Treatments
Ovulation Induction
This is only indicated for patients who have difficulty with ovulation on their own. The goal is to ovulate a single follicle, although frequently multiple follicles are formed due to the medications used. The medications that Dr. Davenport frequently uses are oral ovulation induction agents and injectable gonadotropins. You may have already started this as a conservative treatment plan prior to presenting to FINA.
Superovulation
Using the same medicines as he uses for ovulation induction, Dr. Davenport changes the goal to stimulating multiple eggs in order to maximize the chances of a successful pregnancy each cycle. This is only indicated for certain diagnoses, which Dr. Davenport will discuss further with you at your initial consultation.
Intrauterine Insemination
During this procedure, semen is collected from the male during the time of his partner’s ovulation. The semen is then washed away, leaving only sperm. The washed sperm is then inseminated through a catheter into the female’s uterus, placing the sperm “at the right place at the right time.”
Male Infertility Hormone Therapy
Often, the reason for sperm deficits or abnormalities is inadequate production of specific hormones critical for sperm production. If this is suspected, we will stimulate or replace these hormones as indicated in hopes of correcting the underlying sperm deficit.
Sperm Retrieval
Dr. Davenport performs this procedure on the male testes in order to retrieve sperm in preparation for an IVF cycle. Males who are not producing any sperm in their ejaculate are considered for this procedure, including vasectomized patients and those born with a blockage to sperm transport.
INVOcell™
INVOcellTM is a treatment option that allows egg fertilization and early embryo development to take place in the woman’s body, in vivo, while offering success rates that are comparable to IVF if patients meet certain diagnostic criteria. The costs of INVOcellTM are also lower than IVF. It requires a similar egg stimulation and retrieval process to IVF, but instead of incubating the early egg and embryo in our lab we place an FDA-approved intravaginal culture device into the vagina. This allows the woman to be a natural incubator while the embryos grow. The embryos will then be removed, and an embryo transfer will subsequently be performed.
In Vitro Fertilization
IVF
IVF is a therapy that involves aggressive stimulation of the ovaries so that many eggs become ready to be fertilized all at the same time. Once mature, the eggs are aspirated from the body during a procedure called an ‘egg retrieval’. The eggs are then fertilized, and the resulting embryos are grown in our highly specialized IVF laboratory for 3-6 days. Plans for transfer of the embryo(s) back into the uterus are then made, where attachment, implantation, and growth occur like any naturally conceived embryo(s).
The staff of FINA understands the sometimes taxing nature of IVF and try to make this process as care-free as possible by providing continual emotional support, the clearest of communication, and the utmost attention to every detail. We will have a separate consultation with you prior to IVF to ensure that you understand if and why your specific diagnosis makes you a candidate, and every step of the process, from stimulation to suppression to retrieval to embryo growth to transfer. Our entire FINA staff will then see you through the process of IVF.
Intracytoplasmic Sperm Injection
This is a technique utilized in an “IVF” cycle for fertilization where a single sperm is injected into a single egg. Not everyone benefits from ICSI. The indications for ICSI are 1) a male factor infertility; 2) suspected sperm antibodies; 3) a history of failed or impaired fertilization; 4) a history of multiple sperm fertilizing one egg; and 5) poor embryo development in a previous IVF cycle. Dr. Davenport will thoroughly assess whether this type of fertilization would benefit you.
Preimplantation Genetic Testing
This is an optional procedure that involves biopsy of an embryo’s placental cells (trophectoderm). The biopsy is usually performed on day 5-6 of embryo growth. The biopsied cells are then tested to see if the embryo has the specific genetic abnormality that is being tested for. Genetic abnormalities that can be specifically assessed include aneuploidies (PGT-A), monogenic/single gene disorders (PGT-M), and unbalanced translocations (PGT-SR).
Assisted Hatching
Just before an embryo implants, it must “hatch” out of a shell called the zona pellucida. In certain patients, the enzyme reactions necessary for hatching are dysfunctional, and/or the zona becomes hardened. It is thought that creating a small hole in the zona with a highly specialized laser may assist the embryo in hatching, thereby increasing the odds of successful implantation in these patients. This is also frequently performed in embryos that have undergone a freeze/thaw process.
Reproductive Surgeries
Pelvic Laparoscopy
This is a surgery where you are under anesthesia and a small scope is placed, usually through your belly button, in order to gain visualization of the inside of your pelvis. It can be performed either manually or with the DaVinci robot, depending on your diagnosis and indication. Laparoscopy is commonly performed for tubal disease, endometriosis, ectopic pregnancies, ovarian cyst removal, and unexplained infertility. You and Dr. Davenport will always weigh the benefits and risks of any type of surgery, along with all alternatives to surgery prior to making this decision. For example, in vitro fertilization will prove to be a better and less invasive alternative to surgery in many instances.
Hysteroscopy
This is a surgery where you are under anesthesia and a small scope is placed into your uterus. No new incisions are required. Hysteroscopy is commonly performed for polyps and fibroids in your uterus, if a defect inside your uterus is suspected by external imaging, or if you have scar tissue inside the uterus.
Robotic Surgery
This type of surgery is similar to pelvic laparoscopy in that a camera is placed at the midline, and several laparoscopic “ports” are used for instruments. The difference is that the instruments are much smaller and precise, and are attached to robotic arms. The instruments are then controlled by the surgeon via a console next to the patient. Robotic surgery is commonly performed when severe scarring, endometriosis, or difficult surgery is suspected, or for microsurgery such as tubal reanastomosis.
Tubal Reversal
This procedure is for women who have had their tubes tied, but now desire to conceive. Dr. Davenport believes strongly that each patient who has had a tubal ligation should be individualized when deciding the best method to conceive. We encourage you to find as much information as possible (including obtaining an operative report from the surgeon who tied your tubes) prior to your consultation.
IVF vs. Robotic Tubal Reversal
Factors that go into this decision:
- Patient age
- Other indications for IVF
- Amount of ‘good’ tube left
- Insurance coverage
- History of any tubal disease
- Known pelvic scar tissue
- Future fertility plans
- Type of tubal ligation performed
Tubal Cannulation
This surgery is for certain cases where the tubes are blocked but still healthy. It is usually not performed if other evidence exists that the tubes are compromised. This procedure is weighed against the alternative of IVF. We will help discuss with you which option is right for you.
Abdominal Myomectomy
If fibroids are too large, too numerous, or cannot be accessed via hysteroscopy, we will recommend that the procedure be performed through a 4-6 inch incision. The recovery time is longer for this type of surgery compared to a laparoscopic or hysteroscopic approach.
Egg and Sperm Cryopreservation
Medical Cryopreservation
Frequently, patients with cancer will desire to preserve their eggs or sperm prior to undergoing chemotherapy and radiation, both of which can cause irreversible damage to reproductive potential. Egg cryopreservation or sperm cryopreservation can be performed before or shortly after chemo or radiation begins so that future childbearing can remain an option. We will work closely with your oncologist on a tight timeline if this is an option you wish to explore.
Elective Cryopreservation
Egg or embryo cryopreservation will allow the aging process of the frozen eggs/embryos to halt in time. It is becoming increasingly common for women to cryopreserve their eggs as an insurance policy against aging or when life circumstances are not yet quite right for childbearing.
Younger men who are anticipating needing sperm after their early 40’s may consider cryopreserving sperm when they are younger since offspring of men over age 40-45 years old have been found to have a higher rate of miscarriage and learning disorders compared to offspring from younger men.