Infertility: Which Treatment Is Right for You?

Infertility Treatments That Work

A baby in the womb.

It's untrue that simply waiting it out will put an end to infertility. Like other medical conditions, there are treatments available for those experiencing infertility. At least half of couples undergoing infertility treatments will conceive, and technologies such as in vitro fertilization have brought about many pregnancies. Over 3 million babies have been born worldwide due to this technique.

Symptoms of Infertility

A sperm approaching the ovum.

The main symptom of infertility is failure to conceive after a year of unprotected sex. This is the point at which most doctors recommend seeking fertility care. For women over age 35 who did not conceive after 6 months of trying or who have irregular menstrual cycles, seeing a fertility doctor as soon as possible is recommended. Male infertility is just as common as female infertility, so it's important that both partners be evaluated.

Male Infertility

A close up of mutant sperm.

Male factors are responsible in about 40% of infertile couples. Male factors can include low sperm count, abnormal sperm appearance, blocked sperm ducts, or poor motility of the sperm.

Female Infertility

An illustration of the fertility cycle.

An additional 40% of infertile couples have problems traced to the female partner. These can include irregular or absent ovulation, blockages in the Fallopian tubes, or abnormalities in the reproductive organs.

In the remaining 20% of infertile couples, no specific cause can be found.

Tracking Ovulation

An ovulation test.

Bad timing can contribute to a failure to conceive. Over-the-counter ovulation tests can help you figure out the time of ovulation (egg release) and determine the best time for sex. The tests measure levels of a hormone that increases 12 to 36 hours before ovulation. If the test results are unclear or consistently negative, consult your doctor. About one-third of all cases of infertility are related to irregular ovulation.

Fertility Drugs

A woman takes a pill.

Medications are available to help women who do not ovulate regularly. Clomiphene citrate (Clomid or Serophene) is the most common of these medications. It is relatively effective and inexpensive, and about half of women who take it will conceive, usually within three cycles. Clomiphene may cause the release of more than one egg at a time, so there is an increased risk of a multiple pregnancy (a pregnancy of two or more fetuses).

Injectable Hormones

A woman injects hormones.

After trying clomiphene for 6 months, women who have not conceived may be prescribed injections of hormones to stimulate ovulation. A number of different hormonal preparations are available. As with clomiphene, the chances of a multiple pregnancy are increased with hormone injections.

Surgery for Blocked Fallopian Tubes

A scan shows blocked Fallopian tubes.

Blockage or scarring of the Fallopian tubes prevents pregnancy in some women. This may be due to endometriosis (overgrowth of uterine lining tissue outside the uterus), previous surgeries, or damage as a result of previous pelvic infections. Laparoscopic surgery can remove scar tissue in some women, increasing their chances for pregnancy.

Intrauterine Insemination (IUI)

The intrauterine insemination process.

Intrauterine insemination (IUI) is used to treat different kinds of infertility. In this technique, sperm is placed directly into the uterus at the time of ovulation, reducing the distance the sperm must travel to reach the egg. IUI is often used together with drugs to stimulate ovulation. Pregnancy rates are lower than with IVF, but this procedure is less expensive and less invasive, so it may be attempted first.

IUI With Donor Sperm

A donor sperm bank.

IUI can also be performed using sperm from a donor if the male partner has a low number of healthy sperm. Counseling is typically recommended prior to this choice since the child will be biologically unrelated to the father. IUI with donor sperm is very successful in fertile women, with a cumulative pregnancy rate of over 80%.

In Vitro Fertilization (IVF)

An IVF treatment.

IVF combines the egg and sperm in a laboratory, and can be an option when other treatments have failed. Embryos created in the lab are placed inside the uterus. IVF involves hormone injections and a surgical procedure to retrieve eggs from the female partner, and it can be costly. However, success rates are improving. Pregnancy rates per cycle range from 10% in women aged 43 to 44 to 46% in women under 35. Several cycles of treatment may be necessary.

IVF With ICSI

An MRI of IVF via ICSI

When problems have been identified with a man's sperm, a procedure called intracytoplasmic sperm injection (ICSI) may be recommended along with IVF. This is a laboratory-assisted fertilization that involves inserting a single sperm directly into an egg. The embryos that form are transferred to the uterus in the same way as IVF embryos. Most IVF cycles now also use ICSI.

IVF With Donor Eggs

A human oocyte.

Women who have poor egg quality, are older, or who have not had success with previous IVF cycles, may choose to consider IVF with donor eggs and her partner's sperm. The resulting baby is biologically related to the father and not the mother, although the mother carries the pregnancy. IVF using fresh embryos from donor eggs has a high success rate, resulting in live births 55% of the time.

IVF and Multiples

Twins inside a womb.

When embryos are transferred to the uterus in IVF, it is typical to transfer 2-4 embryos at once, increasing the likelihood of pregnancy but also increasing the likelihood of a multiple pregnancy. It's important to discuss this possibility with your fertility specialist, since a multiple pregnancy is associated with increased risks, such as premature birth, high blood pressure, anemia, miscarriage, and other complications.

IVF with Blastocyst Transfer

A blastocyst transfer.

Blastocyst transfer is a relatively new IVF technology. Traditionally, IVF embryos were transferred to the uterus when they were at a stage of having 2 to 8 cells. In this procedure, the embryos grow for 5 days until they reach a later stage of development known as the blastocyst stage. Then, one or two blastocysts are transferred to the uterus. This eliminates the possibility of triplets and retains the high success rate of IVF.

Donor Embryos

Fertilized eggs.

Donor embryos are embryos donated by couples who have completed the IVF process. Transferring donor embryos is less costly than standard IVF or IVF with donor eggs. This procedure allows the experience of pregnancy. The baby will be biologically unrelated to either parent.

Surrogate Pregnancy

A couple with a surrogate mother.

Surrogacy can be an option for women who have trouble carrying a pregnancy to term. Traditional surrogacy involves insemination of the surrogate with the male partner's sperm. Gestational surrogacy is another option that involves using IVF to create embryos from both partners and transferring these embryos to the uterus of the surrogate. This option allows the baby to be biologically related to both the male and female partners.

Choosing Your Fertility Clinic

A couple talking with their doctor.

The Centers for Disease Control (CDC) keeps records comparing IVF success rates for clinics around the nation, but these should not be your only factor in choosing a fertility treatment clinic. Ask questions about procedures and costs when choosing a clinic, and be sure you feel comfortable with your choice.

Boost Fertility With Natural Methods

A pomegranate fruit.

A few lifestyle changes can increase your chance of a healthy pregnancy, no matter where you are in the treatment process. Both partners, if smokers, should quit. Smoking reduces fertility and is known to reduce pregnancy rates. A study of sperm counts showed dramatic increases in men who stopped smoking. Eat a nutritious diet, and ask your doctor if dietary supplements might be recommended for you.

Using Acupuncture for Infertility?

An acupuncture treatment.

Some couples are trying acupuncture to boost fertility. There is research to indicate acupuncture might improve uterine blood circulation, help regulate ovulation, increase sperm count, and improve rates of success with IVF.

Moving On

A couple kayaking.

Fertility treatments can become a physical, financial, and emotional burden. If you have reached your limit, you can talk with an infertility counselor about other options, including living without children or adoption. The costs of adoption vary widely, and foster care adoption can be an inexpensive option, while some private adoptions may cost around $40,000.

Sources:

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REFERENCES:

  • Medscape: "Infertility"
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