Did you know that one in eight couples have difficulty conceiving a child? If you’ve been having unprotected sex for six months to a year without conceiving a child, you may be one of these couples. There are many different reasons couples struggle with infertility, but fortunately, there are nearly as many strategies available to help. From fertility preservation to natural methods of boosting fertility to IVF, the science of fertility continues to advance and bring more babies into the world every year. How much do you know about fertility treatments? Here, we offer a quick guide to help you understand the basics.
When people think of fertility treatments, many immediately jump to the idea of in vitro fertilization (IVF). In truth, in vitro fertilization and related treatments make up less than three percent of infertility treatments. According to the American Society for Reproductive Medicine (ASRM), the vast majority of couples with infertility- around 85 or 90 percent, are treated with low-tech, conventional methods like medications or surgery.
While scientists have been studying fertility since the 1600s, modern treatments like synthetic hormones weren’t developed until the 1940s. In vitro fertilization became popular in the 1980s, after the first IVF baby was born in 1978. In the 1990s, hormone injections became popular, but resulted in multiple births so often that doctors have since changed the way those drugs are used. Infertility treatment is an exciting field, constantly advancing, and finding the right treatment will depend on many factors. Your fertility doctor will evaluate your needs based on your age, your goals, and underlying conditions you and your partner may have. This evaluation will include a review of your medical history, a physical exam, bloodwork, an x-ray of the uterus and fallopian tubes, and a sonogram of the uterus and ovaries. Some common reasons for infertility include polycystic ovary syndrome (PCOS), endometriosis, blocked fallopian tubes, low egg count, low sperm count, and diminished sperm motility. In 20 to 30 percent of cases of infertility, the cause is unexplained.
- Often, the treatment for infertility begins with oral medications. Assuming there is no blockage of the fallopian tubes, and the problem is not with the man’s sperm, oral fertility medications may help. This is an inexpensive method of treatment, involving pills taken once a day for about five days during the menstrual cycle. The most common oral fertility drugs are clomiphene citrate, or Clomid, and letrozole, or Femara. They have some differences, but ultimately, they work by suppressing estrogen and triggering your follicle-stimulating hormone (FSH) in order to encourage your body to release one or more eggs. Side effects of Clomid include pelvic pain, hot flashes, and mood swings, while letrozole can cause fatigue and dizziness. Additionally, both of these medications raise the chance of carrying multiples, like twins or triplets, which increases the risks associated with pregnancy. Typically, medical providers reassess a couple after three to six months of oral fertility medication.
- Injections of hormones called gonadotropins can also stimulate the ovaries. These medications, which are injected into the fatty tissue of the abdomen or thighs, go by the brand names Menopur, Follistim, Ovidrel, Gonal-F, and Luveris. They are powerful synthetic hormones that can cause the ovary to release multiple eggs at once. Sometimes, these medications are used for women who don’t ovulate or have a low egg count, and they can be used with IUI if the risk of multiple births is low. Typically, however, injectable hormones are used in tandem with IVF. Side effects can include fatigue, bloating, mood swings, nausea, mild pelvic or abdominal pain, or bruising at the injection site, though in rare cases These injectables can cause hyperstimulation syndrome, causing the ovaries to be overactive and leak fluid into the abdomen or lungs. Most cases of hyperstimulation syndrome are mild and easily treatable. Gonadotropins cost about $3,000 to $6,000 per cycle, and if a woman is not pregnant after three cycles, it’s probably time to consider some different fertility treatment options.
- Intrauterine insemination (IUI) is minimally invasive. It’s a good early step in fertility treatment because it simply involves injecting sperm directly into the uterus. By putting egg and sperm in closer proximity, IUI makes conception easier. It’s often effective for couples whose problem is low sperm count as well as for those with unexplained infertility. It’s sometimes done with oral medication or gonadotropins, though it can also be done on its own, with no medication. Sperm is collected the day of the procedure, and put through a process called sperm washing, which takes an hour or two, though the procedure itself takes only about five minutes. IUI is not very expensive, and the side effects are minor, but it only slightly boosts the likelihood of conception.
- If three cycles of IUI do not result in pregnancy, IVF is typically the next step. During this procedure, doctors perform an outpatient surgery to retrieve eggs, which are then inseminated in the lab. The embryos that result from this process are implanted in the uterus, usually one at a time. Most of the time, IVF involves hormone injections for 8 to 14 days, as well as monitoring with blood tests and ultrasounds along the way. The eggs are then retrieved using a needle and inseminated. Sometimes, rather than being inseminated right away, the eggs are frozen for later use. This egg freezing can be done if a woman wants to wait to have children or needs to preserve her fertility because of a medical condition or treatment that threatens it. Once insemination occurs and an embryo is formed, it can be immediately transferred to the uterus or frozen for later implantation. Freezing is often done to allow for genetic or chromosomal testing, and sometimes embryos are frozen to use to conceive later. The success rate is about 50 percent for women under 35 and it goes down from there, ending up at about 12 percent for women 43 and older. IVF is costly, and it may require several cycles to be successful. The odds of success can be enhanced by adding intracytoplasmic sperm injection (ICSCI), in which a single sperm is injected into the egg, to improve the chances of fertilization. IVF can also be modified to fit the couple’s needs. It can be carried out with donor eggs if the woman isn’t ovulating or has poor quality eggs, a sperm donation if the sperm count or sperm motility are too low to facilitate pregnancy, and IVF can be used to impregnate a surrogate. Surrogacy is legally, ethically, and emotionally complicated, however, and is not legal in every state. Some couples use donor embryos for IVF, through a process called embryo adoption.
- If infertility is caused by problems in the uterus, ovaries, or fallopian tubes, it can often be corrected through surgery. Using laparoscopic surgery, in which small incisions are made in the abdomen and the doctor works with tiny tools, guided by a camera, a fertility specialist can diagnose and/or treat a number of issues. There may be blockage of the fallopian tubes, perhaps from a pelvic infection or prior surgery, or there could be endometriosis lesions, uterine fibroids, or pelvic adhesions. The medical provider can cut out or burn off fibroids, scar tissue, lesions, and other things that cause blockages, and this can increase a woman’s chances of becoming pregnant.
Infertility treatment can be a challenging experience, both physically and emotionally. The waiting each cycle to see if attempts at conception can be very hard on a couple, and being on hormones can exacerbate the experience for the woman. What’s more, while donor egg, sperm, and embryos are wonderful innovations that have allowed otherwise infertile couples to experience pregnancy and childbirth, they’re also very complicated emotionally. In cases where genetic material is donated, it means the child is unrelated genetically to one or both parents. It is vital for couples undergoing this kind of fertility treatment to not only talk to a fertility specialist about how best to meet their needs, but also to a counselor, who can help them navigate the unfamiliar landscape of fertility treatment.
If you need assistance starting your family, trust NewLife Fertility to assess your needs and help you find the solution that’s best for you. We are committed to providing patient-centered, effective, innovative, and safe reproductive care in order to help people fulfil their dreams of a healthy family. Beyond just providing fertility treatment, we instill hope by offering advice, experience, and a proven track record of success for infertility patients. Since 2004, we’ve provided the comprehensive care that is essential to successful fertility outcomes, and our success rates have made us one of the top fertility centres in Canada. For more information or to schedule an appointment, contact us through our website.