Infertility as a Result of Adhesions

Sometimes, infertility can be traced to pelvic scarring and adhesions. Infertility is caused when abdominal adhesions prevent the fertilized egg from reaching the uterus. Adhesions around the fallopian tubes can also make it difficult for sperm to reach the ovum. Tubal ectopic pregnancy is very often traced to adhesions in or around the fallopian tubes. Surgical intervention is needed to remove the adhesions which may be causing infertility.

What are Adhesions?
Adhesions or injuries are a type of scar tissue that may form between organs and tissues after a surgical procedure. Adhesions that form after surgery in the pelvic area and after surgeries to remove fibroids are among the leading causes of post-operative infertility. The main cause of intrauterine adhesions is trauma to the uterine cavity following a D&C procedure, prolonged use of an intrauterine device (IUD), endometritis and removal of fibroids in the uterus.

These injuries are typically caused by cauterization, suturing, and abrading tissues and organs during surgery. This internal trauma may lead to infertility and other issues. Once formed, adhesions need to be surgically removed. This means that adhesions that form in one surgery may require future surgery to cut through them to correct infertility or other complications.

Diagnosing Adhesions

Intrauterine adhesions may be diagnosed using an x-ray procedure called hysterosalpingography (HSG). Hysteroscopy is also another method of diagnosis where a hysteroscope (a thin telescope-like instrument) is inserted through the cervix to allow direct visualization of the uterine cavity. Both HSG and hysteroscopy can be performed without general anesthesia.

How are Adhesions removed?

Generally, trauma caused by intrauterine adhesions is removed with hysteroscopic guidance using instruments such as a laser, electrocautery device, or scissors. They are inserted through small incisions. Pelvic adhesions may sometimes be treated by laparoscopy. A laparoscopy is conducted under general anesthesia where the laparoscope is inserted into the pelvic cavity through a tiny incision made just below the woman's navel. After the adhesions are removed, surgeons recommend placing a device such as a plastic catheter temporarily inside the uterus to prevent the adhesions from forming again. Hormonal treatment with progestins estrogens and non-steroidal anti-inflammatory medications are prescribed post surgery to lessen the chance of adhesion reformation.

Conception Chances

After treatment it is seen that patients with mild to moderate adhesions have full-term pregnancy rates of around 70 to 80 percent. Patients with severe adhesions may only have full-term pregnancy rates in the 20 to 40 percent range after treatment. In-vitro fertilization (IVF) is ideally suited for women with blocked fallopian tubes or pelvic adhesions.

East Bay Fertility Center specializes in the comprehensive evaluation and treatment of infertility providing a complete mind-body experience for fertility couples. The Center performs extensive tests to find out the cause of infertility that also includes investigating suspected adhesions in the uterine cavity. Call 925.828.9235 for a free initial consultation.

Testosterone Testing during Infertility Treatment

Testosterone levels are an important factor in fertility. When infertility is suspected, testosterone testing may be recommended for both partners. It involves a blood test and in the male, the test primarily looks for a lower than normal level of testosterone since sufficient testosterone is absolutely critical for normal sperm production. A testosterone test may be used to see whether a problem with the testicles or pituitary gland is preventing a man from being able to father a child. If the testosterone level is abnormal that could also be the reason for erectile dysfunction. Low testosterone may be caused by an underlying hormonal problem such as a pituitary problem, a disease affecting the testes, or physical damage to the testes. Damage may be caused by physical injury, chronic alcohol abuse or a history of mumps.

Testosterone Testing in Women
Testosterone was once considered an exclusively male hormone; but research over the past decade has shown that this hormone also plays a crucial role in women's physical and psychological health. Endocrine abnormalities like increased testosterone levels are factors that affect female fertility.

A blood test to determine testosterone levels is recommended if a woman has irregular periods or none at all. Most of the testosterone in the blood is bound to a protein called sex hormone binding globulin (SHBG). Obesity or hyperthyroidism could lead to increased SHBG levels and therefore, "Free" testosterone may be checked when such conditions are present.

Testosterone and Infertility
Testosterone has an indirect impact on female fertility and female testosterone levels can be an indication for certain conditions that can cause female infertility. High testosterone caused by low estrogen or by ovarian cancer in females may be the root cause for many infertility related issues. Polycystic ovarian syndrome (PCOS) is another possible cause. Another symptom is anovulation (not producing mature egg cells), which leads to infertility. High testosterone does not cause infertility, but testosterone levels can rise in women because of tumors that develop in the ovaries or PCOS.

East Bay Fertility Center California, offers a wide range of infertility treatments along with expert medical counseling to couples facing difficulty in conceiving. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues. With the right type of treatment and intervention, the Center assists couples who have been having problems conceiving to overcome those difficulties in the shortest possible time in order to realize their dreams of having a healthy baby. Call 925.828.9235 for a free initial consultation.

Endometrial Biopsy during Infertility Investigation

In the course of infertility assessment, an endometrial biopsy is one diagnostic tool used to investigate hormonal imbalances that can lead to irregular cycles, frequent miscarriages, or even irregular uterine bleeding. It is indicated when diseases of the endometrium are suspected to be the cause of the infertility and also to find out how ready the endometrium is to accept the implantation of an embryo. The test analyzes whether the lining of a woman’s uterus can support a pregnancy. During an endometrial biopsy a soft, straw-like device (pipelle) or any other pliable instrument is used to suction a small sample of lining from the uterus. The endometrial lining is then analyzed in a lab for abnormal cells.

Problems with the endometrium are called “luteal phase defect", which is a hormonal disorder. An endometrial biopsy checks to see if the endometrium can support implantation and growth of a fertilized egg. The entire procedure takes less than 10 minutes and is far less invasive than a hysteroscopic procedure. The biopsy is usually done about three days before the start of the period. Prior to the biopsy, if a pregnancy is suspected, a pregnancy test must be done to rule out this possibility.

Endometrial biopsy and Infertility
In women with infertility issues, it is very important to know what causes this infertility. The outcome of an endometrial biopsy may determine whether there exists a progesterone deficiency, an estrogen deficiency, or a luteinizing hormone (LH) deficiency. Depending on the hormonal imbalance, a hormone supplement or a prescription drug may be recommended. The test can also be used to check for infection and if this is discovered, a D&C may be needed and/or treatment with antibiotics.

Thus an endometrial biopsy is sometimes necessary to determine the cause of infertility and in some cases the infertility can be reversed. This is a useful tool to detect hormone imbalance that may be the cause of infertility and the doctor will usually prescribe progesterone to relieve it. Thus by performing the simple endometrial biopsy for infertility, a couple may have well taken the first step towards having a child.

East Bay fertility clinic specializes in the comprehensive evaluation and treatment of infertility. Their experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. A former infertility patient herself, Dr. Snowden brings to her patients a rare and valuable firsthand empathy for the personal pain and emotional stress of dealing with infertility. Call 925.828.9235 for a free initial consultation.

Dealing with High-FSH levels and Pregnancy

Follicle Stimulating Hormone (FSH) stimulates the female ovaries to produce a mature egg for fertilization. By measuring a woman's FSH levels, doctors get an indication of the quantity of the woman’s eggs remaining as well as her chances of having a successful pregnancy. Eggs are not replaceable as a woman is born with all of the eggs she will ever have. As she ages, the quality and quantity of the eggs decreases.

Declining ovarian function is indicated by an elevation of FSH levels. Increased levels are seen in primary or premature ovarian failure, sometimes referred to as early menopause. FSH levels are usually checked around cycle day three. The tests may show a rise or fall in FSH levels over a couple of months. A rise is an indication of a problem with a woman’s ovarian egg supply, leading to difficulties in treating infertility. This however does not mean that a woman with high FSH levels cannot get pregnant. Checking FSH levels assists in deciding upon treatment options. Along with FSH level, Estradiol levels are also tested since they are indicators of ovarian reserve.

By measuring the amount of FSH, doctors can suggest specific treatments (such as in-vitro fertilization or intrauterine insemination) that could maximize the chances of becoming pregnant. Assisted hatching in IVF is also an option for women with elevated basal FSH levels who may also have a thickened wall around the egg called the zona.

Can FSH Levels be lowered?

FSH can be artificially suppressed by taking birth control pills or synthetic estrogen. However there are mixed reports whether these options are really beneficial. Research is currently underway to find a way of using stem cells to either create egg cells or to fabricate eggs using donated egg material and the woman’s DNA.

High FSH Levels – What they could mean

High FSH levels correlate with poor pregnancy rates. A normal FSH level is usually under 10, whereas an abnormal level is anything above 25. Measurements between 10 and 25 are generally considered to be borderline cases. FSH levels vary a bit across laboratories depending on which assay system is used. It’s best to retest the FSH in the new RE’s lab so that there is no confusion.

High FSH levels warrant an immediate treatment regimen since even a short delay in treatment could mean the difference between conceiving and not conceiving. This condition is also a case for considering using an egg donor.

For women, in their 20s or early 30s, high FSH may be due to immune abnormalities or an undetected infection. Sometimes the level returns to normalcy on its own. However the high FSH levels that occur in women age 38 and older are unlikely to be reversible.

East Bay fertility Center Dublin California, specializes in the comprehensive evaluation and treatment of infertility providing a complete mind-body experience for fertility couples. East Bay’s experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. East Bay Fertility Center conducts FSH tests in the course of infertility tests to check the ovarian egg supply and recommends the best possible course of treatment.

Call 925.828.9235 for a free initial consultation.

Assisted Hatching – Conception Option for Older Women

Assisted hatching is a good option for couples experiencing poor IVF outcomes or who have been diagnosed with a poor fertility prognosis. The procedure offers them a better chance for conception. It is a technique where an embryo is fertilized outside the womb via IVF and the zona pellucida or outer coating of an embryo is partially opened so as to assist the embryo to escape or hatch from the zona and improve implantation and pregnancy rates.

Sometimes IVF may not lead to positive results because of genetic abnormalities of embryos and abnormalities of the zona pellucida which may impair embryonic hatching.

Assisted hatching helps in overcoming these conditions.
Assisted hatching is recommended in case of advanced maternal age, for those who have had a number of unsuccessful embryo transfers and where embryos have increased zona thickness.

How Assisted Hatching is Performed
Assisted hatching is a very delicate procedure and can be performed only by a skilled micromanipulator or an embryologist. The embryo is held with a specialized holding pipette and a very delicate, hollow needle is used to expel an acidic solution against the outer shell or zona pellucida of the embryo. A small hole is made in the shell by the acidic solution and the embryo is then washed and put back in the incubator. Shortly afterwards, the embryo transfer procedure is initiated. This procedure may be accomplished chemically, mechanically, or with a laser.

Risks Associated with Assisted Hatching
Those opting for assisted hatching should be made aware of some of the risks associated with this procedure:
• A small risk exists of damage to the embryo during the micromanipulation process or at the time of transfer
• Risk of identical twins and in rare cases Siamese twins
• A greater chance of fetal complications
• It does add extra laboratory manipulation and therefore added costs

East Bay Fertility Center offers several IVF techniques, including assisted hatching in select appropriate cases. The Center assesses the possible benefits of assisted hatching before finalizing the process as part of a treatment plan. The patient is made aware of the risks and benefits of the procedure and consent must be given for an embryologist to use assisted hatching. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues.
For couples who have attempted assisted reproductive procedures many times and for women, whose time is running out because of their age, assisted hatching offers hope of realizing their dreams of becoming parents.

Pre-Implantation Genetic Diagnosis (PGD) in Fertility Treatments

For couples undergoing in vitro fertilization (IVF), pre-implantation genetic diagnosis (PGD) is a procedure undertaken to screen the embryos for a host of genetic diseases and disorders to ensure the delivery of a healthy baby. PGD helps physicians to identify some genetic defects within the embryo, prior to implantation, before the pregnancy is established. The couple can then decide whether or not they want to continue with the pregnancy. The procedure was first conducted in 1988 and since then this technology is increasingly being used in fertility clinics in the United States.

PGD is normally recommended for couples where one or both of the parents are a known carrier of a genetic disease such as hemophilia. The procedure involves the removal of one or two cells from an embryo which are then screened for genetic abnormalities. PGD identifies the embryos with chromosome abnormalities, thereby avoiding their transfer during an in vitro fertilization procedure. The analysis helps to detect certain inherited or chromosomal diseases such as Down syndrome, Thalassemia, cystic fibrosis, hemophilia A, Tay-Sachs disease, and Turner syndrome among others, prior to implantation.

Most fertility clinics offer PGD in select cases such as:
• Women over the age of 35 who have had miscarriages or failed attempts at becoming pregnant through IVF
• Women who have repeated pregnancy loss due to genetic disorders or who already have one child with a genetic problem
• Any couple who have been unable to become pregnant through multiple IVF cycles
• Couples who wish to identify a tissue match for a sick sibling who can be cured with transplanted cells

For couples who are at risk of passing on serious inheritable genetic diseases to their offspring, a diagnosis before embarking on a pregnancy is preferable to medically invasive, emotionally demanding prenatal diagnostic techniques. However couples with genetic disorders should receive adequate counseling about the risks of misdiagnosis and the possibility of no diagnosis before going in for PGD.

East Bay Fertility Center California, offers a wide range of infertility treatments along with expert medical counseling to couples facing difficulty in conceiving. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues.

At the center, PGD is offered as an option to couples who are at high risk of passing on a genetic disease to their children. The Center’s IVF experience and access to advanced genetic testing and counseling holds the promise of increasing the probability of a successful pregnancy outcome from an in vitro fertilization procedure and reducing the incidence of genetic disease. The use of this advanced genetic testing procedure allows only normal embryos to be transferred back into the uterus, providing a much better chance of achieving a full-term pregnancy with chromosomally healthy embryos.

The Embryo Toxic Factor in Recurrent Miscarriages

One of the complex medical reasons for recurrent miscarriages may be traced to a condition known as embryo toxic factor (ETF). ETF is a cytokine secreted by the immune system’s white blood cells in response to pregnancy tissue. If excess amounts of cytokine are produced by white blood cells during pregnancy, the immune system may consider the embryo as a foreign body and try and eliminate it, thus leading to miscarriage. Embryo toxic factors have also been reported in women experiencing unexplained infertility and infertility associated with endometriosis.

Diagnosing Embryo Toxic Factor
Testing for embryo toxic factor is a complex laboratory experiment and is opted for only if other tests for miscarriage do not lead to any conclusive results. ETF testing is still considered an experimental testing.

A blood sample is first taken and the lymphocytes are cultured for several days. They are then combined with cultured mouse embryos and left to sit for a few days. Subsequently, a fertility specialist studies the embryo development in relation to how it has been affected by these lymphocytes. If the embryos have stopped developing or have died, it shows the presence of ETF. If the embryos are developing normally, the conclusion is that no ETF is secreted.

The Treatment Regimen

Women suffering from ETF usually have to engage in a multiple treatment regimen to avoid future pregnancy complications. Since the cause of ETF is an over-active immune response, the treatment for ETF revolves around immune system repression. This includes

Intravenous immunoglobin (IVIg) infusions which suppresses the production of cytokines
Vaginal applications of progesterone in suppositories or gel caps, taken until the sixteenth week of pregnancy

In case the woman is undergoing IVF treatment, progesterone oil injections may be given

Recurrent miscarriage is a condition that could be a sign of a more serious problem and a fertility specialist should be immediately consulted. East Bay Fertility Center California, offers a wide range of infertility treatments along with expert medical counseling to couples facing difficulty in conceiving. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues. East Bay Fertility Center specializes in providing infertility treatments such as in-vitro fertilization, insemination, Intracytoplasmic sperm injection, egg donation and gestational surrogacy. With the right type of treatment and intervention, the Center assists couples who have been having problems conceiving to overcome those difficulties in the shortest possible time in order to realize their dreams of having a healthy baby.