Last time, we learned the ins-and-outs of infertility– what can cause it, what signs to look out for, and when to start planning around it. Today, we look at the options available to treat and even prevent infertility.
I might have trouble getting pregnant. What options will my doctor probably give me to help?
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 you have been trying to get pregnant
- The age of both you and your partner, if applicable
- Your overall health (and of your partner, if applicable)
- Your own personal preference
Doctors often treat infertility in for those with a male reproductive system in the following ways:
- Sexual problems: Doctors can help deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
- Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
- Sperm movement: Sometimes semen has no sperm because of a block in the system. In some cases, surgery can correct the problem.
For those with a female reproductive system, some physical problems can also be corrected with surgery.
What are some medicines used for infertility? How do they work?
A number of fertility medicines are used to treat people with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines– you should understand the possible dangers, benefits, and side effects.
Some common medicines used to treat infertility in those with a female reproductive system include:
- Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovary syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
- Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who don’t 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 don’t 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 drugs increase your chances of having twins, triplets, or other multiples. While this may sound like a dream come true, people who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely), and premature babies are at a higher risk of health and developmental problems.
What other procedures can help me conceive? How successful are they?
There are plenty of ways you can get help conceiving aside from medication. Although medication will most likely be included in your regimen, thanks to advancements in science and technology, there are plenty of other procedures you can include to boost your chances in a big way. Most of these options will be listed under an umbrella term: ART.
Assisted reproductive technology (ART) is a group of different methods used to help those who are infertile. ART works by removing eggs from the female reproductive system. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the body of the person choosing to carry the baby.
Success rates vary and depend on many factors. Some things that affect the success rate of ART include:
- Your age (and your partner’s, if applicable)
- Reason for infertility
- Type of ART
- If the egg is fresh or frozen
- If the embryo is fresh or frozen
The U.S. Centers for Disease Control and Prevention (CDC) collects success rates on ART for some fertility clinics. According to a 2014 CDC report on ART, the average percentage of ART cycles that led to a live birth were:
- 39 percent in those under the age of 35
- 30 percent in those aged 35-37
- 21 percent in those aged 37-40
- 11 percent in those aged 41-42
ART can be expensive and time-consuming, but it has allowed many to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses, however, 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 of the body. IVF is the most effective ART. It is often used when the fallopian tubes are blocked or when there are too few sperm in the male reproductive system. Doctors treat the person with the female reproductive system with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed. They are put in a dish in the lab along with the sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the 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 fallopian tube, so fertilization occurs in the body. Few practices offer GIFT as an option.
- Intracytoplasmic sperm injection (ICSI) is often used when there are serious problems with the sperm. Sometimes it is also used for those trying to conceive a bit later in life, 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, donor sperm, or previously frozen embryos. Donor eggs are sometimes used for those who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the person trying to conceive has a genetic disease that can be passed on to the baby. An infertile person may also use donor embryos. These are embryos that were either 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.
Recent research by the Centers for Disease Control and Prevention showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, maybe involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.
Are there any other options, aside from medication and those part of ART?
If you want to have access to as many options as possible, you can consider these alternatives to ART and medication:
- 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 a sperm donor and their own egg. The child will be genetically related to the surrogate and the person who provided the sperm. After birth, the surrogate will give up the baby for adoption by the parent(s).
- Gestational carrier: People with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for those who shouldn’t become pregnant because of a serious health problem. In this case, a person uses their own egg. It is fertilized by the sperm and the embryo is placed inside the carrier’s uterus. The carrier will not be related to the baby and gives the baby to the parents at birth.
Can infertility be prevented?
There is usually nothing that can be done to prevent infertility caused by genetic problems or illness.
However, there are several things that women can do to decrease the possibility of infertility:
- Take steps to prevent sexually transmitted diseases
- Avoid illicit drugs
- Avoid heavy or frequent alcohol use
- Adopt good personal hygiene and health practices
- Have annual check-ups with your GYN once you are sexually active
- Try holistic approaches, such as acupuncture
- Adopt a fertility diet
- Have a balanced exercise regimen (not too much, not too little) to stay a healthy weight
- Keep yourself stress-free and relaxed
Our blog has previous articles with lots of tips on how to start a fertility diet, beginning a meditation and/or routine, and more! Be sure to check our earlier entries for advice and tons of information.