If ovulation is irregular or not occurring Clomid or Letrozole may be the first medication employed. If the patient has PCOS, metformin may be prescribed. Clomid is given as 50 mg. and if ovulation is not regulated the dose may be increased. Clomid should only be used for 3-6 cycles and is most likely to work in the first 3 cycles. Other medications that may be used include progesterone, bromocriptine, Lupron, Antagon, and others.
Follicle stimulating hormone (FSH) is often used in conjunction with intrauterine insemination (IUI). FSH causes the development of multiple follicles and when the follicles mature an injection of hCG is given and the inseminations are scheduled.
FSH must only be used by a trained infertility specialist like Dr. Bachus. Improper monitoring of FSH stimulated IUI cycles can result in high order multiple births. See our Web page on IUI.
IVF may be recommended if 3-6 cycles of IUI fails. This is highly dependent upon the patient, her history, and the cause(s) of her infertility. IVF may also be recommended as a first line treatment for tubal disease, in older women, male infertility, unexplained infertility, and other cases Dr. Bachus deems appropriate.
If the male has moderate to severe male infertility intracytoplasmic sperm injection (ICSI) may be employed. Using ICSI, a single sperm is injected directly into the egg. If there are no sperm in the ejaculate, they can be retrieved from the male reproductive tract using MESA or TESA.
Sometimes IVF fails for reasons that cannot be clearly discerned. In many cases egg quality is a factor. The egg must fertilize, cleave, and have a normal genetic makeup. When the FSH level is marginally high this is an indicator of possible poor egg quality. Very high FSH levels indicate ovarian failure and donor egg is the treatment of first choice.
Donor cycles employ the eggs from young fertile volunteers. The success rates for these cycles equal the rates for the donor’s age group. For example, if 22 year olds eggs are used in a 35 year old women the success rates equal the 22 year old group and are high. Please review our donor egg program Web page.
There are many genetic diseases and chromosomal disorders that can be identified using PGD. PGD is conducted in conjunction with an IVF cycle.
A small biopsy of the embryo is taken and the genetic material is analyzed. If a genetic abnormality is present the embryo is not placed into the uterus.
PGD allows for the identification of male and female embryos with near 100% accuracy and is used for gender selection. If a couple wants a male child only male embryos will be transferred into the uterus.
Dr. Bachus is a highly skilled reproductive surgeon with very extensive training, especially in delicate microscopic laparoscopic surgery. He performs most surgeries laparoscopy as an outpatient procedure. There is much less pain associated with laparoscopic surgery, healing is quicker, and patient returns to normal activities much sooner than with conventional surgery.
Dr. Bachus is especially skilled at delicate tubal surgeries. He is often successful reconnecting tubes that were cut for birth control. Once the tubes are reconnected the chances of pregnancy are high since there is no limit to the number of times intercourse occurs.
Endometriosis is also removed using the laparoscope. Dr. Bachus exercises great care especially when endometrial implants are found on the tubes or ovaries.
Uterine fibroids or polyps are removed surgically using the hysteroscopy or laparoscope. Many uterine deformities can also be surgically corrected. There are other treatments, such as blastocyst transfer, that are not discussed on this overview page. All treatments can be accessed using the site search engine.