Microsurgical Reanastomosis (Tubal Reversal) of the Fallopian Tube in the Sterilized PatientPermanent sterilization by tubal ligation has become an increasingly common procedure. It is often performed at the time of Cesarean section, or shortly after delivery, where it can be done through a small abdominal incision. Alternatively, laparoscopic tubal sterilization may be performed as an elective procedure anytime a patient wants a "permanent" method of birth control.Many reasons lead couples to consider reversal of a tubal ligation. Studies actually show that a relatively large number of patients will eventually desire a reversal of a tubal ligation. If the tubal segments are favorable for surgical reconstruction, the abdomen  is opened through a small transverse (4-5 inch) incision. Next, the closed ends of the tubes are surgically excised. Using a very fine suture (about the diameter of a human hair), the tubes are reapproximated using a surgical microscope to achieve magnification of 10-20 times. The surgery usually takes between 2-1/2 to 3 hours and, although very technical, can often be performed on an outpatient basis or with a single overnight stay in the hospital.Most studies, and our results, would indicate that pregnancy rates of 80% can be achieved with properly selected patients. ^ | ||
Blastocyst Culture and Day 5 TransfersA "new" technique in that has received a great deal of press and generated much interest by ART practitioners and consumers is the "Day 5" or "blastocyst" transfer, which simply means that embryos are grown longer in the lab (for 5 days after oocyte retrieval and IFV or ICSI) than in traditional IVF, in which embryos are transferred on Day 2 or 3. Despite the hype surrounding this advancement, culturing to blastocysts does not necessarily require additional skills or training by the embryo laboratory, since it utilizes the same procedures as culture of earlier stage embryos. The difference is that culture media are now commercially available that can, when used at the appropriate stages, support embryo growth from the zygote (one-celled) stage to the blastocyst stage. At this stage, the embryo can be distinguished by a fluid filled center known as a blastocoele, and has begun to differentiate into two types of cells, cells destined to become the fetus and cells destined to be placenta and other extra-embryonic structures.Probably the main benefit of this procedure is that it allows the embryologist to select the most viable embryos for transfer and thus transfer fewer embryos, reducing the possibility of a multiple pregnancy. Shari Olson, Ph.D. - Embryologist Rocky Mountain Center for Reproductive Medicine®. ^ | ||
InfertilityThe major portion of our practice deals with diagnosis and treatment options of female infertility. Special procedures such as In Vitro Fertilization (IVF), Artificial Insemination (IUI), and Tubal Reanastomosis (tubal ligation reversal) are available. ^ | ||
EndometriosisWe have a particular interest in the diagnosis and treatment of endometriosis as it relates to infertility and pelvic pain. ^ | ||
Transvaginal Hydrolaparoscopy "Fertiloscopy"Transvaginal Hydrolaparoscopy, or Fertiloscopy, is a procedure that is done as part of a workup for infertility and pelvic pain. This outpatient procedure is done in the office using local anesthesia or IV conscious sedation. A needle is inserted through an anesthetized area at the top of the vagina and a very small laparoscope is inserted. Fluid is then used to distend the lower pelvis for visualization of the tubes and ovaries in their natural anatomic position. This allows for inspection of the pelvis for adhesions, endometriosis, or other causes of infertility. Fertiloscopy may also be combined with a hysteroscopy, the procedure performed to visualize the interior of the uterus, and/or tubal dye studies to check tubal patency. This may eliminate the need for an HSG in addition to eliminating the need for laparoscopy. It has been estimated that "Transvaginal Hydro laparoscopy can eliminate the need for standard laparoscopy in about 50% of infertility patients, reducing treatment costs."*We're excited about the use of this technique to reduce the costs associated with laparoscopy and to provide a more comprehensive approach to your infertility care. If you would like to discuss this further with Dr. Bachus, please call for an appointment. *Dr. Rudi Campo, Leuven Institute for Fertility and Embryology. Ob.Gyn.News, Vol 33, No 11 ^ | ||
MicrosurgeryThis highly specialized area of surgery is useful in surgically corrective infertility. Such areas would include tubal reanastomosis after tubal sterilization or surgical removal of scar tissue and adhesions due to pelvic infections, endometriosis, and so on. Dr. Bachus has a great deal of experience in this area. ^ | ||
Gynecological EndoscopyThe use of video laser laparoscopy in the diagnosis and treatment of gynecological disorders is a large portion of our surgical practice. This includes its use as a part of infertility evaluation and treatment of ovarian cysts, laparoscopically assisted vaginal hysterectomies, presacral neurectomy, etc. This procedure is performed on an outpatient basis using small incisions. ^ | ||
HysteroscopyAnother endoscopic procedure is hysteroscopy. It is used to diagnose abnormal uterine bleeding, repetitive pregnancy loss, or as a part of an infertility evaluation. Diagnostic hysteroscopy is performed as an office procedure with local anesthetic. Operative procedures involving removal of benign intrauterine tumors, polyps, scar tissue, and other problematic conditions are performed on an outpatient basis in the hospital with general anesthetic. Endometrial ablation is a special operative hysterectomy for many patients. ^ | ||
Laser SurgeryThis is another area of highly specialized care available through our office. Laser surgery is frequently helpful with infertility problems. It may be used in microsurgery for destruction of adhesions or scar tissue, or removal of endometriosis. It may also be used as the special technique of laser laparoscopy, a procedure that can frequently benefit patients with scar tissue or endometriosis, and can be performed on an outpatient basis. ^ | ||
In Vitro Fertilization (IVF)In Vitro Fertilization (IVF): For patients with irreparably damaged fallopian tubes, profound oligospermia, or failure to conceive after adequate attempts of intrauterine inseminations, in vitro fertilization (IVF) has become the treatment of choice. The technology involves incubating the oocytes and sperm in the laboratory and allowing the resulting embryo(s) to develop for a number of days prior to transferring them into the endometrial cavity.The coculture of sperm and oocytes in a laboratory dish with the intention of producing embryos, received its debut in 1978 with the birth of Louise Brown. This technique was designed to help women with damaged fallopian tubes conceive. Over the last 18 years, a number of different assistive reproductive technologies have been developed to overcome a variety of reproductive  problems. The indications for each of these techniques are less clear than treating tubal factor patients with IVF. Since it is not always obvious why one procedure is chosen over another, and due to the lack of standardization, the statistics and success rates for each procedure are difficult to decipher. When you become a patient, we give you a brochure designed to review the various techniques being used, their indications, and to help you understand how to interpret infertility statistics.
Currently, there are several techniques being performed that are drastically different in financial cost and invasiveness. Understanding this will also help you understand why your therapy was chosen. All therapies are individualized to each couple's situation. ^ | ||
Intracytoplasmic Sperm InjectionIt may sound a little bit like science fiction, but it's taking place right here in Fort Collins at the Rocky Mountain Center for Reproduction®, the office of Dr. Kevin Bachus.And most importantly, it's helping couples who couldn't conceive on their own because of male infertility to achieve normal, healthy pregnancies. Called ICSI (pronounced ICKsee), the procedure is a special extra step in the normal in vitro fertilization (IVF) process. Traditionally, the partner's sperm are mixed with the woman's eggs in a petri dish in the in vitro laboratory. From there, the age-old "sperm-meets-egg" magic happens all by itself, and within a day or two, the resulting embryos are gingerly transferred to the woman's uterus. But sometimes, the partner's sperm doesn't fertilize the eggs, and they need a little extra help. Low sperm counts, poor sperm movement, and poor sperm survival over a 24-hour period are the three criteria Dr. Bachus and embryologist, Shari Olson, Ph.D., examine when considering a couple for ICSI. Two decades of IVF experience have shown physicians that when one, or a combination of these three male infertility factors are present, low fertilization rates can result. ICSI overcomes these barriers through the injection of a single live sperm into the mature egg. In the lab, Olson first "washes" the partner's sperm as she would for a normal IVF procedure. Looking through a microscope, she then readies an egg and holds it on the end of a tiny cylindrical pipette. With an equally tiny v-shaped pipette, controlled by her other hand, she deftly captures a single, healthy-looking sperm by holding it down by its tail.  She immobilizes the tail with a scissoring motion of the pipette, suctions the sperm into the pipette's tip, then injects the sperm through the egg's exterior wall into the main body of the egg, or cytoplasm.Olson must then repeat this tedious process for each of the woman's remaining eggs. "It can take months to learn how to do this and to do it well," says Dr. Bachus. For one couple, ICSI overcame male infertility so severe that only a few sperm (instead of the one or two million normally seen) survived the washing process. But a few sperm were all Olson needed to fertilize the eggs. Still, Dr. Bachus cautions, this approach isn't for everyone. Not every egg survives the rigors of sperm injection and the procedure adds extra costs. "We should only use it, like any other surgical procedure, if necessary," he said. For more information about intracytoplasmic sperm injection, or ICSI, contact Dr. Kevin Bachus at the Rocky Mountain Center for Reproductive Medicine® at 970-493-6353. ^ | ||
Assisted HatchingThis is a new technique to assist with the success rates of IVF. A break in the outer covering of the egg, called the zona pellucida, needs to occur in order for the developing embryo to attach to the lining of the uterus (endometrium). It appears that some individuals have embryos that need assistance in the "hatching" process. With the assistance of highly specialized equipment, the zona pellucida can be weakened in the lab to assist with hatching. ^ | ||
Ovulation InductionThere are several drugs available to mature eggs and induce ovulation. The choice of drugs and dosage is made by your physician and is individualized for each patient's needs. Prescriptions of all these medications will be given to you at your appointment for cycle start.Lupron® is typically begun about four to seven days before your menses are expected and temporarily blocks the pituitary gland from secreting hormones that direct the ovary in a normal cycle. This allows us to have better hormonal control of the next round of follicular development and prevent premature ovulation, which could cancel your cycle. Lupron® is administered by subcutaneous injection that you will be taught to give yourself. Before beginning Lupron®, a pregnancy test and baseline ultrasound will be done. You will be on Lupron® for a variable amount of time prior to beginning therapy with Follistim®. The Lupron® is continued during gondadotropin therapy (Follistim®), and is discontinued after the hCG injection. Follistim® therapy is begun after consultation with one of our IVF nurse coordinators, and requires daily dosing for approximately nine to 14 days. These medications stimulate the recruitment of many follicles simultaneously and are administered by subcutaneous injection. HCG is used to trigger a series of events in the follicle that assists both the oocyte retrieval and the culture of sperm and oocytes. It is administered approximately 37 hours before the oocyte retrieval. The timing of the HCG injection is very important. HCG is administered by intramuscular injection. Progesterone is given after the oocyte retrieval to support the endometrium during the luteal phase (the two-week interval after ovulation). ^ *The Commission on Laboratory Accreditation of the College of American Pathologists has given our IVF/Embryology Laboratory an accreditation award. |
|
|
||
