Infertility is a complex issue, with causes and circumstances that vary with every couple. However, it is a common condition, affecting about 1 in 10 couples in the US.
Infertility originates more often with women’s reproductive systems, but sometimes can occur with men as well. Women undergo most of the available infertility treatments, since a woman’s body is required to carry, grow, and give birth to a child. Same-sex couples can only have a child through donor eggs or sperm and male couples only through surrogacy.
Here is a basic outline of infertility treatments, beginning with the simplest and least intrusive options.
For women: The most common drugs for women include clomiphene and gonadotropins. Clomiphene is typically the first medicine that reproductive doctors will prescribe to stimulate a women’s egg production. Because it causes the woman’s body to produce more and larger eggs, it increases your chances of having twins. If clomiphene by itself doesn’t work, gonadotropins are used to further regulate the woman’s cycle by triggering ovulation. By improving the quality and quantity of the eggs and controlling ovulation, these drugs significantly increase your chance of conceiving.
For men: Fertility drugs are less comprehensive. Men can take antibiotics if there is an infection, medication for erectile dysfunction, or hormone therapy. These medicines only improve conception if there is a problem directly affecting fertility.
For women: Surgery can correct fertility problems in women. Surgical procedures can open fallopian tubes that are blocked, extract endometriosis tissue, eliminate fibroids, and treat PCOS (polycystic ovarian syndrome). Your doctor will determine the appropriate type of surgery for you, based on your condition. There is discomfort with any form of surgery. The good news is that when you can identify the cause of infertility and then accurately treat it, your success rates improve drastically.
For men: Surgery for men is only used if you need to reverse a vasectomy, repair an obstruction in the vas deferens, correct a varicocele, or extract a sperm sample if you cannot produce a sample otherwise.
IUI (Intrauterine Insemination)
This procedure is a form of ART (Assisted Reproductive Technology). ART is used when medications don’t work or when there are no diagnosed conditions affecting fertility that can be corrected by other means. IUI is the process of inserting the father’s (or male donor’s) sperm sample directly into the uterus of the intended mother.
For women: The woman takes drugs like clomiphene and gonadotropins to regulate her cycle and ensure the optimal moment for inserting the sperm. A medical professional in a clinic conducts the insemination with a catheter to effectively place the sperm.
For men: The man will provide a sperm sample either by normal ejaculation or by surgical extraction.
IVF (In Vitro Fertilization)
IVF is a specialized ART procedure. If medicines and IUI have been tried several times and for several months without success, IVF is often the next step. It further controls the conception process by combining the egg with the sperm in a lab.
For women:IVF requires an egg sample from the mother. She will have to undergo the usual round of medicines and ovulation, but instead of fertilizing the eggs inside her, the doctors will sedate her and remove the viable egg samples that are combined with the sperm in a lab. If and when successful fertilization occurs and the eggs become viable embryos, the embryos are then transferred back into the uterus.
For men: Men undergo no additional medical treatments for IVF, but fathers still experience stress with their wives and provide physical and emotional support.
IVF with ICSI
IVF can correct most infertility issues, especially if the cause of infertility is unknown. However, IVF can still fail to result in pregnancy. ICSI (Intracytoplasmic sperm injection) can overcome male infertility or sperm issues. ICSI requires fertilizing the egg with the male’s sperm in the lab. It is a delicate process where a special needle is used to inject the sperm directly into the egg.
Neither the woman nor the man does anything different for this procedure, but it is an additional cost.
Donor Eggs, Sperm, and Embryos
Sometimes infertility is caused by the mother or the father not being able to produce an operable egg or sperm sample. In this case, you can use a donor. If neither partner in a relationship can contribute the genetic material, then you have the option of using a donor embryo.
In gestational surrogacy, a surrogate mother will carry the embryo to full term and give birth to the child. A legal process is followed so that the intended parents will have full legal custody of the baby.
Surrogate mother: The surrogate mother takes medications to regulate her cycles so her uterus can accept the embryo at the proper time.
Intended mother: The intended mother may have to be on medication or undergo egg retrieval if she is providing the eggs for the pregnancy.
Intended father: The intended father will provide sperm unless a donor is needed.
Surrogacy is an important and innovative option for those intended parents who simply cannot carry the child. It involves significant cost and legal contracts, so it’s important to choose a reputable and experienced surrogacy agency to help facilitate this process.