Your Infertility Treatment Options

Infertility is a condition in which a couple has been unable to get pregnant after 12 months of having sex without using any form of birth control. Before being treated for infertility, a couple needs to be evaluated by a doctor to pinpoint the cause of their infertility. The type of treatment you receive depends on the cause or causes of your infertility.

Infertility may be caused by a problem with the woman, the man, the couple, or your lifestyle. Infertility can be caused by more than one factor. In some cases, the cause of infertility cannot be identified.

To treat infertility, your doctor may recommend lifestyle changes, medication, surgery, or assisted reproductive technologies. In some cases, treatments may be combined to improve results. For example, medication and insemination may be used at the same time.

Whether infertility lies with one or both partners, a number of treatment options can be considered. Before you begin treatment for infertility, talk with your doctor about the expected success rates for each treatment and how success is defined. Also talk with your doctor about the cost of each treatment and whether or not it is covered by insurance.

Ovulation Induction

If your infertility evaluation determines that you have a problem with ovulation, you may be given medication to cause ovulation or to cause more eggs to be released at ovulation. Most women who take ovulation induction medication begin to ovulate regularly. If there are no other problems, more than half of these women become pregnant within 6 treatment cycles. In some cases, the ovulation medication results in a multiple pregnancy.

Surgery

Sometimes, surgery can correct the problem that has been causing infertility. If your fallopian tubes are blocked, surgery may be done to open the tubes. Surgery may also be performed to:

• Remove growths such as uterine fibroids or polyps
• Remove scarring from a previous surgery, infection, or endometriosis
• Treat endometriosis.

Surgery can also sometimes be used to correct a problem with the male partner's sperm. The success of this kind of surgery depends on the type and extent of the problem.

Assisted Reproductive Technologies

Assisted reproductive technologies (ART) involve medically processing human eggs or sperm or both to help an infertile couple conceive a child. This process is done in a laboratory. Sometimes, ART treatment uses donor eggs or donor sperm. The sperm may also be obtained through masturbation or with a special condom that is used during intercourse. In some cases, sperm may be obtained surgically.

Here are some of the assisted reproductive technologies that can be used by couples trying to conceive.

With insemination, sperm is placed in your uterus by means other than sexual intercourse. In most cases, the sperm are treated in a lab to decrease the risk of infections and to increase the chance of fertilization. Around the time you ovulate, the sperm are placed into your uterus by your doctor. The sperm can be supplied by your partner or by a donor, whose sperm is frozen and checked for certain genetic disorders and sexually transmitted diseases.

When In Vitro Fertilization (IVF) is used, sperm from the male partner are used to fertilize your eggs in a lab. Eggs are removed from your ovary just before ovulation. In most cases, medication is given to cause more than one egg to mature. Your eggs are removed with a needle that is inserted through your vagina. Either your partner's or a donor's sperm can be used for IVF.

The eggs are combined with healthy sperm and watched in the lab to see if they become fertilized. One or more of the fertilized eggs (embryos) are placed in your uterus. This process is called embryo transfer. Your unused fertilized eggs can be frozen and stored for later us.

The success rate of IVF depends on the woman's age and the reason for the infertility. Multiple pregnancy is possible with this method.

Gamete Intrafallopian Transfer (GIFT) is similar to IVF. Like IVF, eggs are removed from the ovaries using a needle. Unlike IVF, the eggs are fertilized in your body and not in a lab. A laparoscopy is performed in which eggs and your partner's or a donor's sperm are placed in your fallopian tubes. GIFT has about the same success rate as IVF and can also result in a multiple pregnancy.

Zygote Intrafallopian Transfer (ZIFT) is a combination of IVF and GIFT. With this procedure, your eggs are fertilized in a lab and one or more fertilized eggs are placed in your fallopian tubes rather than in your uterus. Like GIFT, this procedure is performed by laparoscopy.

The success rate for ZIFT is about the same as for IVF and GIFT. Multiple pregnancy is a possibility.

If there is a problem with the male partner's sperm, a procedure known as Intracytoplasmic Sperm Injection (ICSI) is performed. Healthy sperm are removed from the man's semen and your eggs are retrieved. The sperm may be obtained though masturbation or by using a special condom during intercourse. In some cases, sperm are obtained through sperm aspiration or testicular biopsy.

In the lab, one sperm is injected into each egg's center. The eggs are checked later to see if they have fertilized. Fertilized eggs (embryos) are placed in your uterus to grow. Any unused fertilized eggs can be frozen for later use. Pregnancy rates with ICSI are about the same as with IVF.