Infertility Treatment Options

The fertility laboratory, Fertility Institute of Hawaii, is located in downtown Honolulu. Dr. John Frattarelli and Dr. Anatte Karmon are the board-certified fellowship-trained Reproductive Endocrinology and Infertility providers in Hawaii who see and treat fertility patients on the island of Oahu (Honolulu and Kailua), Big Island (Hilo and Kona), and Maui (Wailuku and Kahalui).

Though the causes of infertility are numerous and often complex, both male and female factors can be successfully addressed with many of today’s technologies. Our desire is to produce a pregnancy that will result in the birth of a normal child using methods that optimize the utilization of your emotional, financial and physical resources. Thus, we thoughtfully move into the treatment phase. Treatment options may include the use of ovulation induction agents to enhance the production of healthy eggs, minimally invasive surgery such as laparoscopy or hysteroscopy to correct anatomical abnormalities of the female pelvic organs; intrauterine insemination (IUI) of washed sperm that is precisely timed for when fertilization could occur, or more advanced care such as In Vitro Fertilization (IVF). Below are summaries of some of the more common treatments.

Ovulation Induction

The use of ovulation induction agents is one of the most commonly used treatments for many causes of infertility. Ovulation induction medications (commonly called “fertility drugs”) stimulate your ovaries to produce eggs during the treatment cycle. There are oral forms (Clomiphene and Letrozole) that provide a milder stimulation, and injectable forms (Follistim, Gonal-F, and Menopur) that potentially provide a more potent stimulation. Depending on your diagnosis and how aggressive your treatment plan needs to be, intrauterine insemination (IUI) may then be scheduled around the time of ovulation to achieve a pregnancy. To ensure the best chance for successful treatment, precise timing is required. In most cases, your progress will be evaluated through frequent monitoring with ultrasound and blood work. The ultrasounds allow us to visualize the growing follicle (containing the egg) and to ensure that the lining of your uterus is ready to receive a fertilized egg. The blood work tracks your hormonal response to the medication. The injectable ovulation induction medications are also used to control your follicle development in treatments when in vitro fertilization is to be performed.

Intrauterine Insemination (IUI)

Intrauterine Insemination is often used in conjunction with ovulation induction cycles. The underlying principle is to bypass the major loss points for sperm in the female reproductive tract (the vagina and cervix), so that more sperm may be placed closer to the “destination”. This allows more sperm to be in the proximity of the eggs. Insemination can be helpful in several situations. Sometimes fertility medications such as clomiphene citrate (Clomid) can actually change the viscosity of the cervical mucus, making it too thick for the sperm to swim up to the uterus. IUI can be useful for the treatment of mild to moderate male factor, especially those related to poor sperm function such as a low count or motility. To prepare for the IUI procedure, the sperm are carefully washed and separated from the seminal plasma so that the most motile and viable sperm are concentrated into a very small volume. Next, they are loaded into a small catheter and injected into the uterine cavity. This procedure can be performed using the partner’s sperm or that of a donor. The sperm takes 60-90 minutes to prepare, but the insemination takes just a few minutes. You can then go on with the rest of your day.

In Vitro Fertilization (IVF)

In vitro fertilization can be used as a primary therapy for some patients (severe sperm problems, occluded or damaged fallopian tubes, diminished ovarian function, for example) or as a treatment when more conservative therapies have failed. During in vitro fertilization, the ovaries are stimulated to produce multiple follicles. The eggs from those follicles are retrieved during an ultrasound guided procedure and then combined in the embryology laboratory. If fertilization occurs, the resulting embryos are allowed to grow for 3 to 6 days in the laboratory. At the appropriate time, an appropriate number of embryos are transferred in to the uterine cavity, where they hopefully will implant. There are a number of other procedures that can assist in making IVF successful, including intracytoplasmic sperm injection (ICSI), assisted hatching (AH), blastocyst culture, and pre-implantation genetic diagnosis (PGD).

Minimally Invasive Surgery

Laparoscopy provides the opportunity to examine a woman’s internal pelvic organs in a direct fashion, providing a great deal of information regarding the structural and functional relationships of the pelvic structures. This surgery is accomplished through the insertion of a long, thin lighted scope through a small incision (5-10 mm) in the belly-button. Other small incisions can be made to allow additional instruments to be placed in the abdomen so that manipulation of the structures and correction of abnormalities may occur. Due to the minimally invasive nature of laparoscopic procedures, they are usually done on an outpatient basis. However, many complex procedures can be accomplished laparoscopically, so they should never be considered as “minor surgery”.

Hysteroscopy is a surgical procedure that offers a direct view of the inside of the uterus and any abnormalities that may alter the inside of the endometrial cavity. It is accomplished by inserting a long, thin fiber-optic lighted tube through the cervix into the uterine cavity, while fluid expands the cavity to allow for visualization. Hysteroscopy allows for the precise localization of lesions and their surgical treatment with special instruments designed to be used through the hysteroscope.

Microsurgical Sterilization Reversal can be performed on women who have undergone tubal ligation but now desire further children. In many patients, the procedure can be performed on an outpatient basis. The procedure can be very successful for the appropriately selected patient. IVF can also be an effective option for these patients and, in many cases, the optimal therapy. Our reproductive endocrinologists are some of the most experienced in the world and will provide you with a thorough evaluation and recommend which is most appropriate for you.