Testosterone Testing during Infertility Treatment

A blood test to determine testosterone levels is recommended if a woman has irregular periods or none at all. Female testosterone levels can be an indication for certain conditions that can cause female infertility.

Dealing with High-FSH levels and Pregnancy

A rise in FSH levels is an indication of a problem with a woman’s ovarian egg supply, leading to difficulties in treating infertility. Checking FSH levels assists in deciding upon treatment options.

When to Consult a Reproductive Endocrinologist

When the basic treatment for fertility related problems as recommended by an obstetrician/ gynecologist (OB/GYN) do not seem to work, it may be time to start seeing a Fertility Specialist, also called a Reproductive Endocrinologist (RE) who may recommend advanced treatments and medications. The OB/GYN treating infertility usually recognizes the limits of their capabilities and makes appropriate referrals to more specialized care whenever necessary.

Who is a Reproductive Endocrinologist?

Reproductive Endocrinologists complete the same education and medical requirements as OB/GYNs. In addition, they also finish a two- to three-year fellowship in reproductive endocrinology, pass specialized examinations (board certified) and complete a two-year practice in reproductive endocrinology. Thus they are the physicians with the broadest range of qualification, training, specialization and experience in treating reproductive disorders. In fact Board Certification in reproductive endocrinology infertility is the only sure identifier of a trained fertility specialist.

Reproductive Endocrinology combines reproductive medicine and endocrinology, which focuses on organs of the endocrine system and the hormones they produce. These specialists also deal with issues related to menstrual disorders, puberty-related problems and sexual dysfunction as well as the treatment of transsexuals and intersexed individuals undergoing hormone treatment.

A Positive Step towards Infertility Treatment

The decision to consult a RE is a proactive, tangible step towards addressing fertility issues. Board certification is important when choosing a reproductive endocrinologist. At the first visit the RE will ask about the patient’s medical history, any diagnostic procedures that have been done so far, and procreative efforts to date. The RE then specifies the tests which are necessary to be performed.

Who Should Consult a Reproductive Endocrinologist?

In general, women aged thirty-five or older if experiencing fertility issues should seek specialty care from a reproductive endocrinologist as their fertility can decline rapidly.  Staying with their OB/GYN for far too long expecting positive results is the error most couples make, thus wasting valuable time. Younger women can also experience premature menopause, termed “declining ovarian reserve”.  Such a condition, as also disorders like polycystic ovarian syndrome (PCOS), male factor infertility, fallopian tube disease and severe endometriosis all warrant immediate consultation with a reproductive endocrinologist.

Often patients hesitate to consult a fertility specialist due to cost concerns. But since appropriate diagnostic tests and treatment are ordered early in the evaluation during a consult with a specilist, it leads to effective treatment options and ultimately to overall savings in cost. Patients under the care of a reproductive endocrinologist are more likely to conceive, and in a much shorter period of time.

East Bay fertility clinic (http://www.ebfertility.com/) specializes in the comprehensive evaluation and treatment of infertility. Their experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. A former infertility patient herself, Dr. Snowden brings to her patients a rare and valuable firsthand empathy for the personal pain and emotional stress of dealing with infertility. Call 925.828.9235 for a free initial consultation.

Female Infertility Due to Fallopian Tube Damage

A common cause of female infertility is due to blockage and scarring of the fallopian tube. This condition prevents the egg from travelling to the fallopian tube and onward to be implanted in the uterus. Blockage of the tube increases the chance of ectopic pregnancy, where the fertilized egg settles in the fallopian tube rather than the uterus.

Fallopian tube block can be caused by untreated pelvic inflammatory disease (PID), endometriosis and sexually transmitted diseases. Sometimes it can be caused by scar tissue that forms after pelvic surgery. Other potential causes of blocked fallopian tubes include a previous history of uterine infection caused by an abortion or miscarriage, a history of abdominal surgery or a ruptured appendix.

The common tests to diagnose infertility due to fallopian tube damage include

• A hysterosalpingogram (HSG) which is a medical procedure where radio opaque dye is injected through the cervix into the uterus and fallopian tubes. A special X-ray machine then scans the pelvic region to diagnose fibroid tumors, scar tissue, an unusually shaped uterus or blockages in the fallopian tubes.
• Laparoscopic surgery is sometimes performed in order to diagnose tubal factor infertility. This involves making a small incision in the abdomen. A tiny camera is then inserted into this incision, allowing the surgeon to view the fallopian tubes.

Treating Tubal Factor Infertility

Tubal factor infertility can be treated through IVF or fallopian tube surgery.

Invitro Fertilization (IVF)

IVF is recommended for women suffering from tubal factor infertility. IVF involves fertilizing an egg outside the fallopian tubes and then implanting the embryo inside the uterus. Chances of pregnancy through this process are quite high.

Fallopian Tube Surgery

Surgery to remove scar tissue, adhesions and fallopian tube blockage is another option although subsequent pregnancy rates do vary.

A reproductive endocrinologist (fertility specialist) is best suited to take the decision about which of these therapies are to be opted based on several factors, the most significant factor being the degree of tubal damage, the age of the female, and whether other infertility factors (male or female) are present.

For women with significant damage to the ends (fimbria) of their tubes, one IVF attempt offers a better chance of a viable pregnancy than surgery ever will and at a lower overall cost.

East Bay fertility Center Dublin California, (www.ebfertility.com) specializes in the comprehensive evaluation and treatment of infertility providing a complete mind-body experience for fertility couples. East Bay’s experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. East Bay Fertility Center performs tests to check the extent of fallopian tube blockage or damage and recommends tubal surgery if necessary.  Call 925.828.9235 for a free initial consultation.

Azoospermia – A Cause of Male Infertility

Azoospermia is the complete lack of sperm in the ejaculate and is one of the most severe forms of male factor infertility. Since azoospermia does not have any symptoms, it often comes as a surprise to a couple planning parenthood. This condition does not rule out the possibility of fathering a child. New techniques are now being perfected to help men with azoospermia become a parent to biological children.

Azoospermia is of two types:

• Obstructive Azoospermia that occurs when a blockage in the duct system prevents sperm from mixing with the semen.
• Non-Obstructive Azoospermia occurs when there is a problem with the actual production of sperm within the body and is generally attributed to hormonal imbalances.

Causes of Azoospermia

Failed sperm production is often the result of hormonal abnormalities, undescended testicles or vascular trauma to the testes or to the blood vessels within the testes.

Sperm transport problems are often caused by infection including STDS, by congenital absence of Vans Deferens which are tiny tubes that carry sperm to the urethra for ejaculation or due to a previous vasectomy procedure that prevents the sperm from mixing with the ejaculate.

Diagnosis

The initial semen analysis reveals if there is a problem with sperm production or there is a blockage preventing sperm from reaching the ejaculate. A medical evaluation of a male suspected to be suffering from azoospermia includes:

• A thorough physical examination
• Semen analysis
• Blood tests that include a testosterone and FSH level
• A complete review of medical problems, past surgeries, medications and family history

A testis biopsy under local anesthesia may be performed if the above procedures fail to throw light on the sperm production problem.

Treating Azoospermia

There are ways to treat azoospermia and possibly restore fertility in men suffering from the condition. Treatment options include:

• removing blockages in the duct system
• using medications to restore hormonal balances

New methods of surgical sperm removal are now available, wherein small quantities of sperm can be removed from the testes or around blockages. These include:

• PESA (Percutaneous Sperm Aspiration), in which sperm is taken directly from the epididymis.
• MESA (Microsurgical Epididymal Sperm Aspiration), in which sperm is retrieved in higher numbers from the epididymis.
• TESE (Testicular Sperm Extraction), in which a small tissue sample is taken from the testicles in order to retrieve viable sperm.

Thus even if there are no sperm in the ejaculate, sperm can often be harvested and used to achieve fertilization. Assisted Reproductive Techniques (ART) like IVF and ICSI manipulate sperm in a controlled manner and greatly facilitate infertility treatment.
It is important not to give up hope when confronted with azoospermia. A consultation with an infertility specialist for treatment options is the immediate step to be taken. East Bay Fertility Center located in Dublin, California (www.ebfertility.com) is well equipped with the latest technology and offers comprehensive infertility consultation. The Center is headed by Dr. Ellen U. Snowden a Board Certified Reproductive Endocrinologist and offers a complete mind-body experience for couples with fertility issues including male infertiity.

Call 925.828.9235 for a free initial consultation.

Secondary Infertility – Causes and Remedies

Secondary infertility is a term used to describe a condition where a woman who was able to conceive naturally in the past has difficulty conceiving another child. This is a fairly common problem that can be attributed to a number of factors such as low sperm count, endometriosis, damaged fallopian tubes, ovulation problems, fibroids or change in partner.

In some cases, medical tests indicate that the cause of secondary infertility is a combination of factors shared by both partners.

Age as a Cause of Secondary Infertility

The most common cause of secondary infertility may be age. There is a marked decrease in fertility by 35 years of age. By age 45 the chances of natural conception are extremely low. Thus the possibility of becoming pregnant decreases with rising age. Moreover, a woman’s eggs suffer chromosomal damage as they age; the older the eggs, the less likely they are to become fertilized or go to term. Some women also go through menopause at an early age; this may also be a cause of secondary infertility.

Some experts in the field of human reproduction have suggested that male fertility is also affected by age and that male fertility starts declining after the age of 35.

Stress and Secondary Infertility

Stress may also be a factor affecting fertility. Studies show that if a man already has a low sperm count, stress worsens this condition. While stress itself does not cause infertility, the process of “trying” to become pregnant can be stressful, especially on your relationship. The stress levels are often the result of infertility, not the cause of it.

Diet and Lifestyle

Being either underweight or overweight can affect fertility. Smoking and excessive consumption of alcohol has also been found to affect fertility.

Chronic Illness

Chronic illness can also lead to secondary infertility. High blood pressure, diabetes and asthma can affect fertility. Sometimes chemotherapy or radiation treatments for cancer can reduce a person’s fertility.

Remedies for Secondary Infertility

There are a number of steps that can be taken when confronted with secondary infertility to improve chances of conception. The first obvious step is for both the partners to get a complete medical check up done.

Things may change after the birth of the first child. For instance one of the partners could now have a low sperm count; hormones could be out of sync etc. Taking control of the situation and opting for the right line of treatment will help in surmounting the condition.

If faced with fibroids, endometriosis, vaginal infections and pelvic adhesions – all potential causes of secondary infertility – get treatment for these issues which can sometimes successfully cure infertility.

Fertility treatments may be the next line of treatment for curing secondary infertility. A referral to a reproductive endocrinologist for appropriate treatment may be necessary. Initially the fertility specialist will prescribe medications to help conceive another child. If this proves ineffective, more advanced treatments may be necessary.

On a Positive Note

The good news is that secondary infertility is more likely to be treatable than primary infertility. Consult with a specialist, and faithfully follow the prescribed treatment plan, and you can be sure that you’ll have another baby soon.

East Bay Fertility Center, Dublin, California (www.ebfertility.com) has an experienced team of doctors headed by Board Certified Reproductive Endocrinologist Dr Ellen Snowden and offers the most comprehensive line of treatment and intervention for secondary infertility. East Bay Fertility Center makes sure that couples who have been facing problems conceiving a second time will successfully overcome the problem in the shortest possible time and realize their dreams of having a healthy baby. Call 925.828.9235 for a free initial consultation.

Unexplained Infertility

Unexplained infertility is a fairly common medical condition which indicates a failure to determine a credible underlying cause of infertility despite a thorough evaluation of both the male and female partner. Knowing that you’re infertile is tough enough, but not knowing the underlying cause for the problem can be extremely painful to reconcile with.

The diagnosis of unexplained infertility is a difficult process involving a series of exclusion and elimination based on a large number of infertility tests making it an extremely frustrating experience.

Doctors are now of the opinion that unexplained infertility is probably caused by a small problem in each partner, affecting the chances of getting pregnant. These problems are so subtle that they don’t show up on current tests. This means that a clinical problem exists but the probable cause for this problem remains elusive.

Possible Factors Leading to Unexplained Infertility

Abnormal fallopian tubes
Abnormal eggs
Prematurely Aging Ovaries Syndrome
Weak sperm
Immune System Problems
Emotional Distress

Possible Treatment Options for Unexplained Infertility

Intrauterine Insemination (IUI) – Under this assisted reproductive technology, the fertilization process is initiated by collecting sperm from the male partner and releasing it into the female partner’s uterus.

In-vitro Fertilization (IVF) – This process is followed for women who have faulty fallopian tubes or ovaries. The process involves placing the egg and the sperm in a dish and once fertilized, the embryo is placed into the woman’s uterus.

Controlled ovarian hyperstimulation - Intrauterine insemination in conjunction with controlled ovarian hyperstimulation is often used as first-line treatment for couples with unexplained infertility. The treatment involves using drugs to make the woman’s ovaries produce eggs and inserting her partner’s sperm directly into her womb.

For those grappling with a diagnosis of unexplained infertility, the good news is that medical science has made great inroads in cutting down the incidence of this condition. On-going research is tipped to further reduce the incidence of unexplained fertility in the coming years. Moreover studies reveal that very often such couples conceive naturally over a three year period.

East Bay fertility Center, Dublin, California, (www.ebfertility.com) specializes in the comprehensive evaluation and treatment of infertility, providing a complete mind-body experience for fertility couples. At East Bay, our reproductive endocrinologists conduct a detailed review of the entire infertility evaluation when couples approach us with a prior diagnosis of unexplained fertility. This can sometimes reveal an error made in either testing or interpretation in which case we recommend further investigation into questionable fertility factors. Treatment options are pursued based on all known parameters and the preferences of the couple.

East Bay’s experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. Call us at 925.828.9235 for a free initial consultation.

Polycystic Ovary Syndrome Affecting Infertility

Polycystic Ovary Syndrome, also called PCOS, is an endocrine or hormonal disorder and is the most common cause of infertility in women. PCOS may affect a woman’s menstrual cycle, hormones, insulin production, heart blood vessels. and finally appearance. If the quantity of male hormones is more than that of female hormones in a woman’s body then she is likely to suffer from PCOS. This growth of PCOS adversely affects the ovulation rate of a woman and can cause irregular ovulation.

PCOS restricts the growth of ovarian follicles and as a result these follicles are not able to release eggs. The follicles are left with less time to reach maturity and they continue to grow as small size cysts (fluid-filled sacs) in the ovaries. However women with cysts need not necessarily have PCOS.

Symptoms of Polycystic Ovarian Syndrome (PCOS)

The main symptoms of PCOS that doctors look for while diagnosing the causes of infertility include:

• Irregular and/or no ovulation which means no eggs to be impregnated
• Irregular and/or no menstruation
• Increased growth of hair on the face, chest, stomach, back, thumbs, or toes
• High levels of male hormones, also called androgens
• Severe acne, oily skin, or dandruff
• Considerable pelvic pain
• Weight gain or obesity, especially extra weight around the waist
• High cholesterol level and high blood pressure
• Type 2 diabetes
• Male-pattern baldness or thinning of hair
• Skin discolorations around the genitals, chest and arm pits
• Growth of skin tags, or tiny flaps of skin in the armpits or neck area
• Sleep apnea i.e. excessive snoring and occasional stoppage of breathing while sleeping
• Insulin resistance

All of these symptoms need not be present for the diagnosis of PCO. The tests to confirm the suspected diagnosis include:

1. A reverse FSH/LH ratio performed on Day 3 of the menstrual cycle
2. Characteristic appearance of the ovaries on a pelvic ultrasound
3. Characteristic appearance of the ovaries when visualized surgically by laparoscopy or laparotomy

Treatment for Polycystic Ovarian Syndrome (PCOS)

As per the U.S. Department of Health & Human Services, treatment procedures for PCOS differ from one patient to another based on symptoms and whether the woman wants to conceive or needs contraception. A detailed look at the symptoms and family history is essential to start appropriate treatment. Controlling the symptoms of PCOS is the best cure to reduce the risks associated with it.

To control the side effects of PCOS a healthy diet and regular exercise are crucial. The remedies for Polycystic Ovarian Syndrome (PCOS) include:

• Contraceptive pills: Not exactly a cure for PCOS, these pills regulates menstrual periods, reduce male hormone levels and acne growth. But once the pills are discontinued, the menstrual cycle tends to again become abnormal.
• Diabetes Medications: Medicines for type 2 diabetes such as Metformin, also called Glucophage, regulates glucose, decreases testosterone production, slows down abnormal hair growth and normalize ovulation after a few months of use.
• Fertility treatments: The lack of ovulation is the main fertility problem for women with PCOS. However, before starting with fertility treatment it is essential that sperm count and the partner’s tubes are checked to make sure they are open.
• Ovarian Drilling Surgery: This surgery, considered the last treatment option, is used to induce ovulation. This helps in reducing male hormone levels and aids ovulation. However, the surgery carries a risk of developing scar tissue on the ovary.
• Maintaining a healthy body weight: Healthy weight lowers glucose levels, restores regular periods and uses insulin more effectively. It has been proved that losing even a small amount of weight can help balance hormones and restore fertility.

If the normal course of treatment for PCOS does not yield positive conception results, it is essential to seek out the care of a Reproductive Endocrinologist. East Bay Fertility Center (www.ebfertility.com), California, offers a wide range of infertility treatments along with expert medical counseling to couples facing difficulty in conceiving. Under the guidance of Dr. Ellen U. Snowden, Medical Director and physician, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues. East Bay Fertility Center specializes in providing infertility treatments such as in-vitro fertilization, insemination, Intracytoplasmic sperm injection, egg donation and gestational surrogacy.

With the right type of treatment and intervention, East Bay Fertility Center assists couples who have been having problems conceiving to overcome those difficulties in the shortest possible time in order to realize their dreams of having a healthy baby.

Call us at 925.828.9235 for a free initial consultation or visit our website at www.ebfertility.com for more details about infertility treatments and more.

Eating Healthy During Fertility Treatment

A variety of lifestyle factors affect the fertility potential of individuals. Since infertility is a physical problem, a healthy diet plays a vital role in enhancing fertility. Studies have shown that certain foods can regulate the hormones that affect the production of eggs and sperm. A good diet also helps in maintaining a healthy weight, which can greatly impact fertility. Women who are underweight or overweight may have a harder time becoming pregnant because body fat levels do have an impact on the production of sex hormones. It is imperative that in the course of infertility treatment, a healthy diet and lifestyle is maintained.

Tips for Healthy Eating During Infertility Treatment

What you put into your body has a huge effect on the functioning of your reproductive system. A well balanced, nutritious diet is therefore essential for the formation of a healthy embryo especially while undergoing infertility treatment. Below are some natural approaches and lifestyle adaptations that should be followed in the course of fertility treatment, and maintained throughout pregnancy and thereafter:

• Eat a variety of foods such as fruits, vegetables, dairy products, meat, poultry, fish, eggs and nuts to get all the different kinds of essential nutrients
• Choose foods that are high in fiber
• Include enough vitamins and minerals in your daily diet
• It is absolutely essential to have lots of water since it’s an important fertility food
• Intake of calcium-rich foods to get 1000-1300 mg of calcium in your daily diet
• Eat enough servings of iron-rich foods everyday to get 27 mg of iron daily
• Choose at least one good source of vitamin C every day, such as oranges, grapefruits, strawberries, etc. to get the daily dose of 70 mg of vitamin C
• Choose at least one good source of folic acid every day, like dark green leafy vegetables, veal, and legumes such as lima beans, black beans, black-eyed peas and chickpeas
• Choose at least one source of vitamin A every other day such as carrots, pumpkins, sweet potatoes, spinach, water squash, turnip greens, beet greens, apricots, and cantaloupe.

Foods to be Avoided During Infertility Treatment

• Alcohol should be avoided since it can decrease sperm count and increase the production of abnormal sperm. Alcohol may cause premature delivery, mental retardation and birth defects.
• Caffeine intake should be limited. Try and substitute your daily cup of coffee with green tea that has antioxidants, which aid in healthy immune systems.
• The use of sweeteners should also be limited
• The intake of trans fats from margarine, doughnuts and other processed foods should be limited
• It is recommended to replace processed foods with whole grains, fruits, and vegetables
• Avoid eating shark, swordfish, king mackerel, or tilefish as they have high levels of mercury
• Avoid soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese. These cheeses are often unpasteurized and may cause Listeria infection.
• Avoid raw fish, like oysters and clams
• Avoid acidic foods

Ensure that raw vegetables and fruits are washed thoroughly and cook ready-to-eat meats (like hot dogs) and leftovers until steaming hot.

Exercise

Along with a balanced and nutritious diet, it is important to undertake a moderate exercise regimen to improve the chances of conception. Exercise helps to burn off excess body fat, allowing hormone levels to return to normal. However over exercising can actually impair fertility. Exercises like swimming, walking and cycling are recommended.
It’s important to eat right at all times and especially if you are trying to conceive. Eating right does play a major part in improving fertility along with maintaining a healthy weight, exercising regularly, and keeping stress under control.

California based East Bay Fertility Center (www.ebfertility.com) provides expert medical counseling and different infertility treatment options. Our medical staff headed by Dr. Ellen U. Snowden, Medical Director and physician provide personalized and comprehensive services for infertility and reproductive endocrine issues. Infertility can be attributed to the male or the female or to both. East Bay Fertility Center conducts tests to determine the exact fertility problem and suitable fertility treatments are then recommended.

For free initial consultation please call us at 925.828.9235 or visit our website at www.ebfertility.com for more details about infertility support, treatment and more.

The Link between Obesity and Fertility

Obese women are known to face difficulties in trying to get pregnant, usually taking a longer time to conceive, regardless of their age and regular menstrual cycle. Women who are obese have a greater risk of pregnancy-related problems. Obesity is found to damage a woman’s embryos and stops them from developing further. Obese women may face alterations in their ovaries which could be one of the reasons that cause an egg’s inability to become an embryo.

It is believed by the medical world that the characteristics of the eggs are determined by the environment in which they develop within the ovary. Obese women have unexpectedly high levels of fats and inflammation in the fluid surrounding the eggs, which affects an egg’s capacity of developing. The accumulated fat in a woman’s body alters the sensitive metabolism of the egg that has an adverse impact on the embryo formation.

With an altered ovarian follicular condition and increased metabolite and androgen activity levels, obese women have enough reasons for their poorer reproductive systems. Obesity causes blood lipid changes and higher inflammation rate which can impact not only fertility but also a person’s general health. According to studies, a woman is obese if she has Body Mass Index (BMI) that is more than 35.

Effects of obesity on fertility and pregnancy:

Obese women face major health risks during pregnancy. Obesity has been linked to the following infertility and pregnancy complications:
• Reduced ovulation rate
• Preeclampsia that is caused due to increased blood pressure during pregnancy
• Stillbirths
• Reduced chances of conceiving naturally
• Increased risk of miscarriage, pregnancy complications and congenital anomalies
• Long term affect on mother and child’s health
• Gestational diabetes
• Cesarean sections
• Pregnancy hypertension

Obesity can also lead to post-pregnancy complications such as urinary tract infections, endometrial infection, urinary incontinence and injuries that do not heal easily.

Possible Treatment Options for Obesity

There are a variety of obesity treatments available to women. Following are the recommended treatment options for obesity:
• Dietary therapy: the diet of the individual is modified and closely monitored
• Physical therapy: the individual is introduced to a moderate exercise program
• Behavior therapy: this includes correcting the eating disorder and other behavioral disorders of the individual
• Drug therapy: medications including drugs are provided in conjunction with physical and dietary therapy
• Obesity surgery: In some severe cases of obesity, gastric bypass surgery is also recommended

East Bay Fertility Center, Dublin, California offers counseling services not just to couples who are facing difficulties in conceiving but also to obese women with fertility issues. Our medical staff at East Bay Fertility Center helps you stay motivated throughout the infertility treatment. In addition to the infertility counseling services, we specialize in providing infertility treatments such as in-vitro fertilization, insemination, Intracytoplasmic sperm injection, egg donation, gestational surrogacy.

Please visit our website www.ebfertility.com for details to know about different treatment options that we provide.