Treatment Strategies for People Who Desire Pregnancy
When a person or couple is having difficulty becoming pregnant, they may need to see a fertility specialist or reproductive endocrinologist. Reproductive endocrinologists are gynecologists who specialize in the treatment of infertility. If you visit your doctor for infertility, they may run a variety of tests or take ultrasound images of your reproductive system to try to determine the cause of your infertility. They will also do the same for your partner, if applicable.
There are several potential treatment options for people experiencing infertility or reduced fertility. The right treatment for a person or couple experiencing these issues will depend on many factors. This may include age, personal preferences, financial situation, and underlying cause of infertility or reduced fertility.
In some cases, lifestyle changes may increase a person or couple's chances of becoming pregnant. These changes may include quitting smoking, losing weight, reducing alcohol intake, avoiding drugs, and limiting caffeine.1
In most cases, fertility drugs are used to treat people who have an ovulation-related issue. These drugs are used to stimulate the hormones that start ovulation or block hormones that are preventing ovulation. Some of these drugs include:2-4
- Clomiphene (Clomid)
- Letrozole (Femara)
- Gonadotropins (Repronex, Menopur, Gonal-F, Follistim, Bravelle, Ovidrel, Pregnyl, Novarel)
- Metformin (Glucophage)
- Bromocriptine (Cycloset)
Some of these drugs may increase the risk of having a multiple pregnancy. A multiple pregnancy, such as with 2, 3, or more babies, can lead to other risks. This includes premature delivery and decreased birth weights.2-4
Since many of these drugs impact a person's hormones and hormone regulation, they may also cause side effects such as:2-4
- Hot flashes
- Breast tenderness
- Mood swings
- Changes to sexual function, like vaginal dryness or decreased sex drive)
These are not all the possible side effects of fertility drugs. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with fertility drugs.
Laparoscopic surgical treatment may improve a person's chances of becoming pregnant. Surgery may be done to remove endometriosis lesions, ovarian cysts, adhesions (scar tissue), or fibroids if these were the underlying cause of infertility.4
Laparoscopic surgery is done through a small incision in the pelvis. The procedure is done under anesthesia. A long, thin tube with a camera, called a laparoscope, is inserted into the body through the incision. This helps the surgeon performing the procedure. Laparoscopic procedures are generally outpatient. This means the person operated on goes home the same day and has a relatively short recovery time. Other common surgical procedures for infertility may include hysteroscopy or microsurgery.4
Intrauterine insemination (IUI)
IUI, also called artificial insemination, involves delivering sperm directly into the uterus while a person is ovulating. When a person is ovulating, they release an egg, or eggs, from the ovaries. This egg then travels through the fallopian tubes and into the uterus. If the egg is fertilized by a sperm, pregnancy could result. By delivering sperm directly into the uterus around the time of ovulation via IUI, it is possible to increase a person's chances of becoming pregnant.5-8
Even if a person is using IUI, their eggs must make it through the fallopian tubes and into the uterus to meet the inserted sperm and potentially implant into the uterine wall for pregnancy to occur. If a person has a condition that prevents this process, IUI may not be an option. Other methods, such as IVF, may need to be considered. The critical piece of IUI is timing. It is important to inseminate a person while they is ovulating for the highest chance of becoming pregnant.7-8
Assisted reproductive technology (ART)
Assisted reproductive technology (ART) may be used when first-line treatment options have not led to pregnancy. It may also be used when a person or couple wanting to become pregnant needs access to donor sperm or eggs.
ART is more expensive and invasive than other fertility interventions. Some interventions, such as in vitro fertilization (IVF), cost $10,000 or more a cycle. However, becoming pregnant after IVF or other types of ART is not guaranteed. Success rates depend on many factors, including maternal age, cause of infertility, lifestyle factors, and more. Each type of ART carries its own success rate and is used to treat various causes of infertility. Your doctor will help you determine which option is best for you, as well as the potential success rate for your situation.5,6,9-11
In vitro fertilization (IVF)
During IVF, multiple eggs are fertilized by sperm outside of the body in a lab. These eggs and sperm cells can come from the couple trying to give birth or from donors. Multiple fertilized eggs (embryos) are then implanted back into the uterus of the person they came from or into a gestational carrier or a surrogate.5,6,12,13
From there, these embryos can lead to pregnancy. In some cases, IVF may be used as a means of preserving fertility. Eggs and sperm can be harvested from the body and frozen in order to store them for later use. This method may be used by people undergoing treatment that may impact their fertility, eggs, or sperm, such as chemotherapy or radiation therapy for cancer.5,6,12,13
Third party-assisted ART
In some cases, a donor or gestational carrier may be needed for pregnancy. They are many reasons why donor sperm or eggs and/or a surrogate or gestational carrier may be used.
If a person has a condition that causes them to be unable to carry a pregnancy, a surrogate or gestational carrier may be needed. If they have a condition that affects the quality of their eggs, they may need donor eggs. This may also be the case for male partners who have issues with the quality or quantity of their sperm. The process of IVF can be completed with biological or donor eggs and/or sperm and implanted back into the person trying to give birth. Or, they can be transferred into a carrier.5
Have you altered your diet to try and reduce your endometriosis symptoms? If so, did it help?