Infertility treatment options
Infertility treatment options
Medically reviewed by Rashmi Kudesia, MD, M.Sc.
April 23-29, 2023, isNational Infertility Awareness Week.
For Monica Wunderman, the road to parenthood hasn’t been easy. She wunderman has always wanted to have children, but when she struggled to get pregnant she wasn’t sure what to do. She wunderman has two uteruses — which unfortunately doesn’t mean she’s more likely to carry a child — and other health conditions have contributed to her infertility than hers. But thanks to advances in fertility treatment options, Wunderman and her husband are now planning to have a baby through a gestational surrogate. “Not only was it difficult for me to get pregnant, it could have been dangerous,” Wunderman said.
The Wunderman story is more common than one might think. From 1 out of 5 women infertility is diagnosed every year. Another 1 in 4 had difficulty getting pregnant or were unable to carry a pregnancy to term.
“The incidence of infertility has not necessarily increased, but the need for fertility services has increased,” said Cindy Duke, MD, Ph.D., FACOG, founder and laboratory and medical director of the Nevada Fertility Institute of vegas.
What is Fertility Treatment?
If you have been trying to conceive for more than a year, there are a number of tests your healthcare professional (HCP) may recommend:
- Ovulation test – helps determine when in your cycle you are most likely to get pregnant
- Hysterosalpingography – an x-ray procedure to see if your fallopian tubes are open and to see the inside of your uterus for any abnormalities
- Ovarian reserve test – test to determine how many eggs you have left
- Hormonal tests – tests to determine the levels of hormones needed to get pregnant in the blood
- Pelvic ultrasound OR sonohysterogram – medical imaging used to look inside the organs or structures in the pelvis or uterus
- Laparoscopy – a minimally invasive surgical procedure to look directly at your pelvic organs
- Genetic testing – tests to evaluate your DNA to see if there are any problems that can increase the risk of miscarriage or pregnancy complications
The cause of your infertility, as well as your age, general health, and personal preferences can determine the type of treatment your healthcare provider recommends. It’s important to note that many women will need multiple treatments and may need a combination of procedures and medications. Medical options for women dealing with infertility include:
- Clomiphene Citrate: An oral drug that stimulates ovulation. It is usually the first treatment for women who do not have polycystic ovary syndrome (PCOS).
- Letrozole: An oral drug that works by reducing estrogen levels to stimulate ovulation and can be used for women with PCOS.
- Gonadotropins: These drugs are used, usually with IVF, to stimulate the ovary to produce more eggs or to make the eggs mature before they are released.
- Metformin: Women with PCOS may have insulin resistancewhich can lead to infertility. Metformin can improve insulin resistance and can improve ovulation.
For women with uterine problems, surgery can help remove some problems that cause infertility such as uterine polyps or non-cancerous fibroids.
Intrauterine insemination (IUI)
IUI it is a type of reproductive assistance in which sperm is fed directly into the uterus around the time of ovulation. The procedure is quick — it takes about a minute — but some preparation is required, including tracking your ovulation. Women with certain health conditions such as endometriosis and infertility with no known cause can be candidates for IUI.
ART treatment options include egg or sperm donation. This is when eggs, sperm, or embryos from someone other than the intended parents are needed in order to have a child. Some people may choose this option due to medical issues. LGBTQ couples and singles can also choose this treatment.
In IVF treatment, mature eggs are retrieved and then fertilized with sperm in the laboratory. Once fertilized, the embryos are transferred to the uterus.
Assisted hatching it is a procedure often used with IVF. Once an embryo has been created through IVF, it is surrounded by a tough outer layer of cells. Assisted hatching creates a small crack in the outer layer to increase the chances of the embryo implanting in the uterus. Women who have previously been unable to conceive through IVF may wish to consider assisted hatching.
The cost of infertility treatment options
Fertility treatments are not cheap. For example, a single IVF cycle, which includes ovarian stimulation, egg retrieval and embryo transfer, can range from $15,000 to $30,000 and many women may need up to six cycles to get pregnant. Insurance doesn’t always cover the cost, but that’s been 20 states fertility insurance coverage laws.
“Always ask your insurance company if they cover fertility services, not just OB-GYN services,” Duke advised.
The risks of fertility treatments
Fertility treatment options offer hope, but they can also come with some risks, including an increased chance of becoming pregnant more than one child at a time, premature birth, low birth weight and birth defects. Risks to the mother may include bleeding and infection from surgical procedures and ovarian hyperstimulation syndrome (OHSS)which can cause ovarian pain, swelling, and nausea.
How to find a fertility specialist
“When looking for a fertility clinic or specialist, first make sure they are trained, certified and licensed,” Duke said. “Then ask yourself, ‘What do I need as a patient?’” This could include anything from language assistance to mobility accessibility to inclusiveness of gender, racial and ethnicity. “Read the reviews, look at the provider’s website to see what kind of language and photos they use, ask about real-time birth rates — not just the success of getting pregnant — and never be afraid to ask for a second opinion” Duke said.
The impact of infertility
After five successful rounds of IVF egg retrieval, Wunderman remains optimistic that she and her husband will achieve their dream of becoming parents. She also acknowledged that it has been a difficult journey, physically, financially and emotionally.
“If you don’t talk about the problem, it can be terribly isolating,” Wunderman said, offering advice to other women dealing with infertility. “Science is evolving and there are amazing resources out there. Don’t be ashamed – infertility is more common than you think – be an advocate for yourself, find a healthcare provider and clinic that has your back, and be invested in your success throughout the process. Consider all options and then make the right decision for yourself.
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