Treatment of infertility depends on the cause, how long you've been infertile, your age and your partner's age, and many personal preferences. Some causes of infertility can't be corrected. However, a woman may still become pregnant with assisted reproductive technology. Infertility treatment involves significant financial, physical, psychological and time commitment.
Treatment for men
Approaches that involve the male include treatment for general sexual problems or lack of healthy sperm. Treatment may include:
- Treating infections. Antibiotic treatment may cure an infection of the reproductive tract, but doesn't always restore fertility.
- Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
- Hormone treatments and medications. Your doctor may recommend hormone replacement or medication in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
- Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. See 'vasectomy reversal' and 'varicocele' below. In cases where no sperm are present in the ejaculate, sperm may often be retrieved directly from the testicles.
- Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.
Treatment for women
Although a woman may need just one or two therapies to restore fertility, it's possible that several different types of treatment may be needed before she's able to conceive.
- Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. Talk with your doctor about fertility drug options — including the benefits and risks of each type.
- Intrauterine insemination (IUI). During IUI, healthy sperm that have been collected and concentrated are placed directly in the uterus around the time the woman's ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
- Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery.
Assisted reproductive technology
Assisted reproductive technology (ART) is any fertility treatment in which the egg and sperm are handled. An ART health team includes physicians, psychologists, embryologists, lab technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.
In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man's sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization.
Each year thousands of babies are born in the United States as a result of ART. The success rate of ART is lower after age 35.
Other techniques are sometimes used in an IVF cycle, such as:
- Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into a mature egg. ICSI is often used when semen quality is a problem, there are few sperm, or if fertilization attempts during prior IVF cycles failed.
- Assisted hatching. This technique attempts to assist the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
- Donor eggs or sperm. Most ART is done using the woman's own eggs and her partner's sperm. However, if there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
- Gestational carrier. Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple's embryo is placed in the uterus of the carrier for pregnancy.
Complications of treatment
Complications of female infertility treatment may include:
- Multiple pregnancy. The most common complication of infertility treatment is a multiple pregnancy — twins, triplets or more. Generally, the greater the number of fetuses, the higher the risk of premature labor and delivery. Babies born prematurely are at increased risk of health and developmental problems. The goal of infertility treatment should be a single healthy pregnancy, and preventing multiple pregnancies should be discussed before treatment starts. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
- Ovarian hyperstimulation syndrome (OHSS). Use of injectable fertility drugs to induce ovulation can cause OHSS, in which the ovaries become swollen and painful. Symptoms may include mild abdominal pain, bloating and nausea that lasts about a week, or longer if you become pregnant. Rarely, a more severe form causes rapid weight gain and shortness of breath requiring emergency treatment.
- Bleeding or infection. As with any invasive procedure, there is a rare risk of bleeding or infection with assisted reproductive technology.
- Premature delivery or low birth weight. The greatest risk factor for low birth weight is a multiple fetus pregnancy. In single live births, there may be a greater chance of preterm delivery or low birth weight associated with IVF.
- Birth defects. Some research suggests that babies conceived using IVF might be at increased risk of certain birth defects, such as heart and digestive problems and cleft lip or cleft palate. However, most studies conclude that this appears to be related to why couples need infertility treatment and not the IVF procedures themselves.
Complications of male infertility treatment are rare and may occur following surgery including infection, bruising, or lack of efficacy with the procedure.
July 02, 2014
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