Treatment Options

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases, infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

  • Test results
  • How long the couple has been trying to get pregnant
  • The age of both the man and woman
  • The overall health of the partners
  • Preference of the partners

Doctors often treat infertility in men in the following ways:

  • Sexual problems such as premature ejaculation or impotence. Doctors can help men deal with these problems through behavioral therapy and/or medicines.
  • Sometimes surgery can correct the cause of too few sperm. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up any infections affecting sperm count.
  • Sperm movement. Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.

Infertility treatment for women may include surgery for some physical problems. A number of fertility medicines are used to treat ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the benefits, side effects, and possible dangers.

Some common medications used to treat infertility in women include:

  • Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medication is taken by mouth.
  • Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who do not ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
  • Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
  • Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who do not ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
  • Metformin (Glucophage): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
  • Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.

Many fertility medications increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early. Premature babies are at a higher risk of health and developmental problems.

What is intrauterine insemination (IUI)?

IUI is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

  • Mild male factor infertility
  • Women who have problems with their cervical mucus
  • Couples with unexplained infertility

Assisted Reproductive Technology (ART)

ART is a group of different methods used to help infertile couples. ART works by removing eggs from a woman’s ovaries. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman’s body.

Success rate of ART vary and depend on many factors. Some things that affect the success rate of ART include:

  • Age of the partners
  • Reason for infertility
  • Clinic
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen

ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complications of ART are multiple fetuses. But, this is a problem that can be prevented or minimized in several different ways.

Common methods of ART include:

In vitro fertilization (IVF) means fertilization outside the body. IVF is the most effective ART and is often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a medication that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the ovaries. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3-5 days, healthy embryos are implanted in the woman’s uterus.

Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s fallopian tube. So fertilization occurs in the woman’s body. Few practices offer GIFT as an option.

Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These embryos either were created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Gestational Carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who should not become pregnant because of serious health problems. In this case, a woman uses her own eggs. The man’s sperm fertilizes it and the embryo is placed inside the carrier’s uterus. The carrier will not be related to the baby and gives him/her to the parents at birth.