Infertility treatments are available for most causes of infertility. Infertility treatments have advanced with the introduction of many new technologies. In the past, the only infertility treatment for moderate to severe male infertility was the use of a sperm donor. Infertility treatments such as intracytoplasmic sperm injection (ICSI) allow men, even those with severe infertility, to father genetically related children. A single sperm is injected directed into the egg.
Other infertility treatment technologies, such as donor egg, make it possible for women with poor quality or absent eggs to have a successful pregnancy. Available infertility treatment options depend upon the cause(s) of infertility. If a woman is ovulating irregularly or not at all, Clomid or Femara may be a first-line treatment.
If first line medications fail, the next infertility treatment option depends on several patient-specific factors. For some, the next step is stimulated iintrauterine insemination (IUI). “Stimulated IUI” means that a fertility drug is used to stimulate the ovaries. In many cases, three cycles of IUI will be tried before moving to more advanced infertility treatments, such as IVF. IVF is required in a relatively low percentage of patients.
Some conditions, such as hyperprolactenemia, respond to infertility treatment using specific medications. In these cases, Parlodel is given to normalize prolactin levels, allowing ovulation to resume. Sometimes, polycystic ovarian syndrome (PCOS) will respond to infertility treatment with the drug metformin.
Metformin sensitizes the cells to insulin; resulting in a lowering of androgen levels (male hormones) and the return of ovulation, often while helping the patient lose weight. PCOS patients often need additional medications, such as FSH.
Most women will become pregnant using first-line infertility treatments. There are some women who will require IVF as a first-line treatment, such as those with tubal factor infertility.
When this condition is present, the fertilized eggs cannot make their journey through the fallopian tubes, and into the uterus. Using IVF, the tubes are avoided altogether, as the embryo is placed directly into the uterus. Infertility treatments such is IUI would be unsuccessful for women with blocked fallopian tubes.
One infertility treatment option for blocked tubes is sometimes surgery. Surgical intervention to correct tubal damage, or to reverse a tubal sterilization, is sometimes successful. In most cases, IVF will be recommended because the success rates are substantially higher.
As mentioned above, moderate to severe male factor infertility is another condition that will likely require IVF as the first line infertility treatment, in combination with ICSI. Using ICSI, a single sperm is injected into each mature egg, resulting in fertilization that otherwise would not occur. This means that even though there are no sperm in the male’s ejaculate, a pregnancy can be initiated using sperm which has been surgically removed from his reproductive tract using procedures such as MESA and TESA.
If the male has a varicocele, infertility treatment sometimes requires surgical intervention. A varicocele is a collection of varicose veins in the spermatic cord that interferes with sperm “cooling.” Correction of the varicocele sometimes returns semen parameters to normal. However, sperm require three months to develop the results of and any treatments initiated today will not be seen for three months.
Sometimes a couple may know or strongly suspect that they carry a genetic disorder that can be passed to their children. In these cases, preimplantation genetic diagnosis (PGD) with IVF is the recommended treatment. Using PGD, the embryos are screened for a specific genetic disorder or for abnormal or broken chromosomes. A single cell is removed from each embryo and examined using PCR or FISH to identify if the disease is present. Only embryos free of the defect will be transferred to the uterus, thus preventing transference of the disease. If a disease only occurs in males, male embryos will not be transferred.
Donor egg IVF is the preferred infertility treatment if a woman has diminished ovarian reserve or premature ovarian failure (POF), usually indicated by a significantly elevated FSH level. Women in their forties with marginal FSH levels may be advised to undergo donor egg IVF, especially if they do not stimulate well with FSH.
There are cases where a woman cannot carry a pregnancy to term. The uterus may surgically absent, be congenitally abnormal, or damaged. If the uterus cannot be repaired or is absent, a gestational carrier can be chosen to carry the child. There are agencies to help find suitable gestational carriers. In the majority of cases, the mother and father produce embryos from an IVF cycle that are then implanted into the gestational carrier. One delivered, the child is given to the genetic parents. It is very important to have a lawyer involved in this process who is familiar with state laws in this area.