Treatment Strategies for People Who Desire Pregnancy

When a woman or couple is having difficulty becoming pregnant, it may be necessary to see a fertility specialist or reproductive endocrinologist. Reproductive endocrinologists are gynecologists who specialize in the treatment of infertility. If you visit your provider for infertility, they may run a variety or 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 women experiencing infertility or reduced fertility. The most appropriate treatment for a woman or couple experiencing these issues will be dependent on a variety of factors, including age, personal preferences, financial situation, and underlying cause of infertility or reduced fertility. Some of these potential treatment options include the following.

Lifestyle changes

In some cases, lifestyle changes, such as quitting smoking, losing weight, reducing alcohol intake, avoiding drugs, and limiting caffeine, among other changes, may help increase a woman or couple’s chances of becoming pregnant.1

Fertility medications

Fertility medications are typically intended for use by women who have an ovulation-related issue. These drugs are used to stimulate the hormones responsible for initiating ovulation or block hormones that are preventing ovulation. Some of these medications include clomiphene (Clomid), letrozole (Femara), gonadotropins (Repronex, Menopur, Gonal-F, Follistim, Bravelle, Ovidrel, Pregnyl, Novarel), metformin (Glucophage), and bromocriptine (Cycloset).

Some of these medications may increase the risk of having a multiple pregnancy. A multiple pregnancy, such as with two, three, or more babies, can lead to other risks, including premature delivery and decreased birth weights. Additionally, since many of these medications impact a woman’s hormones and hormone regulation, she may experience side effects such as hot flashes, breast tenderness, mood swings, and changes to her sexual functioning (such as vaginal dryness or decreased sex drive). Before beginning fertility medications, talk with your healthcare provider about the side effects that you might expect to experience.2-4

Surgery

Laparoscopic surgical treatment to remove endometriosis lesions, ovarian cysts, adhesions (scar tissue), or fibroids may help improve a woman’s chances of becoming pregnant if these formations were the underlying cause of her infertility. Laparoscopic surgery is done through a small incision in the pelvis while the individual operated on is under anesthesia. A long, thin tube with a camera, called a laparoscope, is inserted into the body through the incision and aids the surgeon performing the procedure. Laparoscopic procedures are generally outpatient, meaning the person operated on goes home the same day and with 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 woman is ovulating. When a woman is ovulating, she releases an egg, or eggs, from her 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 intrauterine insemination, it is possible to increase a woman’s chances of becoming pregnant.5-8

Even if a woman is using IUI, it is still necessary for her eggs to make it through her fallopian tubes and into her uterus to meet the inserted sperm and potentially implant into the uterine wall for pregnancy to occur. If a woman has a condition that prevents this process from happening, IUI may not be an option, and other methods, such as IVF, may need to be considered. The critical piece of IUI is timing. It is important to inseminate a woman while she is ovulating for the highest chance of becoming pregnant.7-8

Assisted reproductive technology (ART)

Assisted reproductive technology (ART) may be utilized when first-line treatment options have not led to pregnancy, or when a woman or couple wanting to become pregnant needs access to donor sperm or eggs. ART is more expensive and invasive than other fertility interventions, with some interventions, such as in vitro fertilization (IVF), costing $10,000 or more a cycle.5 Despite the price, becoming pregnant after IVF or other types of ART is not guaranteed, and success rates depend on a variety of 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 provider will help you determine which option is most suited for you, and what the potential success rate is in your situation.5,6,9-11

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 they can come from donors. Multiple fertilized eggs, also called embryos, are then implanted back into the uterus of the woman they came from or into a gestational carrier or a surrogate. 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 technique may be used for those who might be undergoing treatment that may impact their fertility, eggs, or sperm, such as chemotherapy or radiation therapy for cancer.5,6,12,13

In some cases, a donor or gestational carrier may be needed for pregnancy. If a woman has a condition that causes her to be unable to carry a pregnancy, a surrogate or gestational carrier may be needed. If she has a condition that affects the quality of her eggs, she may need donor eggs. This situation can also be the case for male partners who may have issues with the quality or quantity of their sperm. There are a variety of reasons why donor sperm or eggs and/or a surrogate or gestational carrier may be used. The process of IVF can be completed with biological or donor eggs and/or sperm and implanted back into the mother trying to give birth, or they can be transferred into a carrier.5

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