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Infertility Treatments

Omega Family Global provides this information on infertility treatments as a courtesy to its clients and site visitors.  If you have any questions, please contact us.

Infertility Treatments: Introduction

Infertility treatments number about forty and they are not all addressed here. Omega Family Global (OFG) provides the following information as an overview. Those seeking more advanced information can contact us for more references or consult a fertility physician.

The vast majority of Intended Parents having problems creating a new family are not actually infertile, but rather sub-fertile. A high percentage (85-90%) of Intended Parents wanting a new family respond to less invasive, more conventional, methods which may include: surgery or education about reproductive biology (eg. ovulation timing, and hormone therapy).

A small percentage (~ 3%) of Intended Parents decide to move onto more complicated and costly treatments that fall into the category of assisted reproductive technology (ART).

Infertility problems occur in equal frequency in both men and women. The first step in treating infertility in either men or women is to determine which member of the couple has the problem and determine the root cause. Fertility physicians treating Intended Parents will typically set about ruling out possibilities, and based on data (physical exam, laboratory tests), work toward identifying the underlying causes.

Fertility treatments can be divided into two general categories. One category includes those intended to overcome male infertility and the second include those procedures to overcome female infertility. Infertility treatments for both men and women can be surgical or pharmacological (treated with medicine). The following sections address several common procedures used to treat infertility in either gender. Other sections of the OFG site address those fertility treatments that involve handling both egg and sperm outside the body and hence fall under the category of ART.

Infertility Treatments For Women

There is about a 50% general probability that treatments will be successful for an infertile woman(1). The factors determining the probability of success depend on the problem (hormonal, physical, etc), the woman’s age, history of previous pregnancies, and how long she has suffered infertility. Infertility problems in women can be separated into those that are hormonal and those that are due to physical problems.

Treatments for female infertility with the highest success rates are those due to problems with hormonal imbalances and most often are related to ovulation. Less successful treatments are those that are surgical and used in cases of damaged fallopian tubes, or uterine conditions such as severe endometriosis(1).

Fertility treatments for women fall into three general categories; medication (hormones typically) treatments, surgical treatments for physical problems, and assisted reproductive technology (discussed under Medical Options section).

Fertility treatments in the category of hormonal are most often related to stimulating ovulation. Fertility physicians may use one or more of three different therapeutic approaches to archive ovulation(2).

  1. Use of Clomiphene: This is a medication taken orally that causes the eggs in the ovary to mature and hence be ovulated. If the woman does not become pregnant in six months, physicians typically will turn to other fertility treatments. There is an increased risk of multiple pregnancy with use of this treatment(2). There is about a 10% chance of having twins. However, births of three or more is rather rare and is less than 1% of all cases(2).
  2. Use of Gonarotropins and Human Chorionic Gonadotropin (hCG) : These medications (hormones) are administered by injection and used to stimulate egg growth and subsequent ovulation. This treatment method is often used if the woman does not respond to Clomiphene. The chance of a multiple birth is higher with these treatment protocols(2). About 30% of all resultant births are multiple with about 33% being twins and the remaining 66% being triplets or more.
  3. Use of Bromocriptine or Cabergoline: These medications are taken orally and used to decrease abnormally high levels of prolactin (natural hormone that can block ovulation). With use of either of these medicines, about 90% of treated women will respond and have normal prolactin levels. Once prolactin levels are lowered, 85% of treated women will ovulate(3).
    Other hormonal treatment options include those that impact the thyroid gland. Abnormalities in thyroid gland function can impact fertility. However, this is a less known area of infertility treatment and has less known and used therapeutic options.

Additional Information Sources On Hormonal Infertility Treatment For Women

Surgical Infertility Treatments For Women

A second general category could best be described as infertility due to mechanical issues. In this second example the woman in question might have blocked fallopian tubes, uterine fibroids, a deformed uterus, or some other anatomical issue. The conditions where surgery might be used to treat infertility in women include: endometriosis, fallopian tube problems, fibroids, and polycystic ovary syndrome.

Surgical treatments for infertility in women are most often done in cases of fallopian tube damage. Success rates of reversing infertility with these types of surgeries are low. They also cause increased risk of ectopic pregnancy(3).

Infertility Treatments For Men

As in women, infertility in men can be due to hormonal imbalances or mechanical problems. Evaluation of fertility in men might include examination for signs of hormone deficiencies indicated by increased body fat, decreased muscle mass, and decreases facial and body hair. The physical examination would also look for problems such as infection, a hernia, or varicocele. Questions about a man´s past injury to the testicles or penis, recent high fevers, and childhood diseases such as mumps could also indicate the root cause of the infertility(4). If indicated, hormone levels in the blood might be examined and a biopsy of the testicle might be taken. In some cases genetic screening might be used to identify potential hereditary causes of infertility(5).

Samples of semen might be taken and sent to a laboratory to examine sperm count, motility, and percent abnormal. Some cases of infertility can be overcome by merely concentrating the sperm and placing them in the uterus of the partner (intra-uterine insemination discussed in Summary Section).

As in women, infertility treatments are based on the root cause of the problem; and in the case of no identified problem, evidence-based treatments might be implemented. Infertility in men can be treated with medications to correct hormonal imbalances and/or through surgical intervention. In some cases treatment for erectile dysfunction might be indicated to overcome the infertility. Infertility in men can be treated by surgery to repair varicocele and repairing blockages in vesicles that transport sperm(5).

Other Treatment Options

Intrauterine insemination (IUI) is a procedure that might overcome infertility due to a problem in the man or the woman. This technique is rather simple and involves placement of a man’s sperm into a woman’s uterus by passing through the cervix with a long flexible tube.

The use of IUI might be indicated in treating one or more the following conditions of male infertility; low sperm count, low sperm mobility, and retrograde ejaculation. IUI might be indicated in women that have scarring or defects of the cervix.

After Intended Parents have gone through some of the fertility treatments described here, and have not met with success, they might choose to use procedures under the category of assisted reproductive technology. In assisted reproductive technology, both sperm and egg are handled outside the body, and at times a surrogate will be involved.

In vitro fertilization (IVF) is the most common type of assisted reproductive technology used. In this procedure, an egg is fertilized by sperm in a laboratory and the resulting embryo(s) are placed in a woman´s uterus (could be a surrogate) through the cervix. In IVF, either or both the egg and sperm can be from a donor.

A second treatment, under the umbrella of ART procedures, is termed intracytoplasmic sperm injection (ICSI). This procedure only differs from IVF in that the sperm (only one) is injected, mechanically, under a microscope, into the egg in a laboratory. The embryo(s) that starts to develop, is then placed into a woman´s uterus (can be a surrogate).

References

  1. Jose-Miller, A. B., Boyden, J. W., & Frey, K. A. (2007). Infertility. American Family Physician, 75, 849–856.)
  2. American Society for Reproductive Medicine. (2012). Medications for inducing ovulation. Retrieved June 11, 2012, https://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resour…
  3. American Pregnancy Association. (2011, November). Ectopic Pregnancy. Retrieved July 19, 2012, from http://americanpregnancy.org/pregnancycomplications/ectopicpregnancy.html
  4. Male Infertility Best Practice Policy Committee of the American Urological Association & Practice Committee of the American Society for Reproductive Medicine. (2006). Report on optimal evaluation of the infertile male. Fertility and Sterility, 86, S202–S209.
  5. Jose-Miller, A. B., Boyden J. W., & Frey, K. A. (2007). Infertility. American Family Physician, 75, 849–856.