Infertility

OGI physicians and nurse practitioners guide patients through the process of fertility evaluation and treatment options to help them achieve a healthy pregnancy. Our physicians specialize in infertility care, including the diagnosis and treatment of problems with ovulation, endometriosis, polyps, fibroids, and recurring pregnancy loss. Using medications, procedures, and surgeries to increase the likelihood of conception, we are dedicated to providing the finest medical care with respect and compassion for our patients throughout their fertility journey.

Fertility Evaluation and Management

Fertility Evaluation

Ovulation testing

Ovulation disorders account for a significant proportion of infertility cases. Testing for ovulation can be done with various methods, including basal body temperature charting, ovulation predictor kits, and measuring serum progesterone levels in the midluteal phase of the menstrual cycle.

Hysterosalpingogram (HSG)

An HSG is a procedure done under x-ray in which a small catheter is placed through the cervix into the uterus, and dye is passed through the fallopian tubes. This evaluates the uterine cavity as well as the fallopian tubes.

Hysteroscopy

A hysteroscopy is a minimally invasive procedure that can be done in the office or the operating room. A thin instrument with a camera on the end is inserted through the cervix into the uterus and can be used to remove polyps, fibroids, or sample the tissue lining the uterus called the endometrium.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure performed in an operating room where a thin telescope-like instrument with a light and small camera are inserted through a small incision in the abdomen. This technique can examine the pelvic anatomy for causes of female infertility. Unexplained infertility and suspicion for endometriosis may be indications for a laparoscopy during the fertility evaluation.

Endometriosis

Endometriosis is when tissue that normally lines the inside of the uterus grows outside of the uterus. It can cause pelvic adhesions, inflammation and fallopian tube dysfunction and can affect a woman’s fertility.

Tubal Dye Studies

Tubal factor infertility is when there are problems in the fallopian tubes that prevent the sperm from fertilizing an egg. An HSG is usually the first test done to assess tubal patency. However, if the tubes appear blocked, or if there is another reason to undergo a laparoscopy for fertility evaluation, tubal dye studies can be done to assess if the fallopian tubes are open.

Uterine Fibroids

Fibroids (or leiomyomas) are common, benign tumors that can grow within the uterine walls or in the lining of the uterus. Depending on the size and whether or not they distort the uterine cavity, fibroids can affect fertility and increase risk of miscarriage.

Hormone testing

The complex interactions of hormones in our body affects our ability to conceive. Testing hormone levels involved in the menstrual cycle, like follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone can help detect hormonal irregularities affecting fertility. Anti-Müllerian Hormone (AMH) is another hormone test that can help assess ovarian function and egg reserve.

Uterine Abnormalities

Uterine factors associated with infertility include polyps, fibroids, Müllerian anomalies and Asherman’s syndrome/uterine synechiae. Transvaginal ultrasound, sonohysterography and hysteroscopy are tools used to detect these abnormalities.

Thyroid Dysfunction

Thyroid disease can cause ovulatory dysfunction, therefore affecting fertility. Untreated thyroid disorders can also increase the risk of miscarriage. Treating these disorders can improve fertility outcomes.

Prolactin Abnormalities

Prolactin is a hormone that is made by the pituitary gland and causes milk production. Abnormally high prolactin levels can affect ovulation and are checked in the fertility evaluation. Treatment with medication can help improve fertility for those with high prolactin levels.

Recurrent Pregnancy Loss

Recurrent pregnancy loss is defined as having two or more miscarriages. A thorough physical examination and testing are recommended to assess potential causes of miscarriages. Certain medical conditions, uterine fibroids or polyps, uterine scarring, or congenital uterine anomalies and endocrinologic disorders may also increase the risk of recurrent miscarriages.

Male Factor

At least 30% of infertility cases are related to male factor issues. There are many factors that can contribute to male infertility, including sperm production disorders, ejaculatory disorders, and structural abnormalities. A semen analysis is often the first step to see if there is male factor infertility.

Polycystic Ovarian Syndrome

PCOS is a common condition which impacts fertility, and may be characterized by irregular periods, lack of ovulation, insulin resistance and excess of androgen hormones. Some women may ovulate infrequently or not at all. Evaluation of PCOS typically requires a comprehensive history, pelvic ultrasound, and bloodwork. In many cases, PCOS can be successfully managed, and fertility can be achieved using a multidisciplinary approach with medical, nutritional and psychological support. Ovulation induction agents like Clomid, Letrozole or gonadotropins can be used to achieve pregnancy.

Fertility Treatment

Fertility Medications

Oral medications like clomiphene citrate (Clomid) and letrozole (Femara) are common medications used to treat infertility. They work by promoting ovulation. Typically, these medications are taken for five days in the first part of your menstrual cycle to stimulate the release of FSH and LH hormones from the pituitary gland. Injectable medications called gonadotropins directly stimulate the ovaries to develop follicles. These medications can be used for people who do not respond to oral ovulation induction agents. Generally, these medications are tolerated well, but some potential side effects include nausea, hot flashes, headache, breast tenderness and mood swings.

Surgery

During the infertility evaluation, we may find abnormalities like uterine fibroids, endometrial polyps, ovarian cysts, or tubal concerns that may require surgical intervention. Surgical procedures including hysteroscopy, laparoscopy, and occasionally open abdominal surgery may be performed to help improve fertility outcomes.

Intrauterine insemination (IUI)

IUI is a technique that involves preparing sperm in a solution and placing the sperm directly into the uterus through a catheter. This procedure is timed to be done when a woman is most fertile and can be combined with oral or injectable fertility medications.

IVF Monitoring

While we don’t perform egg retrievals, in vitro fertilization, or embryo transfers at OGI, we partner with some IVF clinics to do the necessary blood tests and ultrasound monitoring for patients undergoing IVF.

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Obstetrics, Gynecology and Infertility was established in 1972. Over the years, we have grown to ten physicians and eight nurse practitioners.

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Patient Testimonials

“Dr. Grajczyk completely changed our lives and our infertility journey. We were living in Texas we had very little support and guidance on how to grow our family. We felt like we didn’t matter by our medical providers during the darkness of infertility. We moved to Minnesota, we’re paired with Dr. Grajczyk at OGI and our hope was restored! Her bedside manner is unlike any medical doctor we have ever met before. She not only listens, she genuinely cares! She gives amazing insight on treating the root cause versus a symptom. She is our dream team! We are blessed to have worked with her and the OGI team for both our miracle babies. We are forever grateful to know and highly recommend Dr. Grajczyk!”

Chelsie

“We are so grateful for the OGI team. After really challenging experiences with infertility and infant loss, they met us where we were at with compassion and the knowledgeable care we were needed. For our infertility care, I loved how quickly accessible the nurse practitioner team was – if I called and left a voicemail I could always count on a call back within about 10 minutes! We now have a healthy, happy 18-month old and could not be more grateful to the OGI team for helping make that dream a reality for us. I have recommended OGI to multiple friends for fertility care. We worked most closely with Dr. Darrah and Sara Norseng, and could not recommend them more highly.”

Alyssa

“We went to Dr. Stephanie Rice for infertility purposes. She outlined all procedures and gave ample time for my husband and I to ask questions. Dr. Rice was there for us through all the ups and downs that accompanied our journey. When we got pregnant with triplets, Dr. Rice continued to care for all of us. I ended up needing an emergency C-Section, and she was there for the birth of our three healthy boys. We highly recommend OGI and especially Dr. Rice!”