Once the cause of infertility is established, a variety of treatments are available. UC Davis specialists provide comprehensive treatment for all types of infertility. To optimize patient care, their offices are open seven days a week.

Services include:

Ovulation induction
Failure to ovulate is a common cause of infertility. Most patients can be stimulated to ovulate with medication such as clomiphene citrate (Clomid, Serophene), or gonadotropins. The effectiveness of these treatments can be determined by careful monitoring.

Clomiphene Citrate
Clomiphene citrate is usually effective at one or two pills daily for five days of treatment each month, but doses as high as five pills daily may be required. A woman's response to clomiphene citrate can be determined by the basal body temperature pattern, progesterone hormone test and endometrial biopsy. Sometimes pelvic ultrasound is required to determine the effect of clomiphene on the ovary or to pinpoint the day of egg release. Ultrasound equipment and staff are available seven days a week for monitoring.

Gonadotropins
Gonadotropins are powerful, expensive drugs usually reserved for patients who do not respond to clomiphene citrate. They also may be used to release multiple eggs (superovulation) in couples with unexplained infertility or for couples undergoing oocyte (egg) aspiration for in vitro fertilization. Gonadotropins have potentially serious side effects, such as multiple gestation and ovarian enlargement. They require frequent monitoring through a combination of estrogen blood tests and ultrasound examination, and they should only be administered by physicians who are experienced in their use.

Surgery can conserve or enhance fertility in women who have endometriosis, pelvic adhesions, blocked or damaged fallopian tubes, uterine fibroids and developmental abnormalities of the female reproductive organs. UC Davis specialists are experienced in the most advanced methods of reproductive surgery.

Surgery for Endometriosis
Endometriosis is a common problem. It is thought to occur from a reverse flow of menstrual blood and endometrial tissue into the abdominal cavity. In susceptible women, endometrial tissue may implant and grow in many abnormal locations (on the ovaries, the bowel, the urinary bladder) causing pelvic pain, infertility, or both. The diagnosis is usually made through laparoscopy.

Treatment for endometriosis depends on its location, severity and the patient's goals for reproduction. Radical surgery involves a total hysterectomy and removal of the tubes and ovaries. In young patients who have not completed their families, therapy is more conservative. Endometriosis can often be treated by laser vaporization or cauterization during laparoscopy, when the disease is first diagnosed, thereby preserving the uterus, tubes and ovaries. Hormonal suppression with medications such as Lupron Depot also may be helpful.

Surgery for Pelvic Adhesions and Blocked Tubes
Pelvic adhesions (scar tissue) and blocked or damaged fallopian tubes are another common cause of infertility. Adhesions can result from infection, previous surgery or endometriosis. There are several treatment options, including laparoscopic surgery, open microsurgery, or in vitro fertilization-embryo transfer (IVF-ET). Once the fallopian tubes have been damaged, they function poorly, even after surgical repair. For many women, the best option for fertility is IVF-ET, which bypasses pelvic adhesions and blocked tubes. When pelvic pain is the problem, surgery may be more helpful.

Surgery for Fibroids
"Fibroid" is the common name given to benign smooth muscle tumors of the uterus. Fibroids may be single or multiple, small or large, and in various locations inside or outside the uterus. They may cause pain or abnormal uterine bleeding. When fibroids grow inside of the uterus, they may cause repeated miscarriages or infertility. For women who have completed their families, hysterectomy may be the best treatment. For women who want to conceive, removal of the fibroids may be possible. This procedure is called myomectomy. Drugs such as Lupron Depot can temporarily shrink fibroids, making myomectomy easier. When fibroids grow inside the uterus (submucous fibroids), they can be removed by hysteroscopy.

Surgery for Sterilization Reversal
Many women choose bilateral tubal ligation for sterilization purposes, but later some regret the decision. While tubal sterilization should be considered permanent, it is sometimes possible to reverse the process and reconnect one or both tubes. The success of sterilization reversal depends on the procedure originally performed, the patient's age, and whether there are other infertility factors present. In ideal circumstances, 75 percent of the women who have sterilization reversal surgery may be able to conceive. Another option, which avoids surgery, is oocyte (egg) aspiration and in vitro fertilization-embryo transfer.

Vasectomy reversal information