Integrated Health Clinic provides a whole-person, patient-centered approach to treating infertility, which can be divided into 6 distinct phases.
Phase 1 – Foundation First
The first visit is 60 minutes in length, and both partners are encouraged to attend. A comprehensive intake, physical exam, and fertility history is taken. Any current or past lab tests, diagnostic imaging, and semen analysis are reviewed. Lifestyle recommendations and diet are addressed. Natural cycle monitoring is initiated.
Phase 2 – Identify and Remove Obstacles
Blood, urine and saliva tests are ordered, based on patient history, to identifying vitamin/mineral deficiencies, environmental toxicities, endocrine/ hormone imbalances, and ovarian reserve. Ultrasound is used to identify structural abnormalities, uterine lining and ovarian function. Ultrasound monitoring continues throughout cycles to monitor follicle development, ovulation, and changes to cycles.
Phase 3 – Supplementation/ Nourish
Oral and/or intravenous nutrient replacement therapy, for any fertility-specific vitamins, minerals and amino acids. Herbs to promote ovulation, and to correct subtle hormone imbalances. Based on the results from the semen analysis, male factor infertility is addressed with recommendations to increase sperm concentration, motility, and morphology, decrease leukocytosis and reactive oxygenation species.
Phase 4 – Balance Hormones
Compounded bio-identical hormone prescriptions may be prescribed for lab-determined hormone imbalances, (ie. Bi-Est, Tri-Est, and Progesterone). These may aid in follicular development, endometrial lining thickness, and luteal phase support. Specific nutritional supplements can influence hormone production pathways to promote conversion to beneficial hormones for fertility, and inhibit the conversion of hormones to less favored hormones.
Phase 5 – Ovulation Induction/ Superovulation
Utilize pharmaceuticals such as Clomid, Tamoxifen, and HCG for ovulation induction and superovulation. Metformin and Hydrocortisone are also prescribed in certain cases. Ovulation induction is used for those patients who fail to ovulate or have irregular and/or longer cycles. Superovulation is a term used to describe utilizing ovulatory drugs, in a normally cycling woman, with the expectation of creating larger follicles or multiple follicles in that cycle. Ovulation induction and superovulation treatments may cause the risk of conceiving multiples, and may also lead to ovarian hyper-stimulation syndrome, (OHSS). They require physician monitoring and follow up with each cycle is recommended.
Phase 6 – Non Medicated/ Medicated IUI
Intra-uterine insemination(IUI) is recommended when a couple has failed to conceive after having completed steps 1 through 4 of the IHC Integrative Fertility Program. It is may be combined from the outset during Phase 5, alongside the ovulatory/ superovulatory drugs. IUI may be initially given when the patient is unmedicated, and timed with a woman’s natural LH surge. They also may be prescribed with the use of HCG as a trigger with the LH surge. However, IUI is most often prescribed with an ovulatory or superovulatory drug regimen, as research shows better pregnancy rates with medicated cycles (ie. Clomid, Letrozole, or Tamoxifen). The most common indication for IUI is unexplained fertility, but it is also indicated for infertility secondary to cervical factor, mild male factor, and mild endometriosis. IUI’s are often prescribed for three consecutive cycles/months. If the 3 cycles have been medicated, often a 1-2 month break is recommended before initiating more rounds. If the couple has not conceived after 6 months of IUI treatment, patients are often referred to PCRM or other fertility clinics offering assisted reproductive therapies such as IVF.