KNOW YOUR SPECIALIST…
Not being able to conceive can be an emotional drain on a couple. Reaching out to an infertility specialist is an important step in growing a family. Taking that step should include the help of a medically trained and qualified Infertility Specialist.
What To Look For In An Infertility Specialist.
A medical specialist who treats patients with infertility is known professionally as a reproductive endocrinologist. Training in reproductive endocrinology requires four years of college followed by four years of medical school. The physician must then complete a four-year residency in obstetrics and gynecology (OB/GYN), during which the physician receives broad training in general Obstetrics and Gynecology. The final course of training is a two or three-year fellowship in reproductive endocrinology. Fellowship training focuses on the diagnosis and treatment of infertility and related disorders. This training includes experience in microsurgery, laparoscopic and hysteroscopic surgery, in vitro fertilization-embryo transfer, sonography, and ovulation induction. In addition, the physician spends a significant amount of time performing clinical or laboratory research.
Upon completion of a fellowship in reproductive endocrinology, a specialist seeks board certification-a multi-step process. To become board certified in reproductive endocrinology, the physician must first obtain board certification in obstetrics and gynecology. This requires successful completion of both a written and an oral examination. Board certification in reproductive endocrinology requires successful completion of additional written and oral examinations. The entire certification process takes several years to complete. Only a physician who has successfully completed a fellowship in reproductive endocrinology and passed the examinations can become board certified as an infertility specialist.
It can be difficult for a patient to determine whether or not her physician is an infertility specialist. Some physicians have gained skills through experience outside fellowship training, and some physicians successfully complete fellowship training and do not obtain board certification.
However, board certification is the only objective criteria by which patients can measure a physician's qualifications.
In couples, about 50% of infertility issues are because of the female. Female age is a very important component of natural fertility. Apart from this, female infertility can be caused by ovulatory dysfunction (anovulation), tubal/uterine and peritoneal factors and other unusual or unexplained factors.
About 30% of infertility in couples may be due to the male while another 20 percent of couples inability to conceive may be due to combined male and female factors. A fertility doctor usually collaborates with urologists to ensure fast-track evaluation and management of the male partner, which increase treatment success rates.
Fertility Promoting Surgery
Many of the fertility promoting surgeries performed by Infertility Specialists are minimally invasive surgery techniques allowing the discharge of patients on the same day without requiring an overnight hospital stay. These techniques include laparoscopy, hysteroscopy and mini-laparotomy. Some surgeries, such as multiple myomectomies, are performed through a larger abdominal incision require a 24 to 48 hour hospital admission to allow the physician an opportunity to observe and support initial recovery
Laparoscopy has become one of the most common procedures performed by surgical specialists. Physicians use laparoscopy for removal of ectopic pregnancies, treatment of endometriosis, assessment and removal of abnormal ovarian masses, ovarian drilling to induce ovulation in clomiphene resistant patients with polycystic ovary syndrome, evaluation and treatment of tubal diseases, treatment of scars, removal of small uterine myomas and more. It involves creation of pneumoperitoneum with CO2 gas to distend the abdominal cavity to ease exploration and placement of a specific telescope (a lens and a light system) connected to a video camera into the abdomen, mostly through the belly button. This site usually requires 5-12 mm incision. The surgeon may need one to three 5 mm incision sites in the lower abdomen to introduce laparoscopic instruments to explore or to perform relevant surgical procedures.
This is a minimally invasive procedure for evaluating uterine cavity and treating various abnormalities. It involves a speculum placement to expose the cervix for transcervical placement of telescope (a light and a lens system) attached to a video camera system into the uterus. Hysteroscopy is an excellent diagnostic technique for potential abnormalities detected in screening tests like saline infusion sonography or hysterosalpingography. In addition to its diagnostic value, it serves as an effective minimally invasive treatment for abnormal uterine bleeding, endometrial polyps and fibroids, proximal tubal occlusion, some uterine abnormalities like uterine septum and intra-uterine scars.
To see the walls of the endometrial cavity and its covering cellular tissue (endometrium), a distention media, mostly normal saline, is used. Although there are hysteroscopic systems, which can be used at an office setting, many operative hysteroscopies may require ambulatory surgery center facilities. Tubal reversals are performed as an outpatient procedure. The procedure is done through a mini bikini incision under loop magnification utilizing microsurgical techniques. The patient may start trying to conceive within 2-3 weeks of surgery following the patient’s complete surgical recover. If the couple cannot become pregnant in 4-6 months, a hysterosalpingography (HSG) may be necessary. After a successful tubal reversal, cumulative pregnancy rates in the year following tubal reversal procedure are in the 50-80 percent range. Several clinical characteristics are associated with the high success rates for tubal reversal: • Patient under 40 years of age • Tubal length after tubal reversal greater than 4 cm • Previous sterilization by Fallope ring, clip or Pomeroy type
(most postpartum tubal sterilizations) tubal sterilization • Absence of associated pelvic pathology such
as endometriosis, severe pelvic scarring • Absence of male factor infertility • Absence of other factors like anovulation
Fertility may be compromised by the presence of myomas (fibroids) distorting or pressing or growing into, the uterine cavity. These mostly benign tumors may need to be resected while minimizing additional harm to the uterus by laparoscopy or hysteroscopy or via an open abdominal incision.