Diagnostic laparoscopy

A minimally invasive outpatient surgical procedure using 2-3 small holes made through the umbilicus and abdominal wall allowing passage of a telescope camera and instruments into the abdominal cavity and pelvis while the patient is under general anesthesia. This procedure is recommended for patients who may have any number of conditions that affect the uterus, fallopian tubes, or ovaries.

If infertility has been longstanding for many years, or a woman has a medical history suspicious for an abnormality of the pelvis, an evaluation with laparoscopy may be warranted. Operative laparoscopy is more complex surgery used to restore a woman’s pelvic anatomy in order to enhance fertility, or provide access to the pelvis in order to remove or separate the fallopian tubes from the uterus prior to proceeding with IVF, as may be indicated in some women with tubal disease that may compromise implantation of a healthy embryo.

* in vitro fertilization (IVF)
* egg donation
* micromanipulation
* male infertility
* artificial insemination
* recurrent pregnancy loss care
* hormonal therapy for menopause
* reproductive surgery
* endometriosis therapy
* pelvic pain management
* advanced laparoscopy
* developmental problems of genitalia

Fertilized Egg

While it was initially reserved for patients with blocked, damaged, or absent fallopian tubes (tubal factor infertility), IVF is now also used to overcome infertility caused by endometriosis, male factor issues, diminished egg quality, ovulatory problems, or other unexplained reasons.

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.

High FSH levels
Reference ranges for luteinizing hormone and follicle-stimulating hormone in the menstrual cycle, expressed in international units. The scale is logarithmic.

The most common reason for high serum FSH concentration is in a female who is undergoing or has recently undergone menopause. High levels of Follicle-Stimulating Hormone indicate that the normal restricting feedback from the gonad is absent, leading to an unrestricted pituitary FSH production.

If high FSH levels occur during the reproductive years, it is abnormal. It may be a sign of:

1. Premature menopause also known as Premature Ovarian Failure
2. Poor ovarian reserve also known as Premature Ovarian Aging
3. Gonadal dysgenesis, Turner syndrome
4. Castration
5. Swyer syndrome
6. Certain forms of CAH
7. Testicular failure.

FSH is available mixed with LH activity in various menotropins including more purified forms of urinary gonadotropins such as Menopur, as well as without LH activity as recombinant FSH (Gonal F, Follistim). It is used commonly in infertility therapy to stimulate follicular development, notably in IVF therapy, as well as with interuterine insemination (IUI). (See Gonadotropin Preparations.)

Operative Hysteroscopy

Incoming search terms:

• uterus vagina cam

Intrauterine Insemination - IUI

A process where sperm are isolated from the male semen ejaculate, washed, and placed into a woman’s uterus using a thin flexile plastic cannula. This process is almost always used in conjunction with an ovulation induction medication.

* Injectable (Follistim™, Gonal-F™, Repronex™, Bravelle™): highly purified preparations of follicle stimulating hormone (FSH) and/or luteinizing hormone (LH) which are taken as subcutaneous injections. These medications provide for a much more potent stimulation than the oral ovulation medications, and as such require much more frequent monitoring.

* Oral (Clomiphene Citrate, Clomid™, Serophene™): oral tablets which function as mixed estrogen agonists and antagonists depending on the tissue (i.e. compete with estrogen for receptor sites). Use of this medication can lead to monthly ovulation for those women who normally do not ovulate on their own, ovulation of more than one egg for those women who do ovulate on their own, and better synchronization of the uterine lining.