Infertility TreatmentFertility treatments are classified into the following categories: The following factors determine the choice of the fertility treatments: - The cause of the infertility.
- The couple's age.
- How long the couple has been trying to conceive unsuccessfully.
- The couple's ability to pay for the treatment.
It's important for people to ask their healthcare provider or pharmacist in advance for possible drug side effects or interactions. The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of highlighted medications. Fertility drugs are primarily used for women with ovulation disorders. Many (but not all) of these medications are given as injections and injection site reactions are common. Bromocriptine and cabergoline
These medications correct abnormal prolactin levels. (High prolactin levels also tend to suppress ovulation.) Clomiphene citrate (CC)
Clomiphene is used by women who aren't ovulating regularly or are ovulating very early or late in their menstrual cycle.
Follicle-stimulating hormone (FSH)
FSH stimulates follicle and egg production.
Gonadotropin-releasing hormone (GnRH) agonist
GnRH agonists suppress FSH and LH to prevent premature release of eggs during in vitro fertilization (IVF) or other assisted reproductive technology (ART) procedures, and to treat endometriosis and fibroids. GnRH antagonist
GnRH antagonists prevent premature luteinizing hormone (LH) surges in women undergoing the fertility procedure of controlled ovarian hyperstimulation.
Human chorionic gonadotropin (HCG)
HCG stimulates the ovarian follicle to ovulate (release its egg). The medication is often used in women with normal follicular development who haven't had success with CC. Menotrophin or human menopausal gonadotropin (hMG)
hMG contains both FSH and LH. The medication is used when the pituitary gland is unable to stimulate ovulation.
Progesterone
Progesterone is a hormone that causes menstrual periods in women who have not yet reached menopause but are not having periods due to a lack of progesterone in the body. back to top Surgery can correct many structural causes of infertility. Its success rate is higher in correcting tubal problems than endometriosis. Less invasive surgical procedures using laparoscopy and operative hysteroscopy are becoming increasingly popular, due to their lower cost and shorter recovery time. Female surgical procedures include: - Repair of endometrial polyps, endometriosis, fibroid abnormalities, fibroid tumors, ovarian cysts, scar tissue, tubal blockages, and uterine abnormalities.
- Reversal of tubal ligations.
Male surgical procedures include: - Correction of varicoceles (enlarged scrotal veins)
- Repair of tubal blockages.
- Reversal of vasectomies.
back to top According to the Centers for Disease Control and Prevention (CDC), ART is defined as fertility treatments that must handle both the woman's eggs and the man's sperm. In addition, ART does not stimulate egg production without the intention of removing eggs from the ovaries. ART is actually a variety of treatments designed to help couples conceive. The doctor chooses the treatment based on the specific needs of the couple. ART treatments all follow these steps: - The eggs are removed from the ovaries of the woman (or donor).
- The sperm are collected from the man (or donor).
- The eggs are mixed with the sperm in a laboratory.
- The resulting embryos are implanted in the body of the woman (or surrogate).
Due to its expense, ART typically is used after other fertility treatments have failed. ART is often used for the following causes of infertility: - endometriosis
- fallopian tube blockages or abnormalities
- male infertility
- unexplained infertility
- ART treatments
ART treatments require a high degree of training and experience of the medical team, as well as expensive equipment. The most common ART procedures are: In Vitro Fertilization (IVF)
The eggs are surgically removed and mixed with sperm in a laboratory dish. Fertilization typically takes place within a few days. The fertilized eggs are then placed in a woman's uterus where they continue to develop. Gamete Intrafallopian Tubal Transfer (GIFT)
A mixture of sperm and eggs surgically removed from the woman is placed into a woman's fallopian tubes. Zygote Intrafallopian Tubal Transfer (ZIFT)
The eggs are surgically removed, fertilized with sperm in a laboratory dish, and then placed into a woman's fallopian tubes 24 hours after fertilization. Tubal Embryo Transfer (TET)
TET resembles ZIFT, except the embryos are allowed to develop longer before being placed into a woman's fallopian tubes. Third Party Reproduction
In some cases, a couple may not have viable eggs or sperm, or the woman may not be able to carry a baby to term. Third party reproduction includes a third person who donates eggs or sperm, or in the case of surrogacy, a surrogate donates the use of her uterus. The third party's responsibility does not extend to raising the child. Legal contracts are common when the fertility treatments include third party reproductive techniques. ART Success RatesThe following factors affect ART success rates: - The age of the partners
- The cause of the infertility
- The clinic performing the treatment
- The ART technology used
- If the egg is fresh or frozen
- If the embryo is fresh or frozen
According to a 2005 report on ART by the Centers for Disease Control and Prevention (CDC), approximately 1% of U.S. infants born in 2003 were conceived through ART. The study also reported the ART success rates for women as follows: - Younger than 35: 37.3%
- Between 35 and 37: 30.2%
- Between 37 and 40: 20.2%
- Between 41 and 42: 11.0%
ART Treatment ConcernsAlthough ART is currently the most successful fertility treatment, the following complications are associated with the treatments: Birth defectsChildren conceived using ART procedures have a 7% rate of severe genetic defects in contrast to 4% for children conceived naturally. Low birth weightLow birth weight is common for both single and multiple birth children conceived using ART treatments. Multiple birthsFertility drugs may increase a woman's chance of giving birth to twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have an increased risk of problems during their pregnancy. The fetuses have a higher risk of premature birth, which may cause health and developmental problems. Due to these issues, some couples decide to have one or more of the fetuses removed to improve the survival rate of the remaining fetuses. Ovarian hyperstimulation syndrome (OHSS)The ovaries may become overstimulated during treatment. If this occurs, the ovaries may enlarge, and cause pain and bloating. These symptoms often improve without treatment. In some cases, however, fluid accumulation in the abdominal and chest cavities may cause breathing problems and low blood pressure, requiring emergency treatment. Surgery complicationsOccasionally ART treatments may cause bleeding or infection. Third party reproduction issuesEthical and legal issues may occur when third party reproduction is used. These problems are more likely to develop if the pregnancy results in serious disabilities, miscarriage, or multiple births. Despite signing legal contracts, the couple or the surrogate mother sometimes change their minds. back to top Although alternative therapy and non-drug treatment claims are not always based on scientific evidence, several medical studies are researching alternative therapies for infertility. Female supplements that may improve fertility include: - Bee propolis may improve pregnancy rates.
- Isoflavones may increase the effectiveness of in vitro fertilization.
- N-acetylcysteine taken in combination with clomiphene treatment by women with polycystic ovary syndrome (PCOS) has shown to improve ovulation and pregnancy rates.
Male supplements that may improve sperm count and function include: Non-drug treatments that may prove beneficial include: - Acupuncture
- Stress reduction techniques
- Yoga
Some of these alternative treatments haven't been well studied, and little information is available about their side effects and drug interactions. It's important to discuss alternative treatments with your doctor before trying any alternative treatments. Managing EmotionsInfertile couples experience different levels of emotional strain which may become debilitating if not treated. If a couple decides to try fertility treatments, the strain of its cost and physical demands are added to the emotional strain they're already experiencing. As couples undergo fertility testing and treatment, they often cycle through the ups and downs of hope, failure, and renewed hope. Many infertile couples also experience feelings of loss, guilt, shame, and failure. It's important for couples to become aware of their feelings and seek help if they're unable to manage them on their own. Most couples benefit from the support of family, friends, health care providers, and counselors. Counselors specializing in infertility issues can be especially useful during testing and treatment. Maintaining a healthy diet and lifestyle; exercising regularly and maintaining a normal weight; and avoiding alcohol, smoking, and drug abuse can help couples both emotionally and physically.
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