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Infertility is relatively common
occurring in about 11% of reproductive age couples.
Fortunately, with today technologies, it is possible
for greater than 80% of infertile couples to achieve
pregnancy. Most of these couples will conceive with
"first level" treatments such as medications,
lifestyle changes, intrauterine
insemination and others. The vast majority will
not require advanced technologies such as
IVF. The type of infertility treatment depends upon
the cause(s) of each couple's infertility.
One of the most important steps
that a couple can take is to contact a qualified reproductive
endocrinologist/infertility
specialist early in the course of their treatment.
The reproductive processes are very complex and specialists
undergo years of advanced training to prepare them to
deliver the best in infertility care possible. These specialists will order fertility tests to help determine the exact cause(s) of a couple's infertility.
Tragically, we often see infertile
women who have undergone months of unsuccessful therapy
with drugs such as Clomid
and often in the absence of a male evaluation. No
infertility treatment of the female will be successful
without enough viable sperm. A reproductive specialist
always requires a male
infertility workup.
The infertility evaluation is designed
to determine the underlying cause(s) of each couple's
infertility and specific therapy is prescribed based
upon the findings. One common cause of infertility is
anovulation
(lack of ovulation) or oligoovulation (irregular ovulation),
which can be caused by hormone imbalances, lifestyle
issues, ovarian failure and other abnormalities.
Fertility tests such as day 3
measurements of FSH, LH, estradiol, and others help
the physician determine the cause(s) of anovulation.
Ovulation is accessed by using urine test kits, measurement
of progesterone levels, visualization of follicular
development on ultrasound, and physical exam. (Read
our section on
female fertility tests for a thorough discussion.)
In many cases, Clomid is all that is needed to establish
regular ovulation and most fertility
specialists will attempt 3-6 cycles of therapy before
progressing to the next step.
Sometimes ovulatory irregularities
are caused by infertility conditions such as polycystic
ovarian syndrome. Specialists are trained to identify
PCOS patients and administer specific therapies such
as oral Glucophage (metformin) or other ovulation inducting
medications. Elevated levels of the hormone prolactin
can also lead to ovulatory irregularities.
Infertility tests might reveal antisperm
antibodies
in the female's cervical mucus. If this is the case,
intrauterine insemination (IUI)
will be a first level treatment. Mild male factor can
also be treated with IUI. If moderate to severe male
factor is present, some couples opt to use a donor and
some choose IVF
combined with intracytoplasmic sperm injection (
ICSI ).
Infertility surgery may be indicated
if there are uterine polyps, fibroids, or endometriosis.
Reproductive surgeons are skilled at performing these
delicate surgical procedures. In the case of endometriosis,
it is critical that all lesions be identified and removed.
Some couples opt for surgery to repair damaged fallopian
tubes, or reverse sterilization. While this is sometimes
successful studies demonstrate that the chances of pregnancy
are higher with IVF.
In
vitro fertilization may be a "first line"
choice for couples in which the fallopian tubes are
blocked or damaged, there is moderate to severe male
factor, advanced age, or other conditions identified
by the specialist. Intracytoplasmic
sperm injection (ICSI) will be used in many cases
of moderate to severe male factor infertility. Using
ICSI, a single sperm is inserted directly in the egg
and it can be obtained from an ejaculate or directly
 from
the male's reproductive tract.
Sometimes a woman will have elevated
FSH levels on day three indicating reduced ovarian reserve
or impending menopause. In these cases, the Clomid
Challenge test (CCCT) will be ordered to learn if
ART therapies will be successful. A poor result means
that an egg donor should be used in the IVF cycle.
In some cases, the infertile female
may have significant damage
to her uterus or have health conditions that prevent
her from carrying a pregnancy. A couple can opt for
traditional or gestational surrogacy,
which is where another woman carries the couples child
through pregnancy and delivery
Our site contains detailed
information on these and many other infertility treatments.
Please review the sections on fertility testing, causes
of infertility, and each treatment category such as
IUI and IVF.
Treatments
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