Slideshow Pictures: Infertility - Which Treatment Is Right for You?
Reviewed by Varnada Karriem-Norwood, MD on Monday, October 10, 2011
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Infertility Treatments That Work
It's a myth that relaxing or "giving it time" will overcome infertility. Fertility problems are medical in nature, and there are effective treatments. Worldwide, more than 3 million babies have now been born through in vitro fertilization (IVF). Other therapies are successful, too -- at least half of couples who seek treatment for infertility will get pregnant.
Symptoms of Infertility
Most couples should consult a doctor after a year of trying to conceive unsuccessfully. This is the main sign of infertility. If the woman is over age 35 and hasn't conceived after trying for six months or has an irregular menstrual cycle, it's best to see a doctor as soon as possible. Remember that the man should be evaluated, too. Male infertility is just as common as female infertility.
In about 40% of infertile couples, the cause is traced to the man. Common problems include:
- Low sperm count
- Poor sperm motility
- Malformed sperm
- Blocked sperm ducts
In another 40% of cases, the woman is diagnosed with a problem, such as:
- Irregular ovulation (release of eggs)
- Blocked fallopian tubes
- Abnormalities in the cervix or uterus
In about 20% of infertile couples, no cause can be found.
In some cases, poor timing is the main obstacle. To find out when you're ovulating (and determine the best time for sex), you can use over-the-counter ovulation tests. These detect a hormonal surge that occurs 12 to 36 hours before the ovary releases an egg. If the tests never yield a positive result, consult your doctor. Irregular ovulation accounts for about a third of all cases of infertility.
If your doctor determines you're not ovulating normally, fertility drugs can help. The most common choice is clomiphene citrate, better known by the brand names Clomid and Serophene. This drug is relatively inexpensive and effective. About half of women who take clomiphene will get pregnant, usually within three cycles. By causing the release of more than one egg at a time, Clomid increases the chances of multiple births.
If you don't get pregnant after taking clomiphene for six months, your doctor may recommend injections of fertility hormones. A wide range of hormonal drugs are available, and they are highly effective in stimulating ovulation. Of those who ovulate, about half become pregnant. Like clomiphene, injectable hormones increase the chances of becoming pregnant with multiples.
Surgery for Blocked Fallopian Tubes
Some women have trouble getting pregnant because scar tissue prevents eggs from traveling down the fallopian tubes. This scarring can be caused by endometriosis, the overgrowth of tissue that lines the uterus, a history of pelvic infections, or previous surgeries. Laparoscopic surgery can remove scar tissue in the reproductive tract and boost the odds of getting pregnant for some women.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a popular option for a wide range of fertility problems. In this procedure, the sperm is placed directly into the woman's uterus while she is ovulating. This reduces the distance the sperm must swim to reach the egg. IUI is often used in combination with drugs that stimulate ovulation. It is less expensive and less invasive than IVF, but pregnancy rates are notably lower.
IUI With Donor Sperm
If the man has few healthy sperm, IUI can be done using sperm from a donor. Most doctors recommend couples see a counselor before choosing this option, because they must be comfortable raising a child who is not biologically related to the father. IUI with donor sperm has a very high success rate in fertile women. It may take several tries, but cumulative pregnancy rates are over 80%.
In Vitro Fertilization (IVF)
IVF offers hope when other infertility treatments are unsuccessful. It eliminates any barriers between egg and sperm by combining them in a lab. The growing embryos are then placed inside the uterus. Undergoing IVF can be unpleasant and expensive, with an average cycle costing $12,400. But success rates are growing every year. In 2007, pregnancy rates per IVF cycle ranged from 10% for women ages 43-44 to 46% for women under 35.
IVF With ICSI
When a man's sperm count is extremely low or the sperm don't move well, they may not be able to fertilize an egg without help. A procedure called intracytoplasmic sperm injection (ICSI) can overcome this problem by inserting a single sperm directly into an egg. The resulting embryos are then transferred to the uterus through the normal IVF procedure. The majority of IVF cycles now use ICSI.
IVF With Donor Eggs
Women who are over 40, have poor egg quality, or have not had success with previous IVF cycles may consider IVF with donor eggs. This involves combining the husband's sperm with another woman's eggs. If the procedure is successful, the wife becomes pregnant with a baby who is biologically related to her husband but not herself. In 2007, IVF using fresh embryos from donor eggs resulted in live births 55% of the time.
IVF and Multiples
To boost the odds of success with IVF, it's common to transfer two to four embryos at a time. But this means the woman may become pregnant with twins, triplets, or even quadruplets. Carrying multiples raises the risk of miscarriage, anemia, high blood pressure, and other complications during pregnancy. It also makes premature birth more likely. Couples undergoing IVF should discuss these issues with their fertility specialist.
IVF with Blastocyst Transfer
A recent breakthrough in IVF technology is known as blastocyst transfer. In standard IVF, embryos are transferred to the womb when they reach the two- to eight-cell stage. In the newer procedure, the embryos are allowed to grow for five days until they reach the blastocyst stage. The healthiest one or two blastocysts are chosen for transfer. This eliminates the possibility of triplets while maintaining a high success rate.
Using Donor Embryos
Couples who have not had success with IVF or are looking for a less expensive option may want to consider using donor embryos. These are embryos donated by other couples who have finished the IVF process. Transferring donor embryos costs less than standard IVF or IVF with donor eggs. If successful, the procedure allows a couple to experience pregnancy. The baby will not be biologically related to either parent.
For women who have trouble carrying a pregnancy to term, surrogacy is an option. In traditional surrogacy, the surrogate was inseminated with the husband's sperm. But today, most couples choose gestational surrogacy. IVF is used to create embryos with the wife's eggs and husband's sperm. The embryos are transferred to the surrogate. If the procedure succeeds, the baby will be the biological child of both husband and wife.
Choosing a Fertility Clinic
When choosing a fertility clinic, ask plenty of questions about the available procedures and costs. Make sure the clinic offers the latest technologies and keeps patients involved in treatment decisions. The CDC maintains a database comparing IVF success rates for clinics around the nation. But don't base your choice solely on these rates. Infertility treatment is a long-term process, and you want to feel comfortable with your clinic.
Natural Ways to Boost Fertility
No matter where you are in your quest to start a family, you can boost your fertility with a few lifestyle changes. If you smoke, quit. Smoking reduces fertility and has a documented impact on pregnancy rates. In one study, men who stopped smoking saw their sperm counts climb 800%. Next, eat nutritious foods and ask your doctor about supplements. Research suggests certain vitamins and minerals can improve fertility in men and women.
Acupuncture for Infertility?
Acupuncture has shown promise in treating many conditions, ranging from asthma to headaches. Now some couples are trying the popular form of Chinese medicine to address infertility. Research suggests acupuncture may improve sperm quality, improve blood flow to the uterus, normalize ovulation, and boost IVF success rates.
If infertility treatments become a burden -- physically, emotionally, or financially -- it may be time to consider other alternatives. An infertility counselor can help you and your partner explore the options. Many couples are able to find satisfaction living without children. Others choose to build their family through adoption. Costs range from nearly nothing for foster care adoption to as much as $40,000 for a private adoption.
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