Infertility is the inability to naturally conceive a child or to carry a pregnancy to full term. There are many reasons why a couple may not be able to conceive, or may not be able to conceive without medical assistance. The following information will provide you with information about infertility treatment.
The infertility treatment recommended by your health care provider will depend on the results of your (and your partner's) infertility evaluation. Some causes of infertility have a specific treatment, such as surgery to remove a fibroid tumor or medicines to treat a thyroid problem, while the treatment of other infertility problems is less specific.
Infertility associated with infrequent or absent ovulation often can be treated with hormone medications called fertility drugs. Since fertility medications have potential side effects and may result in multiple births you should carefully consider them only with input from your health care provider.
Typically, female infertility is most often treated by:
taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle;
taking medications to stimulate ovulation;
taking antibiotics to remove an infection; and
having surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvis area.
For definitions of the many infertility terms, please visit Terms and definitions.
The following (adapted from websites listed below) provides an overview of infertility treatment options:
Fertility drugs regulate your reproductive hormones and trigger the release of one or more of your eggs per ovulation cycle.
For a comprehensive review of infertility medications, effectiveness, and costs, please visit Infertility drugs
Surgery may help fix genetic defects or blocked fallopian tubes, or remove endometriosis, fibroids, or ovarian cysts. Surgery can cost anywhere from $3,000 to $10,000. Success rates are about 40-60 % of women treated for endometriosis and scar tissue conceive while the success rate for women who have their tubes cleared is much more variable.
When the "typical" methods are not successful, it may be necessary to go into more advanced infertility treatments (discussed in the next section). These include, but are not limited to, intrauterine insemination (IUI), known by most people as artificial insemination, and Assisted Reproductive Technology (ART).
Artificial insemination procedures take place when a concentrated dose of sperm (from your partner or a donor) is injected into your uterus with a catheter.
• Side effects: After the sperm is injected into your uterus, you may feel cramping for a day or so. Also, you may need to take fertility drugs before the procedure, which will raise your risk of having multiples and developing ovarian hyperstimulation syndrome (OHSS). Plus, if you use your partner's sperm, he'll have to provide a sample on demand.
• Success rates: About 5 to 25 percent of women who undergo artificial insemination conceive.
• Cost: You should expect to pay $300 to $700 for this procedure.
Assisted reproductive technology (ART)is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman's body, mixing them with sperm in the laboratory and putting the embryos back into a woman's body. The most common complication of ART is multiple fetuses.
Success rates for assisted reproductive technology 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
The U.S. Centers for Disease Prevention (CDC) collects success rates on ART for some fertility clinics. According to the 2003 CDC report on ART, the average percentage of ART cycles that led to a healthy
baby were as follows:
37.3% in women under the age of 35
30.2% in women aged 35-37
20.2% in women aged 37-40
11.0% in women aged 41-42
ART can be expensive and time-consuming. Many states are starting to mandate coverage. For information regarding insurance coverage, please visit the page infertility Insurance
issues.
The most common type of ART is in vitro fertilization (IVF). IVF and other types of ART are presented below.
In vitro fertilization (IVF) where fertilization outside of the woman's body. IVF is the most effective ART. It 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 drug that causes the ovaries to produce multiple eggs. During IVF, eggs removed from your ovaries are fertilized with sperm (from your partner or a donor) in a laboratory. After 3 to 5 days, the resulting embryos are placed in your uterus.
• Side effects: You may need to take fertility drugs before the procedure, which will raise your risk of having multiples and of developing ovarian hyperstimulation syndrome (OHSS). Plus, if you use your partner's sperm, he'll have to provide a sample on demand.
• Success rates: Between 28 and 35 percent of women who try in vitro fertilization conceive.
• Cost: This procedure usually costs between $8,000 and $15,000.
Gamete intrafallopian transfer (GIFT) involves collecting eggs from the ovaries, then placing them into a thin flexible tube with the sperm. The mixture is surgically injected into your fallopian tubes so fertilization can occur naturally inside your body.
• Side effects: This procedure has a longer recovery time than IVF. You may feel temporary discomfort in your chest and shoulders from the carbon dioxide used during surgery. Also, you may need to take fertility drugs before the procedure, which will raise your risk of having multiples and of developing ovarian hyperstimulation syndrome (OHSS). Plus, if you use your partner's sperm, he'll have to provide a sample on demand.
• Success rates: About 25 to 30 percent of women who try GIFT conceive.
• Cost: This procedure usually costs between $8,000 and $15,000.
Zygote intrafallopian transfer (ZIFT)
As with GIFT, your eggs and sperm are mixed together in a lab. But during zygote intrafallopian transfer (ZIFT), your doctor makes sure your eggs are fertilized before surgically placing them in your fallopian tubes.
• Side effects: This procedure is similar to a cycle of GIFT, but you'll spend more time waiting on the lab. You may feel temporary discomfort in your chest and shoulders from the carbon dioxide used during surgery. Also, you may need to take fertility drugs before the procedure, which will raise your risk of having multiples and of developing ovarian hyperstimulation syndrome (OHSS). Plus, if you use your partner's sperm, he'll have to provide a sample on demand.
• Success rates: About 25 to 30 percent of women who try ZIFT conceive.
• Cost: This procedure usually costs between $8,000 and $15,000.
Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Zygote intrafallopian transfer (ZIFT), combines IVF and GIFT. The eggs and sperm are mixed outside of the body. The fertilized eggs (zygotes) are then injected into the woman's fallopian tubes, where fertilization takes place.
Intracytoplasmic sperm injection (ICSI) involves the injection of a single sperm into a mature egg. The fertilized egg is then placed in the woman's uterus or fallopian tube. Used with in vitro fertilization, ICSI is often a successful treatment for men with impaired sperm.
• Side effects: Your partner's sperm may need to be drawn from his testicle with a microscopic needle or surgical biopsy — but it's less painful than it sounds.
• Success rates: About 35 percent of couples who try ICSI conceive.
• Cost: ICSI can cost anywhere from $10,000 to $17,000.
Other assisted reproductive technology (ART) include donor eggs, donor sperm, assisted hatching, fertility preservation, freezing (cryopreservation) of sperm, eggs, & reproductive tissue, and frozen embryo transfer (FET).
Donor eggs and embryos
ART sometimes involves the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby. Using IVF techniques, an egg (or embryo) donated by another woman is mixed with your partner's sperm and implanted in your uterus.
• Side effects: You'll need to choose the donor of the egg (or embryo) — which can be a long process. Plus, you may feel a sense of loss at not having a baby with complete genetic ties.
• Success rates: Around 43 percent of women who try IVF using donor eggs or embryos conceive.
• Cost: You should expect to pay $10,000 to $20,000 for IVF with a donor egg or embryo (including compensation for the donor)
Gestational carriers (also known as surrogate mothers)
If a woman does not have any eggs, or her eggs are not of a good enough quality to produce a pregnancy, she and her partner might 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, but the surrogate will give the baby to the couple at birth.
A gestational carrier might be an option for women who do not have a uterus, from having had a hysterectomy, but still have their ovaries, or for women who shouldn't become pregnant because of a serious health problem. In this case, the woman's eggs are fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. In this case, the carrier will not be related to the baby, and will give the baby to the parents at birth.
A gestational carrier (or a surrogate mother) carries your embryo, or a donor's embryo, to term, and then signs away all her parental rights.
• Side effects: You may feel like you don't have control over the pregnancy — from what the carrier eats to how she handles stress. Carefully choose someone you can communicate with.
• Cost: This procedure may cost anywhere from $15,000 to $50,000. (About $12,000 goes to the surrogate mother. The rest goes to legal fees set by lawyers and agencies.)
Infertility often has profound psychological effects. The man and/or woman may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer. In many cultures and subcultures the inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment.
A psychologist or other mental health professional, experienced in infertility and infertility options, can often be an invaluable resource to help the infertile person or couple.
For more about infertility and for specific information on receiving psychological help and treatment, visit the websites below and please feel free to contact me. I have been helping people with infertility issues and adoption for over 35 years.
