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Fertility Problems (cont.)

Exams and Tests

Testing for fertility problems usually starts with simple tests for both partners. In addition to an interview and physical exams, these first tests will:

If your test results show no cause of infertility, your doctor may recommend checking fallopian tube function. Depending on your age and other risk factors, you may then be offered further testing. Or you may begin treatment with superovulation (to produce more eggs), intrauterine insemination (which puts sperm into the uterus with a tube), or both.

For more information, see the topic Infertility Tests.

Testing can be stressful, costly, and sometimes painful. You may need only a few tests. Or you may need many tests over months and years.

Click here to view a Decision Point.Fertility Problems: Should I Be Tested?

Treatment Overview

Some fertility problems are more easily treated than others. In general, as a woman ages, especially after age 35, her chances of getting pregnant go down. But her risk of miscarriage goes up.

If you are 35 or older, your doctor may recommend that you skip some of the steps younger couples usually take. That's because your chances of having a baby decrease with each passing year.

It's important to understand that even if you are able to get pregnant, no treatment can guarantee a healthy baby. On the other hand, scientists in this field have made many advances that have helped millions of couples have babies.

Take time to plan

Before you and your partner start treatment, talk about how far you want to go with treatment. For example, you may want to try medicine but don't want to have surgery. You may change your mind during your treatment, but it's good to start with an idea of what you want your limits to be.

Treatment for fertility can also cost a lot. And insurance often doesn't cover these expenses. If cost is a concern for you, ask how much the medicines and procedures cost. Then find out if your insurance covers any costs. Talk with your partner about what you can afford.

Thinking about this ahead of time may help keep you from becoming emotionally and financially drained from trying a series of treatments you hadn't planned for.

Click here to view a Decision Point.Infertility: Should I Have Treatment?

Initial treatment

Treatment for the woman

Treatments for fertility problems in women depend on what may be keeping the woman from getting pregnant. Sometimes the cause isn't known.

  • Problems with ovulating. Treatment may include taking medicine, such as:
  • Unexplained infertility. If your doctor can't find out why you and your partner haven't been able to get pregnant, treatment may include:
  • Blocked or damaged tubes. If your fallopian tubes are blocked, treatment may include tubal surgery.
  • Endometriosis. If mild to moderate endometriosis seems to be the main reason for your infertility, treatment may include laparoscopic surgery to remove endometrial tissue growth. This treatment may not be an option if you have severe endometriosis. For more information, see the topic Endometriosis.
Treatment for the man

Your doctor might recommend that you try insemination first. The sperm are collected and then concentrated to increase the number of healthy sperm for insemination.

When initial treatments don't work

Many couples who have problems getting pregnant arrive at a common point: They must decide whether they want to try assisted reproductive technology (ART).

  • In vitro fertilization (IVF) is the most common type of ART. In this treatment, a fertilized egg or eggs are placed in the woman's uterus through the cervix.
  • Intracytoplasmic sperm injection, or ICSI (say "ICK-see"). In a lab, your doctor injects one sperm into one egg. If fertilization occurs, the doctor puts the embryo into the woman's uterus.

To learn more, see Other Treatment.

If you haven't already thought about adoption, this might be a time to think about it. Some couples decide at this point to spend their resources on adoption instead of IVF. Other couples see IVF as the best option.

Fertility treatment clinics

Fertility treatment clinics aren't widely available in some parts of the country, especially in rural areas. You may need to travel for treatment.

When you review clinic success rates, be aware that clinics treating more severe fertility problems may have lower success rates. So it's possible for a clinic with a lower success rate to have greater overall expertise than clinics with higher success rates.

The success rate of a clinic is influenced by many things, including the doctors' skills and experience and the cause or causes of your fertility problem.

When you review treatment success rates, remember that live birth rates are always lower than ovulation and pregnancy rates. Miscarriages are common among all women. But they are more likely in women with risk factors such as older age or a poorly controlled chronic health condition.

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