A number of practices can be used to treat women with fertility problems. Some treatment options seek to restore fertility—by bringing about or restoring ovulation. Still other treatment options are designed to assist in reproduction in more invasive ways. In every case, it’s important to discuss the treatment options with a doctor, weighing their benefits, dangers, and potential side effects for you, your partner, and your baby.
To treat anovulation, doctors use a variety of medications. The purpose of these meds is to induce ovulation if a woman is not ovulating or regulate it if she has been irregular. These include:
Women with ovulation problems due to high levels of prolaction, a hormone that causes milk production, may be prescribed bromocriptine to help control the levels of the hormone.
Clomiphene Citrate (Clomid)
Taken orally, this drug acts on the pituitary gland to promote ovulation by increasing levels of FSH and LH. Women with polycystic ovarian syndrome (PCOS) are often prescribed this medicine, as are women with normal ovulation as a way to increase fertility.
Follicle-Stimulating Hormone or FSH (Gonal-F, Follistim)
Problems with the pituitary gland can lead to ovulation problems. FSH is injected directly into the ovaries to stimulate ovulation, bypassing the pituitary gland altogether.
Doctors use this medicine to stimulate the pituitary gland, which in turn causes the body to ovulate.
Human Chorionic Gonadotropin, or HCG (Ovidrel, Pregnyl)
This medicine is often used in combination with clomiphene, hMG, or FSH to stimulate the ovary’s follicles to release eggs.
Human Menopausal Gonadotropin or hMG (Repronex, Pergonal)
Like FSH, hMG bypasses the pituitary gland and works directly on the ovaries to stimulate ovulation.
Women with insulin resistance and PCOS have higher-than-normal levels of male hormones in their body, which can interrupt ovulation. Metformin helps lower these levels. Doctors often prescribe metformin with FSH or clomiphene citrate to stimulate regular ovulation.
As a potential side effect of these medicines, women are more likely to have multiples, and multiple fetuses are at a higher risk for premature birth, certain birth defects, and low birth weight.
Some techniques, which involve retrieving eggs from the woman and sperm from the man, can help an otherwise infertile couple have a child. These methods include:
Intrauterine Insemination (IUI)
In this procedure, sperm that has been specially prepared for insemination is injected into the woman’s uterus for fertilization and implantation. In some cases, women are given ovulation-stimulating medicines before an IUI treatment to increase the chances of success.
Assisted Reproductive Technology (ART)
Assisted Reproductive Technology, or ART, combines different methods to help infertile couples. For this treatment, eggs are removed from the woman’s ovaries and combined with sperm to create embryos. These embryos are then placed back inside the woman’s uterus for implantation. The types of ART include:
In vitro fertilization (IVF): This term refers to 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 too low. Doctors induce ovulation in the woman to harvest multiple eggs. Once they are mature, the eggs are combined with the man’s sperm in a dish in a laboratory setting. A few days later, the fertilized, healthy embryos are then implanted in the woman’s uterus.
Zygote intrafallopian transfer (ZIFT) or Tubal embryo transfer: This technique is similar to IVF—fertilization of eggs occurs in a laboratory—but instead of transferring the fertilized eggs into the uterus, they are transferred to the Fallopian tube, where they travel down through the tube into the uterus for implantation.
Gamete intrafallopian transfer (GIFT): This less-commonly practiced form of ART involves transferring both non-fertilized eggs and sperm into the woman’s Fallopian tube. Once there, the fertilization occurs in the woman’s body, instead of outside.
Intracytoplasmic sperm injection (ICSI): This ART method is used in couples where the man’s sperm count and quality have serious problems. In ICSI, a single sperm is injected into a mature egg, and the fertilized egg is then transferred to the uterus or Fallopian tube.
Some couples use donated eggs, donated sperm, donated embryos, or previously frozen embryos (made from their own eggs and sperm) in these ART methods.
Compared to medicines or lifestyle treatments, reproductive assistance techniques and ART can be expensive, and in many cases, they are not covered by insurance. Discussing the financial toll these techniques may place on you is important.