A number of practices can be used to treat women with fertility problems. Some treatment options seek to use medication to restore ovulation. Other treatments assist reproduction in more invasive ways. Discuss your treatment options with your doctor. You should weigh the risks, benefits, costs, and the potential side effects for you, your partner, and your baby.
According to the Mayo Clinic, up to 25 percent of female infertility is caused by problems with ovulation. Therefore, it’s not surprising that a great deal of fertility treatment focuses on helping women produce viable eggs. Ovulation problems are usually treated with medications.
A variety of drugs can help induce ovulation. Drugs can also regulate it for women who do not ovulate consistently.
The type of drugs that are used to treat ovulation issues will depend on the underlying cause of the problem.
Clomiphene Citrate (Clomid)
Clomid (clomiphene citrate) is one of the most common treatments for ovarian problems. Taken orally, this non-hormonal drug acts on the pituitary gland. It increases levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Essentially, clomid stimulates the normal hormonal mechanisms that promote ovulation. Women with polycystic ovarian syndrome (PCOS) are often prescribed this medicine. Women with normal ovulation may also be prescribed it to increase fertility.
Human Chorionic Gonadotropin, or HCG (Ovidrel, Pregnyl)
Another common infertility treatment is human chorionic gonadotropin (HCG). This hormone stimulates the ovarian follicles to release eggs.
Problems With Prolactin
Prolactin is the hormone that causes milk production. High levels can impair ovulation. This is why breastfeeding can be used as a form of birth control in certain circumstances.
Women with high prolactin levels may be prescribed bromocriptine to help control it. This drug is also known as Parlodel.
Problems with PCOS
Women with insulin resistance and PCOS have higher-than-normal levels of male hormones (androgens). This can interrupt ovulation. Metformin (Glucophage) helps decrease insulin resistance, which subsequently leads to decreased androgen levels and potentially the resumption of ovulation.
Doctors often prescribe metformin with FSH or Clomid. The combination helps stimulate regular ovulation.
The Risk of Multiple Births
Ovulation stimulation can cause the release of more than one egg. If doctors don’t check for the number of viable follicles, this can cause potentially serious problems. Women with multiple follicles are more likely to have multiple pregnancies. Multiple fetuses are at higher risk for:
- premature birth
- certain birth defects
- low birth weight
If you are undergoing fertility treatment, it can be hard to skip a cycle. However, talk to your doctor if ovarian treatment produces more than 2 to 3 follicles in a cycle. You need to understand the potential risks of a multiple pregnancy. These must be balanced with the potential costs of repeated treatment and the risks of waiting.
Blocked or damaged fallopian tubes can cause problems with fertility. Reasons a woman may have blocked tubes include:
- pelvic inflammatory disease
- a previous ectopic pregnancy (pregnancy that occurs outside the uterus)
- tubal ligation (female sterilization surgery)
- hydrosalpinx (fluid-filled tubes)
These problems can often be corrected with surgery to clear the blocked tube. Sometimes a damaged tube is removed entirely. This can make in vitro fertilization (IVF) easier.
Surgery can also be used to:
Assisted Reproductive Technology (ART) is a group of methods used to help infertile couples. For these treatments, eggs are removed from the woman’s ovaries. They are combined with sperm to create embryos. Viable embryos are placed back inside the uterus for implantation. Different types of ART are appropriate for different couples.
The Cost of ART
Compared to medicines or lifestyle treatments, ART can be expensive. In many cases, more than one treatment is needed. They are not always covered by insurance, so it is important to think about the financial toll these techniques may place on you before starting treatment. You may want to put an upper limit on your spending in advance.
Discuss your financial concerns with your doctor. You may be able to participate in research studies or donate gametes to lower your costs.
Using Donor Gametes
Not all couples have the option of using their own gametes to get pregnant. They may choose to use:
- donor eggs
- donor sperm
- donor embryos
Use of donor gametes and embryos can improve your chances of getting pregnant. However, some couples have emotional concerns about the process. Many doctors recommend counseling for any woman or couple intending to use donor gametes.
In Vitro Fertilization (IVF)
IVF describes any fertilization that occurs outside the body. It is often used in couples where the woman’s Fallopian tubes are blocked or the man’s sperm count is low. Doctors induce ovulation in the woman to harvest multiple eggs. Mature eggs are combined with the man’s sperm in a laboratory. A few days later, fertilized embryos can be implanted in the woman’s uterus.
Embryos can also be frozen for future cycles. Most doctors will not implant more than one or two embryos. Implanting multiple embryos increases the risk of a multiples pregnancy. Multiples pregnancies are harder to carry to term. They are associated with worse infant outcomes.
Zygote Intrafallopian Transfer (ZIFT)
ZIFT is also known as tubal embryo transfer. This is a variant on standard IVF. Instead of transferring fertilized eggs into the uterus, they are transferred to the Fallopian tube. They then travel down into the uterus for implantation. This is typically used in situations when couples have failed to conceive after trying for a full year and multiple attempts at intrauterine insemination (IUI) have failed.
Gamete Intrafallopian Transfer (GIFT)
This is a less common type of ART. Retrieved eggs and sperm are transferred into the Fallopian tube. Once there, fertilization will hopefully occur. If it does, pregnancy should hopefully proceed normally.
GIFT may be used by couples who have ethical issues with the potential to produce extra embryos.
Intracytoplasmic Sperm Injection (ICSI)
This ART method is used to treat male infertility. It is a form of IVF. ICSI can help with fertilization when there is little sperm or sperm is of low quality. In ICSI, a single sperm is injected into a mature egg. The fertilized egg is then transferred to the uterus or Fallopian tube.
In this procedure, specially prepared sperm is injected into a woman’s uterus. Bypassing the cervix increases the odds of fertilization and implantation.
This type of procedure is not generally considered to be ART. This is because it doesn’t require manipulation of a woman’s eggs. However, some women do undergo ovarian stimulation before IUI. This increases the chances of success.
IUI is a form of artificial insemination. Artificial insemination can also be done vaginally, if donor sperm is needed. However, this is rarely done for women with fertility problems. IUI has a higher rate of pregnancy than vaginal insemination.