The Infertility-->Fertility Team at


Also serving Cortez, Pagosa Springs, Telluride and Farmington, NM

Expert Diagnosis and Treatment Starts Here


Getting Pregnant

When intercourse (or insemination) takes place around the time of ovulation (egg release from the ovary) and enough sperm are delivered to the opening of the womb (cervix) in the vagina, a pregnancy may occur– assuming of course that birth control is not being used.

• Estimating the time of ovulation and having enough healthy sperm in the male ejaculate are critical. Both of these evaluations can be performed or ordered at Durango Reproductive.

Causes of Infertility

• Female problems can lead to infertility about 40-45% of the time.

• These problems can include absent or infrequent ovulation, female mucus problems, endometriosis and/or internal pelvic scarring.

• Male problems can cause infertility also about 40-45% of the time. Abnormal (low) sperm counts and abnormal sperm movement account for the biggest reasons.

• About one-third of the time both a female and a male problem is found.


Unexplained Infertility

• In 10-20% of the time no cause or causes of infertility are found. This can be very frustrating for couples who are tying to get pregnant and for their doctors too.

Treatments for Infertility-->Fertility

• Many effective and safe treatments are now available to treat infertility-->fertility.

• Treatments include methods to cause or improve ovulation (egg release) improve female mucus, improve inflammation from endometriosis and improve sperm delivery to the womb so that pregnancy can occur.

• Some couples may eventually need to have in vitro fertilization (IVF) to get pregnant.

• DR can correctly diagnose infertility-->fertility problems and provide the latest treatments and even do most of the preparation up to egg harvesting for IVF if needed. Medications to cause/improve ovulation include:











   All of these medications should only be used by experienced practitioners who are familiar with the side-effects and  complications involved with their use. Close monitoring (ultrasound and blood tests) of ovarian growth is necessary for safe use.


Clomiphene Citrate (Clomid) – This oral medication is FDA approved for the induction of ovulation (egg release). It is an anti-estrogen and may be indicated in women who have normal or elevated estrogen levels.

Letrozole (Famara) – This oral medication is FDA approved for the treatment of breast cancer and is being used ‘off-label’ by fertility specialists for the induction/improvement of ovulation (egg release). It is also being used to increase the androgen (male hormone) level in the follicular fluid that bathes the egg, for women over the age of 35. It may have a particular use for women who have had multiple miscarriages. Letrozole blocks the conversion of androgen to estrogen.

Human Chorionic Gonadotropin (hCG) – This injectable (by needle) medication is used to mimic (act like) the luteinizing hormone (LH) surge that triggers ovulation (egg release). The use of hCG to trigger ovulation allows for better timing of intercourse and for intra-uterine insemination (IUI).

Gonadotropins – These injectable (by needle) medications include follicle stimulating hormone (FSH) and luteinizing hormone (LH), separately or in combination. They are used to induce ovulation.  hCG may be used instead of LH in some circumstances.

Side Effects and Complications of Fertility Treatments

The two major complications of the use of the medications listed above are multiple gestations (more than one fetus/baby) and/or ovarian hyper-stimulation syndrome (OHSS). OHSS can result in the need for bed rest, hospitalization and very rarely even death. This significant complication, resulting from the use of fertility drugs, can be minimized by appropriate dosage and use of these medications only by experienced fertility specialists.


Minor side-effects of these fertility drugs include dizziness, hot flashes, a feeling of being bloated and headache. Clomiphene citrate (clomid), in our experience, is associated with more of these minor side-effects than letrozole (famara). Some studies also show a lower multiple birth rate with letrozole.


For intra-uterine insemination (IUI) – rarely an infection can occur after an IUI. At DR we use strict sterile technique for these procedures and will treat with antibiotics when appropriate.


More details about the risks and complications of treatment for infertility can be found on our consent forms (at the office or online) and you should feel free to ask any questions you may have about the risks of treatment before starting. As with any appropriate medical treatment the potential benefits should always be greater than the possible risks.


Birth Defects and Cancers from Fertility Treatments

Couples who are infertile (or who take a longer time to become pregnant) are reported to have children with a slightly higher number of birth defects, when compared to the normal (fertile) population. Fertility drug use does not seem to increase this any higher in infertile couples who are treated with them. The normal (fertile) population generally has 2.5 to 3 babies born with birth defects per 100 births and this is reported to be increased to 3 to 3.5 babies born per 100 with birth defects in infertile couples with or without treatment. Increased birth defects do not seem to be a significant risk caused by using fertility drugs.


Cancers from fertility drugs: Some reports in the medical literature have shown increases in both breast and ovarian cancer in women who are treated with fertility drugs. More recent studies, however, have tended to be reassuring with respect to any increased risk of these cancers. If there is any increase in these cancers it is probably very small. Pregnancy and childbirth is known to lower the risk of breast cancer, especially when the first child is conceived and delivered before the age of 30.


Please read through our consent forms online for more information about treatment risks.

Educational Links:

Call 970-382-9505 or email Karen Zempel today to schedule a consultation with Dr. Gambone.

P: 970-382-9505     F: 970-382-9558

1199 Main Avenue - Suite 218, Durango, CO 81301

Located in the Bank of Colorado Building