After you have completed a fertility assessment, it is time to begin thinking about your options. Fertility treatment is usually defined as medications that stimulate egg and sperm production or procedures that involve handling eggs or embryos.
Infertility treatment goes well beyond fertility treatments. Infertility treatment may also include lifestyle changes, surgery, weight loss, and treatment for an underlying medical condition.
The cause of your infertility will determine the treatment plan you choose.
Good news is that low-tech treatment options like surgery or medication are available for 85 to 90% of infertile couples. Only 5% of assisted reproductive technologies such as IVF are used. Just under half of those who have fertility treatments will have a child.
What are your Fertility Drug Options
Fertility drugs are used to stimulate the ovulation. However, they can also stimulate sperm formation in certain cases of male infertility. About 25% of cases of female factor infertility are due to ovulation disorders. This is the most common reason to use fertility drug treatment.
However, fertility drugs can be used during IUI cycles and almost always during IVF treatment. In 80 percent of cases, fertility drugs can increase ovulation. This is not the same as pregnancy success rates or live birth rates. Clomid, Femara and gonadotropins are all common fertility drugs.
IUI Treatment or Insemination
Intrauterine Insemination (also known as artificial insemination) is a procedure where specially washed and sterilized sperm are placed directly into the uterus. If there is a problem with the woman’s cervical mucus or unexplained infertility, this treatment can be used. IUI can also be used to donate sperm.
IUI has a low success rate. One study showed that only 4 percent of IUI women are able to get pregnant with a nonfertility drug cycle. However, 8 to 17 percent of IUI cycles that use fertility drugs to produce higher quality eggs have a high success rate.
IUI has a cost advantage that is significantly lower than IVF. IUI is not the only method of artificial insemination. However, it is the most popular. Insemination can also be used for painful sex (which prevents intercourse to have children) and lesbian couples who wish to have a child with donor sperm.
Surgical Fertility Treatments
Problems with the fallopian tubes, pelvis, or lining of the abdomen are common causes of infertility in females. This test is called an HSG (or hysterosalpingogram).
The doctor may perform laparoscopic surgery if the HSG indicates that there is a possibility of obstruction. Treatment for infection may include surgery and antibiotics.
Sometimes scarring or blockage is irreparable. IVF might be recommended in these cases. Surgery hysteroscopy is another option. This can be used to treat adhesions in the uterine cavity.
Ovarian drilling can be used to treat PCOS-related infertility. It is not recommended because of the high success rates of other treatments and the potential risks.
Laparoscopy can be used to treat endometrium in women suffering from endometriosis. This procedure is recommended for women with severe menstrual cramps and pelvic pain. It is less likely to be used to treat infertility.
If uterine fibroids interfere with fertility, laparoscopy might be an option. Uterine transplant is a new technology currently being developed. Some women would not have to use a surrogate in order to conceive. This technology would allow them to use their own bodies and a transplanted umbilical cord.
Reproductive Technologies Assisted
Assisted reproductive technology (ART) is a term that refers to fertility treatments that use eggs or embryos. These include IVF, GIFT and ZIFT. The most commonly used form of ART today is IVF. Only 2% of all ART procedures involve GIFT and ZIFT is only used a mere 1.5 percent of the times.
In an IVF procedure, fertility drugs can be used to stimulate the ovaries’ ability to produce eggs. If all goes well, the eggs can then be retrieved from the woman’s eggs in an outpatient procedure.
The eggs are then placed with sperm in a special mixture of nutrients and left alone until fertilization occurs. One to three embryos are then placed in the woman’s uterus after fertilization.
Mini-IVF is a third-party option. Mini-IVF and IVF are different in that less medications are required. It is important to stimulate the ovaries enough to produce a few eggs, not many.
Mini-IVF costs less than full IVF, but is slightly more costly than IUI. This treatment is more likely to be successful than IUI and has a lower chance of developing ovarian hyperstimulation syndrome.
The egg and sperm are not fertilized outside of the body with GIFT (gamete intrafallopian transfusion). Instead, they are inserted into the fallopian tubes of the woman.
ZIFT (zygote intrafallopian transfer) is a method where the zygote can be placed inside one of the fallopian tube. This procedure is often done by laparoscopic surgery.
Surrogacy and Third Party Gamete Donation
Sometimes IVF alone doesn’t suffice. For some couples, IVF alone is not enough.
In cases of low ovarian reserve, primary ovarian failure, or repeated unexplained failed IVF cycles, an egg donor might be recommended. A surrogate and an egg donor can also be used to aid a gay couple.
In rare cases of male infertility, or when a couple is looking to have a child together, a sperm donor might be an option. A sperm donor can be used in IUI and IVF treatments.
A donor embryo may be used for the same reasons as an egg donor or sperm donor. IVF using embryo donation is cheaper than IVF with eggs from a donor egg or conventional IVF.
You can use a friend, relative, or fertility clinic to find a donor. Never try to find a donor via a social media post or forum. There are many scammers. It is important to hire an attorney who specializes on family and fertility law.
Surrogacy refers to when a woman is able to carry a child for another person. If a woman is unable to have a healthy pregnancy or has problems with her uterus, this may be necessary. This is also useful for repeated and unexplained IVF failures. A surrogate may also be used by gay male couples to have a child.
Depending on the type of surrogacy chosen, the biological parents could be either the infertile couple or an egg donor, sperm donor, or both.
Traditional surrogacy occurs when the surrogate’s biological mother is the surrogate. The intended father or sperm donor may be the biological father. This type of surrogacy is discouraged due to potential legal issues.
Finding the right doctor
If you are having difficulty conceiving, your gynecologist will be the first to see you. She may also be able to prescribe basic fertility treatments. Clomid is often prescribed by OB/GYNs to many women.
Expertise is required for more complex cases. Reproductive endocrinologist (RE), is a specialist in fertility. Reproductive endocrinologists are experts in both male and female fertility. They are usually found in a fertility clinic with other fertility doctors and nurses.
Every fertility clinic is not the same. Be sure to research the doctor before you make a decision. Other fertility specialists include andrologists and reproductive immunologists.
Treatment of Underlying Diseases
Without discussing underlying conditions and lifestyle changes that can improve fertility, no discussion on fertility treatment would be complete. Fertility treatment that ignores an underlying medical problem may prove to be less successful.
Infertility can be caused by untreated celiac disease, diabetes, or thyroid imbalances. Sometimes, natural fertility can be restored by treating these conditions.
The way you eat and your lifestyle can have an impact on fertility. Couples may opt to use natural or alternative fertility treatments in addition to traditional fertility treatments. Or they might choose to stick with the natural route.
There are many factors that influence success rates. Infertile couples will require fertility treatments, in addition to lifestyle changes and other therapies.
Side Effects and Risks
Depending on the fertility treatment being used, side effects and risks can vary. Clomid will not be used for surgical fertility treatment. Side effects of fertility drugs most commonly include headaches, bloating, mood swings, and bloating. Rarely, side effects may be fatal.
Ovarian hyperstimulation syndrome (OHSS), is a potential side effect of fertility drugs. OHSS may cause mild discomfort and bloating. If left untreated, OHSS may become fatal.
Although it is rare for Clomid to cause serious OHSS, 10 percent of IVF patients will experience it. Contact your doctor if you experience any of these symptoms.
Your chances of having multiples are higher with IVF treatment and fertility drugs. Gonadotropins (or injectable fertile drugs) are the most dangerous for multiples.
Clomid has a 10 percent chance of you having twins. However, Clomid can increase your chances of twins or more. Injectable fertility drugs have a 30 percent chance of conceiving twins. Multiple pregnancies can pose many risks for both mother and baby.
IUI treatment carries a higher risk of infection and ectopic pregnancies. IVF treatment can increase the risk of multiples and OHSS. There are also risks associated with IVF treatment such as possible infection, bleeding, puncture to bladder, bowel or other surrounding organs and premature birth (even if you don’t have twins). The use of anesthesia during egg retrieval can also pose risks.
Although IVF may increase the chance of certain birth defects, this is still a questionable issue. It is not clear if this risk is due to treatment or infertility. The chances of a male child becoming infertile after IVF with ICSI (when sperm cells are directly injected into eggs) could increase by using IVF with ICSI.
There are some who worry that fertility treatments can increase your chance of developing cancer. The latest research shows that fertility treatments are generally in good standing. But, infertility and breastfeeding are not necessarily a cause for concern.
Success Rates
Your age, the treatment you are receiving, your fertility issues, your experience with infertility and your gender all impact your success rates. Clomid treatment for PCOS at 23 years old doesn’t guarantee a live birth rate equal to that of a woman at 42 with low ovarian reserve.
Talk to your doctor about their experiences with similar cases and how he believes your chances of success.
Although IVF is commonly regarded as a foolproof treatment, it is not true. IVF isn’t always successful. To achieve pregnancy, most couples will need to undergo a few IVF cycles. A large study showed that there are 34 to 42 percent chances of having a successful pregnancy after three cycles.
What happens if Fertility Treatment fails?
When you start a fertility treatment program, there is so much to be hopeful about. Everybody wants the first cycle to be “the one”. Unfortunately, this is not always possible. It’s highly unlikely that it will happen.
Even couples with perfect fertility may not be able to get pregnant the first month. Don’t think that one failed cycle means you are doomed.
Before you can determine if a treatment is going to work, most treatments must be tested between three to six times.
Discuss with your doctor what next steps to take after a negative pregnancy test. Many people believe that IVF will be the next step if all other treatments fail. There are many options and levels of fertility treatment available before IVF becomes the next step.
IVF is a recommended first treatment for some couples. What happens if IVF fails to work after several cycles?
Some couples may choose to try again on their own. Depending on the reason for infertility, this may be possible. However, a small number of couples can still get pregnant after infertility.
Payments for Fertility Treatments
The cost of fertility treatment and testing will vary depending on where you live and the insurance coverage you have. It also depends on what fertility clinics and specialists are available in your local area.
The majority of insurance companies in America cover basic fertility testing. They may or not cover fertility treatments. There are many options for coverage, from those who cannot afford Clomid to those who have partial IVF coverage.
You should also note that the cost of treatment can vary depending on what you require. A cycle of Clomid can cost $50, but a cycle with injectable fertility drugs could cost several hundred to a few thousand dollars.
Conclusion
We encourage you to be an advocate for yourself. Ask questions and request additional time to consider your options. Make sure you fully understand the risks and success rates of any treatment.
Before you sign the dotted line, make sure you fully understand your financial obligations. Also, don’t hesitate in consulting a lawyer or a fertility counselor if you are considering surrogacy or gamete donation.
This phase of your life is not permanent. You will eventually stop using fertility treatments. You will, regardless of whether you have a child through treatments, be able to live a happy, fulfilling life.