Infertility Treatments

The American Society for Reproductive Medicine (ASRM) defines infertility as being unable to conceive a child, in spite of trying for a certain period of time. (Read about "Infertility") In younger women, the time frame is one year. For older women it could be 3 to 6 months. You may think that it is unusual, but according to ASRM, that's 10 percent of the population of reproductive age, or over 6 million people. Many times the causes are biologically based but even healthy couples, with no medical issues, can have problems. ASRM says that only 20 percent of couples get pregnant the first month they try.

The Food and Drug Administration (FDA) says one of the main causes of infertility is sexually transmitted diseases or STD's. (Read about "Sexually Transmitted Diseases") so the best way to avoid problems is preventive action. FDA calls condoms the best form of birth control to avoid STD's. (Read about "Birth Control") Other causes of infertility can include low sperm count in males. In women, causes of infertility include abnormalities in ovulation, blockages in the fallopian tubes and/or uterine problems stemming from pelvic inflammatory disease (PID) (Read about "Pelvic Inflammatory Disease"), endometriosis and uterine fibroids. (Read about "Endometriosis" "Uterine Fibroids" "Menstrual Disorders" "The Ovaries")

Options

ASRM says roughly one-third of infertility cases result from male factors, about one-third are due to female factors, 10 - 15 percent it is a combination of problems in both partners and in about 20 percent of cases the cause is unknown.

Male factors include low sperm count or low motility. In such cases, artificial insemination with the partner's sperm or in vitro fertilization may be an option. Changes in lifestyle, tobacco use and alcohol intake can also help. Donor sperm can also be used if the male has a low or no sperm count. Intrauterine insemination (IUI) may be another option. This procedure involves placing sperm directly into a woman's uterus to facilitate fertilization. The Centers for Disease Control and Prevention (CDC) says intracytoplasmic sperm injection (ICSI), a procedure in which a single sperm is injected directly into an egg during in vitro fertilization (IVF), is also commonly used to overcome male infertility problems.

One of the most common female factors, according to ASRM, is an ovulation disorder due to a hormonal imbalance. (Read about "Polycystic Ovary Syndrome" "Thyroid") The woman may not be releasing eggs, or not producing sufficient hormones. In such cases, medication may be prescribed either orally or by injection to stimulate ovulation.

In cases involving problems with a woman's uterus or tubes, surgical options to correct the underlying medical condition may be used or the couple may choose in vitro fertilization as an alternative. (Read about "Endometriosis" "Uterine Fibroids")

There is also a growing field called assisted reproductive technology (ART). The Society for Assisted Reproductive Technology (SART) says there are a number of different options. Some of them include:

• intrauterine insemination (IUI)
• assisted hatching
• intracytoplasmic sperm injection (ICSI)
• in vitro fertilization (IVF)
• tubal embryo transfer (TET)
• frozen embryo transfer (FET)

Two other methods, gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) are also available but less commonly used.

In IUI, concentrated sperm are placed in your uterus on the day shortly after ovulation, and from there, the sperm can reach the fallopian tubes to fertilize an egg.

Assisted hatching is designed to assist the implantation of the embryo into the lining of the uterus.

In ICSI, sperm is injected directly into an egg to achieve fertilization in conjunction with another IVF procedure.

IVF is the only method available to women who have blocked fallopian tubes. In IVF and in ZIFT and TET, eggs are removed from the ovaries and combined with sperm outside the body. The embryo is then placed back inside the woman. In the case of IVF, the embryo is placed in the uterus. In the case of ZIFT and TET, the embryo is placed in the fallopian tubes. SART says there is little difference in the success rate of the procedures. However, ZIFT and TET may require a surgical procedure, IVF does not.

GIFT is a surgical procedure where the eggs are taken from the ovaries and are immediately placed in the fallopian tubes with sperm. The fertilization takes place inside the body.

When IVF, ZIFT or TET is done, there may be extra embryos produced. Those can be frozen and a woman can then use them, at a later date, instead of going through a new round of medication and of harvesting eggs.

The odds

SART says the success rate for each attempt is about 20 percent for couples who have had children before or about equal to the normal population, but this does vary with the patient's age, response and other conditions. ART does result in higher than normal multiple births (Read about "Multiple Birth Pregnancies"), with 25 percent of ART pregnancies being twins, according to SART.

For couples considering ART, ASRM says there are a number of questions they can ask to help them make an informed choice. One issue, of course, is cost. Couples should ask how much the entire procedure costs, including drugs per treatment cycle, and any costs for embryo freezing, storage or transfer. They should also see how much, if any, of these costs are covered by their insurance. In addition, couples should try to get an idea of the amount of time that will be involved, and whether they need to take time off from work. They should ask about any potential health risks associated with the procedures. Finally, couples should ask about counseling that's available while they are trying and if they do not get pregnant.

Related Information:

    Genital Health - Male

    Genital Health - Female

    Healthy Pregnancy

    Pregnancy and Nutrition