Treatment Options for Infertility

Once doctors have completed all the required examinations to test for infertility, it’s time to establish a calculated treatment plan catered to the woman’s cause, age and other specific reasons for infertility.  Treatment plans often rely on medication, surgery or assisted reproductive technologies (ART).

Fertility Drugs

Doctors prescribe fertility medication to help regulate or induce ovulation. These drugs do come with certain risks. For example, oral fertility drugs increase the risk for multiple babies about 10%, and injectable medications increase the risk by 15% to 20%. There are a variety of drugs available on the market today. These drugs include:

Clomiphene (Clomid) – This drug stimulates ovulation by causing the pituitary gland to release more FSH and LH.  The increase in these hormones helps to grow ovarian follicles, which contain an egg. Clomiphene is usually prescribed for women who have polycystic ovarian syndrome. Potential side effects include hot flashes, headaches, nausea, weight gain and fatigue.

Gonadotropins – This class of medication is used for women who don’t ovulate. Instead of encouraging the pituitary gland to activate hormones, gonadoropins stimulate the ovary directly. However, the goal remains the same – increased production of follicles. This medication is given by injection on a typical schedule of 7 to 12 days. If ovulation doesn’t happen during this time frame, the injections can be extended.

Human Menopausal Gonadotropin (Repronex, Pergonal) – This drug contains both FSH and LH, and is used to stimulate the ovaries. This medication, also known as menotropins, is injected during a 7 to 12 day schedule, and is administered two to three days after the start of a woman’s period.

Follicle Stimulating Homone (Bravelle, Fertinex, Follistim) – This medication is derived from the urine of postmenopausal women and is a purified form of FSH. The drug works by stimulating the ovaries to produce mature egg follicles. These medications are also administered by injection and the standard dosage is five days followed up by a clinical exam to determine the effectiveness.

Human Chorionic Gonadotropin – This drug is usually used with clomiphene and FSH. The goal of this medication is to stimulate the follicle to ovulate. The medication is administered through an injection, and potential side effects include slurred speech, weakness to one side of the body and confusion.

Surgical Options

Doctors use a variety of the following surgical options to help improve the odds of fertility:

Tubal Surgery – Tubal surgery can be performed if a woman’s fallopian tubes are blocked. The goal of this surgery is to create a new tubal opening or dilate a tube to improve the chances of becoming pregnant.

Tubal Reversal Surgery – This procedure is performed after a woman has had her tubes tied.

Tissue Removal – During this procedure, doctors use lasers to remove adhesions or endometrial tissue.

Assisted Reproductive Technology (ART)

These medical techniques are used to help infertile couples conceive. This technology works by removing eggs from a woman’s body; they are then mixed with sperm with the ultimate goal of creating an embryo. Recent data published by the United States Centers for Disease Control and Prevention reveal the following success rates for ART:

  • 39% in women under 35
  • 30% in women 35 to 37
  • 21% in women 37 to 40
  • 11% in women 41 to 42

While these statistics may be favorable, ART does have potential drawbacks. ART can be time-consuming and expensive, and there is no guarantee of success. Moreover, the likelihood of multiples increases with ART.

There are a variety of procedures that doctors utilize with assisted reproductive technology. Common methods include:

Intrauterine Insemination (IUI) – During this procedure, also known as artificial insemination, doctors place the sperm directly into the cervix or uterus through a long catheter. Prior to the insemination, doctors prescribe three cycles of clomiphene to stimulate egg production. If this procedure fails after at least six cycles, injections of a gonadotropin-stimulating drug will be added to the cycle.

In Vitro Fertilization (IVF) – During this method, doctors prescribe ovarian-stimulating drugs to help produce multiple eggs. The mature eggs are removed and transferred to a dish in the lab and mixed with sperm for fertilization. After a period of three to five days, the embryo is then implanted into a woman’s uterus.

Zygote Intrafallopian Transfer (ZIFT) – During this procedure, doctors implant a healthy embryo into a woman’s fallopian tube instead of the uterus.

Gamete Intrafallopian Transfer (GIFT) – Similar to ZIFT, but this method involves implanting mature eggs and sperm directly into the woman’s fallopian tube.

It should be noted that the above procedures are sometimes modified in cases where women can’t produce eggs or if a man’s sperm count is low. In these cases, donor eggs from other women or donor sperm is used.

Metformin (Glucophage) – This oral medication is prescribed to insulin-resistant women and for women who have been diagnosed with PCOS. Metformin helps lower male hormones, which assists in ovulation.

Bromocriptine (Parlodel) – Some cases of infertility are due to increased levels of the milk-producing hormone prolactin. This medication is used to reduce prolactin levels in these women.