The IVF process begins after a careful evaluation with the woman using an individually designed prescription of fertility medications, monitored with both blood testing and ultrasound scanning. This is supervised meticulously to ensure the highest number of good quality oocytes (eggs) achievable. The eggs are retrieved in the office through a tiny transvaginal probe under a light anesthetic. The male partner’s sperm sample is collected and mixed with the eggs in a dish, or in some circumstances may be micro-injected to fertilize the oocytes. No incisions are made, and most patients feel ready to go home after only about one hour of recovery time.

Over the next 24 hours, the number of fertilized eggs (embryos) is identified, and development is monitored for 48 to 72 hours. Finally, selection of embryos to be placed in the uterus is made in consultation with the couple, and embryos are transferred in an easy, painless procedure between three and five days following retrieval.

Embryo transfer is done in the office without need for any anesthesia. Dr. Honoré uses a small catheter to transfer the embryos through the cervix and into the correct location inside the woman’s uterus. In some cases, ultrasound may be used to guide the embryo placement for a more favorable outcome.

An individual sperm is selected and prepared by our Ph.D. embryologist for injection into each specific egg to accomplish fertilization. This improves fertilization rates in cases of severe male-factor infertility, and is an alternate to conventional insemination in a wide range of situations.

In this technique our embryologist will carefully produce microscopic punctures in the outer shell (zona pellucida) of a developing embryo on the third day after fertilization to improve the development of the embryo and increase the chances of implantation. This method can improve outcomes in many clinical scenarios; Dr. Honoré will be glad to discuss this option to see if it is right for you.

A technique in which our embryologist actually opens a developing embryo and removes a single cell (blastomere,) which can be tested for several inherited disorders. One of the newest techniques around, this allows families with significant histories of life-threatening inheritable disease to screen their embryos for the presence of the disorder. Due to the complexity and invasiveness of this technique, PGD is not appropriate for general prenatal screening or sex-selection. Dr. Honoré will be glad to discuss the possibility of PGD testing in context of your family history to see if you would benefit.

When more good-quality embryos are produced in an IVF cycle than will be used immediately by the couple, there may be the option of cryopreserving (freezing) the embryos for later use. Ongoing pregnancies with live births have resulted from embryos that have been frozen for as long as 20 years.

Transferring frozen embryos into the uterus can yield pregnancy rates comparable to fresh embryo transfer. This may allow a couple a second chance at a pregnancy if the initial IVF is unsuccessful; for other couples it can give a chance for a second child at a later date without having to undergo the entire IVF process again.

When a woman has a normal uterus but is unable to produce viable eggs, Dr. Honoré can combine donated eggs with the husband’s sperm using the methods described above to result in normal fertilization. This technique is completed with an embryo transfer into the woman’s uterus. Dr. Honoré has considerable experience and interest in egg donation and is glad to discuss whether this technique would be right for your situation.

In cases where a woman’s uterus may not be suitable for pregnancy and childbearing, but she has normally functioning ovaries, IVF can allow a genetic and biological pregnancy for a couple to be carried by another woman. This differs from true surrogacy where the embryos are biologically reacted to the gestational carrier.

Dr. Honoré monitors this process closely in the office with blood tests and ultrasounds to assure that optimum results are obtained at each cycle. The judicious use of both oral medicine and advanced injectible medications ensures your therapy will achieve optimal ovarian and uterine responses, thereby maximizing your chances of success each attempt.

In this procedure, Dr. Honoré’s advanced andrology staff prepares the sperm, and then the physician places them directly into the uterus with a small catheter. Women consistently describe this as easy and painless. This allows normal fertilization of the woman’s egg(s) to take over at this point. For couples with trouble conceiving because of abnormal sperm counts or motility (sperm movement), IUI allows a greater number of active sperm to reach the uterine cavity and fallopian tubes. Our advanced laboratory covers the full range of techniques to prepare sperm, including treatments for antisperm antibodies.

When male fertility issues are untreatable, a couple may choose to use anonymous frozen donor sperm. This is an easy process in which sperm are prepared, and placed directly into the woman’s uterus in an office procedure similar to that described above.

Men who are facing the possibility of sterilization by vasectomy, or due to prostate or testicular surgery, or cancer treatments often choose to preserve their now-healthy sperm for the possibility of fatherhood in the future. Our office provides consultation, collection and storage services in a private, comfortable environment.

Both women and men may be surprised to learn that infertility affects men as often as it does women. Nearly 40% of all fertility problems in couples can be attributed to problems with the male partner, and in another roughly 10% there may be a simultaneous problem with both partners. Unfortunately, evaluation of the male is often overlooked as being unimportant. Dr. Honoré will discuss clearly and frankly with you what the role of male infertility is and how to go about the necessary evaluation. We have our own advanced andrology laboratory in-office that will get your partner’s evaluation underway; if problems are identified Dr. Honoré can help you sort out your treatment options. In cases of especially severe problems or when specialized surgery for the male may be helpful, Dr. Honoré will assist in coordinating your care with expert specialists in this area.

Men are often reluctant to undergo testing, and it is important for their partners to understand that this is a normal response. It is equally important for men to understand how important their role in the process is and to go through the needed testing and, if necessary, treatments. Dr. Honoré will be glad to discuss frankly and respectfully you and your partners concerns in this area. He and his staff are aware how sensitive this issue is, and husbands are assured that they will always be treated with the utmost privacy and respect.

For women whose fallopian tubes have been ligated (“cut” or “tied”) this procedure can be performed to sew them back together. A microsurgical procedure, done in a hospital under general anesthesia, this operation is done through a small laparotomy (open) incision. Typical hospital stay is usually 24-48 hours. For younger women with no other history of infertility problems, this may be an attractive alternative to IVF.

For women whose tubes are blocked for reasons other than tubal ligation (see BTA,) other surgical options may be able to restore a working tube. A procedure in which a special catheter and wire may be recommended to open a blocked fallopian tube; this is usually done via laparoscopy under general anesthesia as a minor (outpatient) surgical procedure.

When fibroids cause problems in female fertility, or in cases of recurring pregnancy loss, myomectomy can be done to remove the fibroid and restore a normally functioning uterus. Selected cases of smaller and mid-sized fibroids (up to 6 cm) may often be removed favorably on an outpatient basis by hysteroscopy or laparoscopy. For larger fibroids this is done using a microsurgical technique through a laparotomy incision with a two to three day hospital stay.

Hysteroscopy is a surgical examination of the uterine cavity through a fiber-optic telescope inserted through the vagina and cervical canal. Although this requires general anesthesia, it is usually done on an outpatient basis so patients return home the same afternoon. Removal of many fibroids, removal of uterine polyps, and correction of many congenital uterine abnormalities can be accomplished this way.

Surgery is necessary to diagnose endometriosis. In laparoscopy a surgical instrument is inserted through a small incision in the navel to allow direct visualization of the ovaries and the exterior of the fallopian tubes and uterus. The surgeon then has the capability of treating conditions such as endometriosis as part of the same operation. Even extensive procedures, including removal of large ovarian cysts, can be done on an outpatient basis with the patient returning home that same day.

A newer surgical treatment for problems related to Polycystic Ovarian Syndrome. Use of a laparoscope inserted through a small incision in the navel allows direct access of the ovaries. Using special instruments that deliver focused electric current, 10 small holes are “drilled” in the surface of each ovary. Typically within a few months after the procedure blood insulin and testosterone levels decrease, and most patients notice improvement in their normal ovulatory cycles. Great care is taken during the procedure to ensure that no damage occurs to the ovary and to keep the likelihood of adhesion (scar) formation as low as possible.

Some women are troubled not by difficulties conceiving but by multiple recurring losses once they do become pregnant. Patients often find the process of understanding why this happens to be confusing. Since different and sometimes overlapping problems can be involved, the first step towards a successful live birth is always a thorough and systematic evaluation to pinpoint the diagnosis. Dr. Honoré will be glad to discuss this with you, and guide you through this process. While nothing can ever guarantee a successful outcome, patients feel reassured from the start understanding how to work toward overcoming these problems. Once a clear diagnosis is made, a treatment plan will be formulated, and there is help for most known causes of recurrent pregnancy loss.

PCOS is a very common cause of ovulatory problems, infertility, and metabolic problems in women. The syndrome is characterized by absent or infrequent menstrual cycles, often with elevated testosterone levels and enlarged polycystic ovaries on ultrasound. In addition to irregular cycles, many women complain of acne, unwanted hair growth, and often weight gain.

In addition to causing problems with normal fertility, PCOS is now understood to be involved in other metabolic problems in women. Abnormalities in blood lipids, androgenic hormones, and how a woman’s body utilizes insulin have all been related to PCOS, in addition to high blood pressure, fat distribution, risk of endometrial hyperplasia, and risk for developing diabetes. Understanding the cause and effect in PCOS is very important and Dr. Honoré will guide you through this process so you understand these decisions. Once a clear diagnosis of PCOS is made, Dr. Honoré will discuss your individual treatment needs to address general health issues as well as symptomatic complaints you may have. Patients are reassured to know that most can be managed with a combination of safe medications and lifestyle changes.

For some women with PCOS, particularly those with significant insulin resistance, medication and life-style changes alone may not be sufficient to reach the treatment goal. For these women, whether they are seeking pregnancy or optimizing their health management, a surgical treatment called Laparoscopic Ovarian Diathermy (also called ovarian drilling) may be the answer. Use of a laparoscope inserted through a small incision in the navel allows direct access of the ovaries; then using special instruments that deliver focused electric current, approximately 10 small holes are “drilled” in the surface of each ovary. Typically within a few months following the procedure blood insulin and testosterone levels decrease, and most patients notice improvement in their normal ovulatory cycles. Often patients can conceive naturally following this procedure. Dr. Honoré takes great care to ensure that no damage occurs to the ovaries and to keep the likelihood of adhesion (scar) formation as low as possible.

Endometriosis is a common cause of chronic pelvic pain as well as infertility in women. In this disease there is growth in a woman’s pelvis of abnormal tissue that resembles endometrium or uterine lining. This tissue is most often found on the ovaries and on the surfaces behind the uterus but can be found almost anywhere in the abdomen and even in the whole body. Extensive or advanced disease can cause major alterations of the normal anatomy and is associated with both infertility and pelvic pain. Pain with intercourse is a very common complaint for women with endometriosis. The only way to make a certain diagnosis is by surgery (usually laparoscopy), and surgery is also highly effective for treatment of the disorder.

Surgery is necessary to diagnose endometriosis and is often highly effective for treatment as well. In laparoscopy a surgical instrument is inserted through a small incision in the navel to allow direct visualization of the pelvis and accurate identification of areas of disease; Dr. Honoré then has the ability to treating as endometriosis as part of the same operation. Even extensive procedures, including removal of large ovarian cysts, can be done on an outpatient basis with the patient returning home that same day. In one large study, thousands of women who had undergone laparoscopic treatment for pain from endometriosis reported a 95% satisfaction rate with their result after the surgery.

Not all women with endometriosis require surgery for pain management. It is important that the cause of her pain be established to avoid mistreating other conditions. Once a diagnosis of endometriosis is certain, many women choose medical treatment for management of pain symptoms. A variety of medications can be used to reduce pain caused by the existing disease. These medicines are safe and, in many cases, give relief comparable to that obtained with surgery. If you suffer from chronic pelvic pain, your first step towards improved quality of life is to pinpoint the cause of your pain. If endometriosis is discovered, or for women who may already have a diagnosis of endometriosis, medical treatment may be the solution for you. As a cautionary note, be aware that medical therapy for treatment of infertility due to endometriosis is not effective. Dr. Honoré and your regular gynecologist are good resources for considering medical treatments, and would be pleased to help you decide whether this is the right choice for you.