Fertility (IVF) Treatments

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 can still become pregnant with assisted reproductive technology or other procedures to restore fertility.

Treatment for men

Approaches that involve the male include treatment for:

• General sexual problems. Addressing impotence or premature ejaculation can improve fertility. Treatment for these problems often is with medication or behavioral approaches.
• Lack of sperm. If a lack of sperm is suspected as the cause of a man’s infertility, surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes possible. In some cases, sperm can be taken directly from the testicles or recovered from the bladder and injected into an egg in the laboratory setting.

Treatment for women

Drugs

Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. Commonly used fertility drugs include:

• Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
• Human menopausal gonadotropin (Repronex, Menopur). This injected medication is for women who don’t ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, human menopausal gonadotropin (hMG) and other gonadotropins directly stimulate the ovaries. This drug contains both FSH and LH.
• Follicle-stimulating hormone (Bravelle). FSH works by stimulating maturation of egg follicles the ovaries.
• Human chorionic gonadotropin (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG and FSH, human chorionic gonadotropin (HCG) stimulates the follicle to release its egg (ovulate).
• Gonadotropin-releasing hormone analogs. This treatment is for women with irregular ovulatory cycles or who ovulate prematurely — before the lead follicle is mature enough — during hMG treatment. Gonadotropin-releasing hormone (Gn-RH) analogs suppress pituitary gland activity, which alters hormone production so that a doctor can induce follicle growth with FSH.
• Aromatase inhibitors. This class of medications, which includes letrozole (Femara) and anastrozole (Arimidex), is approved for treatment of advanced breast cancer. Doctors sometimes prescribe them for women who don’t ovulate on their own and who haven’t responded to treatment with clomiphene citrate. These drugs are not approved by the Food and Drug Administration for inducing ovulation, and their effect on early pregnancy isn’t yet known.
• Metformin (Glucophage). This oral drug is taken to boost ovulation. It’s used when insulin resistance is a known or suspected cause of infertility. Insulin resistance may play a role in the development of PCOS.
• Bromocriptine (Parlodel). This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.

Surgery

Depending on the cause, surgery may be a treatment option for infertility. Blockages or other problems in the fallopian tubes can often be surgically repaired. Laparoscopic techniques allow delicate operations on the fallopian tubes.

If you have endometriosis, your doctor may treat you with ovulation therapy, in which medication is used to stimulate or regulate ovulation, or in vitro fertilization, in which the egg and sperm are joined in the laboratory and transferred to the uterus.

Assisted reproductive technology (ART)

Each year thousands of babies are born in the United States as a result of ART. An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.

ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART is lower after age 35.

Insemination and assisted reproductive technology (ART) can improve the odds of pregnancy. They introduce the sperm to the egg in the woman’s reproductive tract (insemination) or in the lab (ART).

Insemination

Insemination flushes the sperm through a thin, flexible tube directly into a woman’svagina, cervix, uterus, or fallopian tube. This puts sperm closer to the egg. And it can overcome fertility barriers such as low sperm count and cervical mucus.

Insemination can be used with donor sperm. It can be combined with other fertility treatments, such as clomiphene or hormone shots.

In vitro fertilization (IVF)

IVF involves retrieving mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a laboratory, and implanting the embryos in the uterus three to five days after fertilization.

Electric or vibratory stimulation to achieve ejaculation

Electric or vibratory stimulation brings about ejaculation to obtain semen. This procedure can be used in men with a spinal cord injury who can’t otherwise achieve ejaculation.

Surgical sperm aspiration

This technique involves removing sperm from part of the male reproductive tract, such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if the ejaculatory duct is blocked.

Intracytoplasmic sperm injection (ICSI)

This procedure consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure.

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).

Gamete or Zygote intrafallopian transfer (GIFT or ZIFT)

GIFT is the transfer of eggs and sperm into a fallopian tube through a small incision in the belly.

ZIFT is the in vitro fertilization of an egg. The egg is then transferred to a fallopian tube through a small incision in the belly.

Success rates with IVF are as good as with GIFT and ZIFT or better. And IVF is less expensive. It is also less risky, because it isn’t a surgical procedure.

Complementary and alternative treatments These treatments include: Acupuncture; which may be effective for improving sperm quality and enhancing IVF success rates. Dietary changes. Relaxation techniques. Mind-body medicine. It is important to talk with your doctor before you use any complementary or alternative treatments.