be performed.

Ninety percent of cases are treated with conventional therapies, including drugs and surgery.  When a woman doesnít ovulate or has an irregular cycle, she may benefit from fertility drugs such as Clomid that induce ovulation.  This is prescribed to stimulate the pituitary gland to produce hormones to stimulate the ovaries to ripen and release an egg.  About 80% of all women successfully ovulate when taking such medication.

While Clomid can be very effective, it should not be used for more than 3 to 6 months.  

If the medication doesnít induce ovulation, a more aggressive treatment plan may be appropriate.  Stronger injectable drugs that act directly on the ovaries, stimulating ovarian follicles to ripen and each release an egg, may be necessary.

Fertility drugs wonít help women whose fallopian tubes are blocked or damaged because the eggs cannot reach the uterus.  In these cases, surgery to unblock the tubes is an option. 

When the womanís tubes are clear for conception to occur, intrauterine insemination (IUI) is often recommended.  The ovaries are stimulated by fertility drugs to produce no more than three eggs; then, at the time of ovulation, a sample of fresh semen from either the womanís partner or a donor is prepared and placed high up in the uterus through a catheter. 

In gamete intrafallopian transfer (GIFT), the womanís eggs are retrieved from her ovaries and placed in a catheter with the male sperm.  Eggs and sperm are then injected directly into the fallopian tubes. 

The most widely practiced reproductive technique, however, is in vitro fertilization (IVF).  Fertility drugs are used to produce multiple eggs and are then retrieved from the ovary and fertilized in the laboratory with sperm.  A small selection of the resulting embryos are then implanted in the uterus.  Unlike IUI and GIFT, in vitro fertilization can be used to treat women with tubal damage. 

It is important to note that no one can be blamed for infertility, any more than you can be blamed for diabetes or heart disease.  Infertility is a disease process that can be diagnosed and successfully treated.  

The Infertility Work-up

If you suspect a fertility problem, the first step in getting help is a basic infertility evaluation by a reproductive endocrinologist/infertility specialist.  The goal of an infertility evaluation is to find out why you and your partner cannot conceive and to plan treatment options.

Infertility testing begins with basic, less invasive testing and proceeds to more sophisticated and complex testing, usually after the first-line testing has failed to uncover the cause of infertility.  The infertility work-up is used to help determine why conception isn't happening and determine what may be done to correct the problem:

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Is there a sperm problem?
One of the most important parts of the work-up is to identify if there is a sperm problem.  This may influence further testing of the woman or may indicate the need for the man to undergo treatment while the woman undergoes further testing.  

A semen analysis provides information about the volume of semen; the number of live sperm in the semen; the motility of the sperm; forward progression; and sperm morphology -- the shape and form of the sperm.

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Is there a problem with ovulation?
Tests for ovulatory status are designed to determine if egg development and ovulation are occurring regularly.  A woman with a history of irregular or absent periods may have ovulatory dysfunction.

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Can the egg and sperm unite?
Infertility may be caused by factors in either the man or the woman that make it difficult for the sperm and egg to come together.  Tests used to identify this kind of problem include cervical mucus testing, post-coital testing, antisperm antibody testing or a sperm penetration assay.  Other tests that may be used to identify structural defects, blockages or abnormalities of the uterus or fallopian tubes include hysterosalpingogram, laparascoopy, hysteroscopy and ultrasound.

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Can implantation occur and be maintained?
Infertility may be linked to problems in the development of the endometrium (uterine lining) and the hormones that work to maintain pregnancy, often referred to as luteal phase deficiency.  Tests to identify a luteal phase deficiency include an endometrial biopsy (a small tissue sample that helps determine if the uterine linings can maintain a pregnancy), ultrasound testing or progesterone level measurement.


Preconception Care

Preconception Care is strongly addressed. There are numerous lifestyle and environmental factors which can profoundly affect impact the ability to conceive and have a successful ongoing pregnancy. Preconception detoxification, testing and treatment, are urged and provided through various modalities

Polycystic Ovarian Syndrome (PCOS), Insulin Resistance (IR),

Polycystic Ovarian Syndrome (PCOS) also knows as Insulin Resistance (IR). If left untreated, PCOS can be the precursor to the metabolic syndrome. This condition affects both women and men and is associated with reproductive, cosmetic, emotional and medical co-morbidities. The incidence of this condition is rapidly increasing and is becoming epidemic in nature. The medical conditions which can be avoided include high blood pressure, elevated cholesterol, and central obesity, which can lead to cardiovascular conditions (heart attacks or strokes) and/or diabetes.

If you suspect a fertility problem, the first step in getting help is a basic infertility evaluation by a reproductive endocrinologist/infertility specialist.†The goal of an infertility evaluation is to find out why you and your partner cannot conceive and to plan treatment options.

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