All About Infertility Treatment for Men and Women

Overview of Your Options for Fertility Treatment

Pregnant woman holding an ultrasound photo in front of her pregnancy abdomen, conceived with fertility treatments
The good news is that two-thirds of infertile couples will get pregnant with the help of fertility treatments.. Thanasis Zovoilis / Taxi / Getty Images

Your infertility treatment plan will depend on the cause or causes behind your infertility. Infertility treatment also depends on whether the problem is from the woman's side, the man's side, both sides, or remains unexplained.

The good news is that 85% to 90% of couples dealing with infertility are treated with low-tech treatments, like medication or surgery, with less than 3% being treated by assisted reproductive technologies like IVF.

Of those treated for infertility, two-thirds will go onto have a baby.

Fertility Drug Options

A common cause of infertility in women, ovulation disorders account for about 25% of female factor infertility cases.

The first line of treatment for most women with ovulation problems is through medication. Fertility drugs can help a woman ovulate 80% of the time.

Common fertility drugs include Clomid, Femara, and gonadotropins.

Clomid (clomiphene citrate): Probably the best well known fertility drug, Clomid is usually the first drug used in treatment.

Primarily, it's used to treat female infertility, but it can be used to treat male infertility as well.

About 40% to 45% of couples using Clomid to induce ovulation will get pregnant within six cycles of use.

Femara (letrozole) and Arimidex (anastrozole): These medications may also be used to induce ovulation in women with ovulatory disorders, even though they aren't "fertility drugs" officially.

Studies have shown similar success rates as with Clomid, though some studies found a possible link between Femara and an increased risk of birth defects.

Gonadotropins, including LH, FSH, and hCG: Gonadotropins include FSH, LH, or a combination of the two.

Gonal-F and Follistim are likely the most well-known gonadotropins. They both contain the hormone FSH.

hCG (human chorionic gonadotropin) may also be used, as it mimics LH in the body.

These hormonal medications are typically used when clomiphene citrate fails, or if the pituitary gland can not create LH and FSH on its own. They may also be used during IVF cycles.

Surgical Infertility Treatment

In 35% of female infertility cases, problems are found with the fallopian tubes or problems with the lining of the pelvis and abdomen.

Usually, this problem is diagnosed through a test called an HSG, or hysterosalpingogram.

If the HSG shows possible blockage of the tubes, the doctor may perform laparoscopic surgery to evaluate the situation, and possibly repair the problem.

If infection is present, treatment is a little different. It may require surgery and antibiotics.

Sometimes, blockage or scarring is not repairable. In this case, IVF may be recommended.

A new technology being tested and developed right now is uterine transplant. This would allow some women who would have had to use a surrogate to conceive to use their own body and a transplanted uterus.

However, uterine transplant is not available except through research studies right now.

Some cases of male infertility may require surgery. Varicoceles is a common cause of male infertility, and sometimes calls for surgical treatment.

If sperm counts are very low or even zero, it may be possible to remove young sperm cells directly form the testes. These sperm are then matured in the lab and used for IVF with ICSI.

IUI: Intrauterine Insemination and Other Forms of Artificial Insemination

Intrauterine insemination, once known as artificial insemination, is a procedure that involves placing specially washed sperm directly into the uterus.

This treatment may be used in some cases of male factor infertility, if there's a problem with the woman's cervical mucus, or in cases of unexplained infertility.

IUI may also be used for donor sperm.

The success rate of IUI is not very high -- with one study showing 4% of women achieving pregnancy with a non-fertility drug cycle, and 8% to 17% success for IUI cycles that use fertility drugs to produce more, high quality eggs. The advantage of IUI is the cost, which is much lower than IVF.

IUI isn't the only form of artificial insemination, though it is the most common.

Other reasons for using insemination include painful sex (that prevents having intercourse to have a baby) or lesbian couples who want to have a baby with donor sperm.

IVF and Assisted Reproductive Technologies

Assisted reproductive technologies (ART) refer to infertility treatments that involve the handling of eggs or embryos. This includes IVF, GIFT, and ZIFT.

IVF is the most common form of ART in use today. GIFT treatments make up for less than 2% of all ART procedures, and ZIFT is used less than 1.5% of the time.

IVF (In Vitro Fertilization): In a typical IVF procedure, fertility drugs are used to stimulate the ovaries to produce eggs. Assuming all goes well at this stage, those eggs are then retrieved from the woman's ovaries in an out-patient procedure.

Next, the eggs are placed together with sperm, in a special cocktail of nutrients, and left alone until fertilization takes place. After fertilization, one to three embryos are placed inside the woman's uterus.

Mini-IVF: An option you may not know about is mini-IVF. The primary difference between IVF and mini-IVF is that fewer medications are used. The goal is to stimulate the ovaries only enough to get a few eggs and not several. 

Mini-IVF is less expensive than full IVF but slightly more expensive than IUI treatment. It may be more successful than IUi, and it comes with a lower risk of ovarian hyperstimulation syndrome and conceiving multiples.

This means less risk to you and your babies.

GIFT: With GIFT (gamete intrafallopian transfer), the egg and sperm, or gametes, are not fertilized outside the body. Instead, they are placed together into one of the woman's fallopian tubes.

ZIFT: With ZIFT (zygote intrafallopian transfer), the zygote is placed in one of the fallopian tubes. This is usually done via laparoscopic surgery.

Surrogacy and Third-Party Gamete Donation

Sometimes, IVF alone isn't enough.

Third-party gamete donation includes:

  • Using an egg donor
  • Using a sperm donor (may be done with IUI or IVF)
  • Using an embryo donor

Surrogacy is when a woman carries a pregnancy for a couple. This may be needed if a woman doesn't have a uterus or has uterine problems that prevent carrying a healthy pregnancy. It is also used for unexplained repeated IVF failure.

Gay male couples will sometimes use a surrogate to have a child as well.

Depending on the kind of surrogacy, the biological parents may be the infertile couple or an egg, sperm, or embryo donor may be used.

Traditional surrogacy is when the surrogate is the biological mother. A sperm donor or the intended father may be the biological father. However, because of potential legal problems, this kind of surrogacy is usually discouraged.

What's the Success Rate of ART?

For women under age 35, the live birth rate for each IVF cycle is 30% to 35%.

For women ages 35 to 37, the rate is 25%.

For women ages 38 to 40, the rate is 15% to 20%, and for women over age 40, the success rate is 6% to 10%.

ART is also sometimes performed with donor eggs and/or sperm. For women whose eggs are of lower quality, donor eggs may be the best option.

The live birth rate for egg donation is between 40% to 45%, but less than 10% of couples choose to use donor eggs or sperm.

Alternative and Natural Fertility Treatment Solutions

Lifestyle choices and diet can also impact fertility. Some couples may choose to pursue alternative or natural fertility treatments alongside fertility treatments, or they may decide to only go with a natural approach.

Success rates vary considerably. The vast majority of infertile couples will need fertility treatments in addition to any lifestyle changes or alternate therapies.

More on getting pregnant with infertility:

Sources:

Assisted Reproductive Technologies: A Guide for Patients. American Society of Reproductive Medicine. Accessed January 29, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ART.pdf

Patient Fact Sheet: Recurrent Pregnancy Loss. American Society of Reproductive Medicine. Accessed January 29, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/recurrent_preg_loss.pdf

Medications for Inducing Ovulation: A Guide for Patients. American Society of Reproductive Medicine. Accessed January 29, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ovulation_drugs.pdf

Infertility. National Library of Medicine: MedlinePlus. Accessed January 29, 2008. http://www.nlm.nih.gov/medlineplus/infertility.html

Infertility in Women. A.D.A.M. Healthcare Center. Accessed January 29, 2008. http://adam.about.net/reports/Infertility-in-women.htm

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