Initial Consultation
The initial consultation includes a comprehensive review of the patient's medical and infertility history leading to an evaluation of the probable cause of the couple's infertility. If the purpose of the visit is for the treatment of an infection, the origin of the infection will be assessed. The patient should come to this interview prepared. The "Contact Us" page of this web site provides two downloadable questionnaires; the medical history and the reproductive history questionnaires. The advance collection of the required information expedites the process. In lieu of the initial consultation, patients may opt for a telephone conference for a preliminary review of their case. Patients are offered this option prior to traveling long distances for testing and therapy.
Evaluation of the Microbial Profile of the Genital Canal.
Since our studies have repeatedly shown that infections are the main cause of all functional disturbances in the genital tract of both males and females, all work ups start with a microbiological evaluation of the genital tracts of both sexes. Microbiological studies include Chlamydia trachomatis, mycoplasma, aerobic and anaerobic bacteria and yeast-like organisms. Urine samples are tested for the parasite, Trichomonas. A history of an abnormal PAP test warrants testing for the HPV virus.
Comprehensive Antibiotic Therapy
Antibiotic therapy is based on culture studies and sensitivity tests. Therapy is administered for both males and females for symptomatic infections, including Pelvic Inflammatory Disease, Interstitial Cystitis, Urethritis Syndrome, in women and Urethritis, Prostatitis, Seminal Vesiculitis, in men or for the purpose of restoring fertility. Treatment modalities include a wide variety of broad spectrum antibiotics.
Hormone Tests
A battery of hormone studies are performed, including FSH, LH, Estradiol and Progesterone on pre-set days of the menstrual cycle. Since most hormone abnormalities are reversed by antibiotic therapy, all abnormal readings are repaeated following the completion of antibiotic therapy.
Fertility Drug Treatment of Ovulatory Disorders
Clomiphene, Metrodin, Pergonal and HCG (Human Chorionic Gonadotropin) are the most frequently prescribed drugs for infertility. We rarely use these drugs at our center. If antibiotics fail to restore the normal hormone levels of the menstrual cycle we may resort to them.
Evaluation and Treatment of Male Infertility
As in females, subnormal male fertility responds best to antibiotic therapy. All attempts are made to exclude environmental factors affecting semen parameters. The patient undergoes a complete evaluation for infections, and antibiotic therapy as indicated. We do not use Clomiphen or other injectable fertility drugs except in a very small, well-defined group of patients with documented pituitary disfunction. A special section on this site is devoted to male infertility.
Artificial insemination (AI)
AI, using the husband's seminal fluid, is limited to cases with severe oligospermia, prior to recommending IVF or donor sperm insemination. In either case, prior to AI, all infectious issues are taken care of. We offer artificial donor insemination with samples obtained from licensed sperm banks. We strongly oppose using AI as one of the first steps in infertility treatment. There is no data showing that with normal sperm count and good post coital test AI offers any benefit. To use AI to overcome a poor cervical factor or to correct for borderline sperm count can have disastrous consequences. The high chance of contaminating the upper compartment could lead to, at best, to a secondary infertility condition, and at worst , to infection of the upper compartment with disastrous fertility outcome.
Counseling
Counseling and therapy offered for the treatment of premenstrual syndrome, post partum depression, dysmenorrhea, Policystic Ovarian Syndrome (PCO), Premature Ovarian Failure (POF) and habitual abortion (recurring miscarriages) and for patients with previous high risk pregnancies.
IVF procedures
In the rare situations where irreversible structural or immunological damage make antibiotic therapy alone ineffective, we refer our patients to a select group of qualified institutions.that perform IVF. The referral is strictly limited for the performing of the IVF procedure. These patients follow our recommendations for antibiotic therapy through all fazes of the procedure. Duo to their high risk for residual infections, they can receive antibiotic therapy after conception or all through the pregnancy. If the Chlamydia test was positive before conception, repeat tests are performed in set time intervals all through the pregnancy and antibiotic courses ordered accordingly. These patients always deliver under antibiotic prophylaxis
Follow up care
We offer follow up care for our pregnant patients throughout their pregnancies, and if infectious complications develop, we recommend additional antibiotic therapy. See above.
Therapy for benign prostatic hypertrophy.
Our clinic offers injection therapy for males with Benign Prostatic Hypertrophy (BPH). Due to the frequent association of chronic prostatitis with BPH, a suspicious rise in PSA levels can occur. We recommend intraprostatic antibiotic injections prior to undergoing a series of prostatic biopsies to rule out cancer.
Telephone consultation
Out of town patients benefit from this service. A one hour telephone consultation is almost always sufficient to asses the most probable cause of a clinical problem and suggest the most expeditious therapy. The price of this consultation is $375, the same as the charge for a first office visit. If, at a later date, the patient visits us eventually, this fee will count as payment for the first visit.
Services
