Anyone who has ever had trouble conceiving knows that fertility struggles can be overwhelming and heartbreaking. Luckily, there are tons of fertility treatments out there that can help—but first, doctors have to get to the bottom of the issue. While there are times when doctors can’t figure out exactly what’s going on, they’re often able to nail down the issue—and this is because fertility issues are very common. “Infertility is a medical condition in which the ability to become pregnant and give birth to a child is limited or impaired in some way. Patients struggling with infertility often feel that they are alone, but infertility is actually very common, affecting an estimated one in seven couples,” explains Dr. Elliott Richards, MD Director of Research of Reproductive Endocrinology and Infertility, Cleveland Clinic. “While not all of these people seek out treatment, the CDC reports that 12% of all women of reproductive age use some type of fertility service.” Dr. Richards says fertility treatments address the underlying cause of infertility, so certain fertility treatments may not work for some patients. If you’re thinking about talking to your doctor about fertility treatments and want to understand what options are available, there are probably more possibilities than you think. Here’s everything you need to know.
Are Fertility Treatments Right for You?
Infertility is often defined as the inability to conceive after 12 months despite regular intercourse and regular menstrual cycles, or six months if the woman is 35 or older, Dr. Richards explains. “While this is a good general rule, this definition doesn’t apply for many patients, such as single individuals desiring to be a parent, many transgender individuals, patients in same-sex relationships, or patients with recurrent miscarriages,” he says. “In addition, fertility treatments may be utilized by patients who don’t want to get pregnant yet but desire to preserve their fertility for personal or medical reasons.” Dr. Richards adds that the best way to determine if you need fertility treatments is to first start by talking to your gynecologist or a reproductive endocrinologist. For men, there are urologists trained in male fertility that can also help. There are a variety of fertility treatments that can help with conceiving, so here’s a look at the different types of treatments that could help you expand your family.
Fertility Treatments
1. Medications to induce ovulation
Dr. Richards says for a woman without regular menstrual cycles and ovulations, there are oral and injectable medications to help induce ovulation. “The most common two are clomiphene citrate (Clomid) and letrozole (Femara),” he says. Both of those medicines help to stimulate the ovaries to correct irregular ovulation, and suppress estrogen production. There are also hormone shots called gonadotropins that will directly stimulate ovulation. Metformin is also used if your irregular ovulation is caused by polycystic ovary syndrome (PCOS). It’s normally used to treat diabetes, but it also works to sensitize insulin levels to help achieve regular ovulation.
2. Medications to improve egg or sperm quality
“There are supplements that may improve egg and sperm quality, but typically they are not enough on their own and are done in combination with another treatment,” says Dr. Richards.
3. Surgery to reverse a prior tubal ligation
All hope is not lost for women who previously had their tubes tied and now want to have a child. Dr. Richards says talk to your doctor to find out if you are a candidate for surgery to reconnect the tubes back together.
4. Surgery to repair a blocked tube
Sometimes surgical measures will need to be taken to repair a part of the reproductive system. “Tubes can be damaged by pelvic infections and inflammatory conditions like endometriosis. In some cases, the blocked fallopian tubes can be repaired surgically, depending on the location and extent of the damage and the condition of the tube,” explains Dr. Richards.
5. Surgery to remove a uterine polyp, fibroid, adhesion, or septum
“If the uterine cavity, which is the inside of the womb where the embryo implants and the fetus grows, is damaged or distorted, fertility can be affected. Special hysteroscopic procedures can be performed where a small scope is placed through the cervix to guide tiny instruments to remove lesions and restore the normal cavity,” says Dr. Richards. Skin incisions aren’t performed, so it’s the least invasive.
6. Surgery to remove endometriosis
Endometriosis is a painful disorder where the tissue that normally lines the inside of your uterus, grows outside of the uterus and attaches itself to nearby organs. “Endometriosis is an inflammatory condition that affects 10% of reproductive women and is a common cause of unexplained infertility. Surgery can be performed to diagnose and treat endometriosis lesions, which can improve fertility in some patients,” says Dr. Richards.
7. Surgery to transplant a uterus
No, this isn’t just a storyline for the show Greys Anatomy, you can actually have a uterus transplant. “For women without a functional uterus, a uterus can be transplanted temporarily into their body so that they can carry children. While this is not yet available to men or transgender women, many predict that this treatment will be available one day to this population,” Dr. Richards said.
8. Intrauterine insemination (IUI)
This is a simple office procedure where the male sperm is washed and prepared, then a small catheter is passed through the woman’s cervix to inject the sperm directly into the uterine cavity. The goal of this treatment is to improve the chances of fertilization by increasing the number of healthy sperm that reach the fallopian tubes when the woman is most fertile. This procedure may be right for couples dealing with low sperm counts or poor sperm motility, same-sex couples or couples using a surrogate, or single women who want to have a child on their own.
9. In vitro fertilization (IVF)
“In this complex procedure, the ovaries are stimulated with medications for several days and eggs are extracted and fertilized in a specialized lab. The resulting embryos are either transferred into the uterus or frozen for future use,” says Dr. Richards. IVF has several stages and cycles, and you’ll start with taking hormone injections which can have some unpleasant side effects. IVF can be a good choice for those dealing with severe fallopian tube blockages, ovulation problems, diminished ovarian reserve, poor egg quality, PCOS, endometriosis or sperm deficiencies. “IVF is able to treat many male fertility problems, such as low sperm counts or abnormally shaped sperm. For men with extremely low sperm counts, special sperm extraction procedures can be done in conjunction with IVF. For some men, there may be medications and surgeries to improve sperm counts without having to extract sperm,” adds Dr. Richards.
10. Egg freezing
This is a process in which medication is used to stimulate a woman’s ovaries to produce multiple mature eggs. Dr. Richards says the procedure is similar to IVF, except the eggs are immediately frozen and stored for future use. Once you are ready to get pregnant, the eggs are thawed and fertilized with your partner or donor’s sperm and implanted into the uterus using the IVF procedure. A simple blood test to determine your levels of anti-mullerian hormone will indicate how many eggs you have left in your ovaries to help you decide if this is the best option.
11. Surrogacy
A surrogate carries a child for another woman or same sex couple. The parents undergo IVF and the embryo is implanted in the surrogate’s uterus. Both parents have a genetic tie to the baby, but the surrogate doesn’t. “Many patients utilize egg and/or sperm donors in IUI or IVF procedures above, or they may utilize a gestational surrogate to carry their genetic offspring,” says Dr. Richards. Surrogacy costs can often skyrocket to over $100,000 depending on fertility costs, the surrogate’s medical costs, legal fees, and any other associated costs. Next up: Get inspired by these 100 uplifting quotes about fertility.
Sources:
Elliott Richards, MD is the Director of Research of Reproductive Endocrinology and Infertility at Cleveland Clinic.Centers for Disease Control and Prevention, Infertility statistics
