Locations

Mandeville
800 N. Causeway Blvd.
Suite 2C
Mandeville, LA 70448
(985) 892-7621

Metairie
4770 South I-10 Service Rd. W.
Suite 201
Metairie, LA 70001
(504) 454-2165

Baton Rouge
8595 Picardy Ave.
Suite 240
Baton Rouge, LA 70809
(225) 763-4800

Toll free inside Louisiana:
(800) 375-0048

Toll free outside Louisiana:
(800) 433-9009

Infertility Information

Nearly 2.5 million American couples are infertile. They have been unable to conceive despite a year or more of trying. Among women 20-24 years old, the group that delivers one third of this country's babies, the infertility rate has tripled since 1965. The reproductive process is so intricate that even the most fertile couple has only a one in four chance of conceiving each month. Since fertility naturally declines with age, a fertility evaluation is recommended for couples over the age of 30 who have not conceived after six months of unprotected intercourse.

From our extensive experience, we know that this fertility evaluation, to be complete, must take place in more than one phase of the cycle. The complete fertility evaluation begins with a thorough personal history, a physical examination, and a laboratory evaluation, with particular attention to conditions which might cause problems during pregnancy.

In the process of discovery, we may find more than one problem contributing to infertility - this is often the case. However, some infertile couples may be diagnosed, given simple drug therapy, and become expectant parents shortly thereafter. On the other hand, known problems, such as endometriosis, may not be the only source of a couple's inability to conceive. When pregnancy does not occur within three to six months of treatment, other causes must be sought.

Donor Insemination

Therapeutic donor insemination is indicated when semen quality is too poor to permit pregnancy by artificial insemination with husband sperm (AIH), in vitro fertilization (IVF), or intracytoplasmic sperm injection ((ICSI)) (MALE INFERTILITY); when a male portion is absent; or when an acquired or inheritable disease make his sperm unsuitable.

Donor Sperm Source

Donor specimens may be obtained from any licensed sperm bank, at the patient's request.

Safety

All donor sperm initially prepared or imported by FINO has been cryopreserved for a minimum of six months and is used only after the sperm donor has tested negative for the HIV virus. Extensive testing for other infectious diseases is also performed before donors are accepted. Genetic screening is done if the donor has any history of possible inherited disease.

Male Infertility

Some of the factors affecting fertility include mumps, high fever, diabetes, a previous injury or surgery, or infections such as sexually transmitted diseases, chemical exposure, stress, drug and alcohol use, medications, exercise habits, timing and frequency of sexual intercourse, and family fertility history.

A semen analysis is a test which evaluates the quality and quantity of sperm and seminal plasma. This may detect factors that impair the sperm's ability to travel to the fallopian tubes or penetrate the egg. Since sperm counts may change daily, more than one sample may be needed.

Sperm motility is the sperm's ability to swim progressively forward. At least 50% motility is considered normal (World Health Organization-1992).

A sperm count below 20 million per mL is considered subfertile (World Health Organization-1994).

Abnormally shaped sperm cannot fertilize an egg. At least 30% of sperm should have normally shaped heads and tails (World Health Organization-1994).

The postcoital test, performed 12 to 18 hours after intercourse, is used to evaluate male infertility, in addition to and in some cases instead of a semen analysis. There should be at least 5 progressively motile sperm per high powered microscopic field (400x) 12 hours after intercourse. Couples with no male or cervical factor may have more than 100 motile sperm. A poor postcoital test may be due to mucus factor (infection, too thick or too little mucus), poor semen quality, or mechanical problems (sperm not reaching Cervix).

Antibody tests determine whether the man or woman produces antibodies to sperm. Antibodies in blood, cervical mucus, or seminal fluid, may react to sperm as invaders and destroy or immobilize them.

Increased white blood cells (WBC) in semen indicate infection. There should be fewer than one million WBC per mL (World Health Organization-1992).

Male Infertility Treatments

Treating Infection

Infections of the reproductive tract affecting fertility can usually be treated with antibiotics.

Improving Sperm Concentration

Sperm washing concentrates the more active sperm, which can then be inseminated into the woman.

Sperm Antibodies

In vitro fertilization (IVF) is often the only way to avoid sperm antibody problems.

Fertility problems related to varicoceles, ductal obstructions, or ejaculation can usually be treated. If a man chooses to reverse a vasectomy, the procedure itself is usually successful, but fertility may not be restored.

The Fertility Institute of New Orleans is pleased to work with the patient’s own urologist or will recommend a urologist.

Artificial Insemination with Husband’s Sperm (AIH)

Artificial insemination with husband’s sperm (AIH) is most often successful in cases of cervical mucus infertility and problems of intercourse, and may be successful if semen quality is only a little below fertility standards. When semen quality is too low for AIH to be successful, in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may still be successful. When no sperm are present, therapeutic donor insemination (TDI) may be an option. AIH is much more successful when sperm is placed in the uterus [intrauterine insemination (IUI)].

Semen Quality Required for Successful AIH

Successful AIH is dependent on five factors:

Semen quality which need not be as high as World Health Organization (WHO) standards (see Results of AIH).
Method of preparing sperm for insemination (swim-down technique, presently used at The Fertility Institute of New Orleans, and swim-up technique appear to result in higher pregnancy rates than wash techniques.
Timing and method of insemination (IUI best) (either Luteinizing Hormone surge or human chorionic gonadotropin may be used).
Number of preovulatory follicles (follicle number may be improved by ovulation induction drugs).
Presence of pelvic disease (pregnancy rates in IUI cycles are only half as high if tubal adhesions or endometriosis is present).

Parameters for AIH

The Fertility Institute of New Orleans’ database contains complete records of sperm quality and treatment from more than 5,000 AIH and TDI cycles. When initial semen quality is less than needed for at least a 4% pregnancy rate per cycle, we believe IUI should not be attempted. Instead, IVF, (ICSI), or donor sperm should be considered.

Pregnancy rates per cycle will be doubled when pergonal or metrodin are used from cycle day 2 or 3. Results are halved by endometriosis or tubal adhesions.

Results for CC remain constant for three or four cycles of IUI and then decline rapidly. Results for pergonal and metrodin decline rapidly after three cycles.

The semen parameters for IUI are concentrations >5x10(6)/ml, total count >10x106, normal morphology >30%, progressive motility >20%, total motile sperm >5x10(6). When these parameters are met or exceeded the pregnancy rates with one follicle ranges from four to ten percent.

Female Infertility Diagnosis

Conditions that have long been considered as causes of infertility are:

failure to ovulate
insufficient or ineffective sperm
tubal obstruction
Endometriosis
poor development of uterine lining
pelvic adhesions
mucus factors
uterine fibroids

In addition to these traditional causes, modern diagnostic techniques and new information obtained from in vitro fertilization have revealed other causes for previously unexplained infertility:

Egg quality
Failure of sperm to penetrate the egg
Failure to release an egg at the time of apparent ovulation
Immunological problems may prevent fertilization and/or implantation of the embryo

Factors such as scar tissue and endometriosis have been found to often be associated with inadequate ovulation or failure to fertilize.

Female Infertility Treatments

We believe that the best fertility clinics are able and willing to provide not just one type of treatment, but a complete range of therapies, from treatment of genital tract infection, management of difficult problems of ovulation induction or other hormonal problems, microsurgery, laser surgery, laparoscopic laser surgery, to the more complex treatments of IVF, GIFT, INTRACYTOPLASMIC SPERM INJECTION (ICSI).

Our staff represents experts in all of these types of treatment and freely transfers patients to the physician whose expertise matches their needs. We do not believe that all patients have to have laparoscopy or major surgery or even IVF or GIFT procedures. In cases where other treatment has been tried and failed, we use the procedures indicated.

Our treatment philosophy and our experience, proven by thousands of successes, is that many couples' infertility is successfully treated by non-surgical means. We attempt these treatments first, except in cases where the necessity for surgery is obvious.

Infections of cervical mucus and sperm are readily treated by antibiotics.
Ovulation dysfunction is treated in staged fashion. At least three months of ovulation induction is allowed before moving to more advanced therapy.
Low sperm counts, depending on severity, are treated first by correcting infection. In severe cases, the husband is referred for additional treatment by a urologist.
Endometriosis or pelvic scar tissue due to infection or previous surgery, are treated first by laparoscopic laser surgery. Medical treatment is prescribed for some endometriosis.
If fallopian tubes are open, we allow patients time to conceive before considering major surgery.

Finally, when other treatment has failed to result in pregnancy, we recommend assisted reproductive technologies (ART). We believe that individualizing treatment for each couple is needed, rather than using one treatment for all. Our 1996-98 continuing or delivered pregnancy rate per embryo transfer in all ages was 29.3%.

HEALTHY BABIES ARE THE ULTIMATE CREDENTIALS FOR SUCCESS!