Fertility Treatment IUI / IVF

The Compassionate Approach to Conception

Dr. Amui-Bellon's professional medical career has been a blessed and fulfilling journey, along with a very impressive pregnancy success rate. 

She has been able to assist thousands of women, within all age groups, with various fertility challenges and issues. 

Infertility can be emotionally traumatizing to a couple, and/or individual. The issues affecting infertility could be as simple as not having relations frequently enough, or having relations only when the woman thinks she is fertile. 

Dr. Amui-Bellon provides an individualized, informative, and compassionate approach with all her fertility patients.

Processes and Fertility Options

The first line of treatment for infertility is not IVF (In Vitro Fertilization). 

A full work up must be done in order to ensure the best and quickest way to conception.

The differential diagnoses of infertility are varied, and several options are available to the couple, or patient. Each diagnosis is managed differently. 

Conception can occur with; Sexual Relations, plus or minus, medications with monitoring, Intra-Uterine Insemination, IUI, where the sperm is concentrated and placed into the woman’s uterus with or without the use of medications and monitoring, or In Vitro Fertilization, IVF, where the eggs are recruited and harvested after injectible medications are given; these eggs are then fertilized in the lab with the partner's sperm and then the best embryo or embryos are then transferred into the woman's uterus (Embryo Transfer).

Relations

Relations, or having vaginal sex has always allowed couples to have children, though up to 15% of the reproductive aged community may have fertility challenges. The natural cycles can be enhanced in several ways. Most women wait until they are "fertile" to have relations. The woman may think she is fertile, however, if she is having relations infrequently, she may miss the window of opportunity to have a child. When the woman is attempting conception, it is better to have relations frequently, and as often as every 2 - 3 days to assure the sperm stands ready at all times to fertilize the egg (Ovulation and Fertilization). 

Typically in a given month, the mature egg will not wait more than 24 hours for the sperm to fertilize it, once the egg has ovulated. If the woman ovulates, but misses the sperm, then the woman will have to wait until subsequent cycles when the sperm is always ready and stands attention to fertilize the egg.  It is also a good thing for the men to have frequent relations so that fresh sperm comes out to fertilize the eggs. Some men will wait, hoping they are "saving up the sperm" for ovulation time, however, if there are long periods of abstinence or no ejaculations, then most of the sperm that come out tend not be motile.

IUI (Intra-Uterine Insemination)

IUI (Intra-Uterine Insemination)  Intrauterine insemination is a simple process where the sperm is ejaculated outside of the woman, analyzed, washed and concentrated and then placed into the woman's womb. Most IUI cycles are done with medications (for example, Clomid, Letrozole, Hcg etc,), but it does not have to be. 

IUIs tend to be the next line of treatment when relations have not assured a successful pregnancy or when there is some male factor issue. At other times the vaginal secretions or cervical mucus may be hostile to the sperm so that an IUI is the better course of action. 

IUI's are done in the doctor's office with a speculum in the vagina and once the Sperm is processed, (washed and concentrated), the concentrated sperm is then placed in the woman's uterus. Most women tolerate the IUI procedure well. After the IUI is done, most women will need luteal phase support with Progestins.

IVF (In Vitro Fertilization)

Before IVF, In Vitro Fertilization is done, the physician counsels the patients on the processes of IVF, risks, benefits, and alternatives. 

IVF is considered an aggressive procedure as it requires injectable medications, frequent monitoring, labs, and Ultrasound, an outpatient procedure. 

IVF is the process where multiple eggs are recruited with Gonadotropin mediations, through differing protocols with controlled ovarian hyperstimulation. The IVF Egg retrieval procedure is done with MAC anesthesia or under twilight, transvaginally. On occasion the egg retrieval is done trans-abdominally. Very few IVF centers do the retrieval trans-abdominally. Once Egg Retrieval is done, Fertilization occurs conventionally or with ICSI, Intra Cytoplasmic Sperm Insemination. The fertilized egg is allowed to grow in the lab for a few days and then Embryo transfer is performed about 3 or 5 days after retrieving the eggs. There are age criteria for the number of embyros transferred to a woman, depending on the patient's history and prognostic factors. The physician and patient, based on the findings of the work up then plan out the best course of action for the patient or couple. IVF may not be necessary if the couple is young, (Less than age 35). They can be monitored with lab work and Ultrasound, then the physician can predict with accuracy, when the woman will ovulate. The physician then will counsel them to have relations, or perform an IUI. 

INFERTILITY EVALUATION

In this day and age, couples claim they are waiting until "the right time" to have children. Some women have been told they cannot, and should not have pregnancies based on previous testing, fibroids, advanced maternal age, male factor, advanced paternal age and other criteria. Others remarry and then want to have their own biological children. Either way, the processes of assisting women to have children require three foundational questions answered:


1. Enough high quality eggs to assure a successful pregnancy?       

2. Sufficient sperm to fertilize the eggs?

3. Environment to house the baby for nine months?  


Once these three basic fundamental questions are answered, and can be well supported, successful pregnancy outcomes can usually be assured.


Customarily, the three basic requirements include the following: 


First, is the baseline Ovarian Reserve Testing with a day 2 or 3 FSH; or AMH levels which can be done at any time in the woman's cycle. A normal Ovarian Reserve assures there is adequate ovarian reserve to recruit eggs from the woman. 


Secondly, the environment where the baby is first formed or where the egg is fertilized (fallopian tubes - in spontaneous pregnancies); and the Endometrial Cavity, (the womb), where the baby sits in and grows for 9 months needs to be evaluated to ensure that environment is adequate to house a baby for 9 months. This test for the uterine and tubal environment is the Hysterosalpingogram Test also known as the HSG Test. It is a test that is performed in the Radiology suite under fluoroscopy. It is an uncomfortable test, but a necessary test to assure no endometrial filling defects and tubal normalcy and patency. 


Thirdly, the couple will need sperm to fertilize the Eggs. Important information is gleaned from the Semen Analysis. When no sperm is found in the ejaculate, repeat testing is necessary with the proper abstenance period, and if it still shows the same result, then Testicular Aspiration can be done to collect sperm from the Testicles. In that case IVF would be necessary. 


Regardless of whether relations, IUI or IVF is needed to assist the couple to have a child, these three fundamental tests are necessary and must be answered. Once these tests are done and resulted as normal, it is fairly easy to assist a couple with future pregnancy outcomes.        


Most fertility physicians may not endorse the idea of women waiting until their 50’s to have children. It is better for these women to grow up with their children. However, if the patient has the desire to have children, and there are no medical contraindications to pregnancy, they are medically stable, they have met certain physical exam requirements to assure successful pregnancy outcomes, then they should be assisted to have children.