New Trends in Infertility Treatment
Experts describe the latest advances in techniques for treating infertility.
Donor eggs are another option, especially for older women, Ringler says. While many women balk at the idea of using another woman's eggs, "they have to go through their personal journey of acceptance," he says. Their desire to have a baby often wins out over genetics, he says. "If a woman is over age 43, donor eggs are the most realistic [approach]."
Ory agrees. "We have no patient over age 45 successfully using her own eggs," he says of women coming to his Florida clinic.
For infertility due to "male factor" problems, a technique called intracytoplasmic sperm injection (ICSI) has made a dramatic difference, says Shamonki. A single sperm is injected into an egg. "Routine use of ICSI, generally used for male factor infertility, has improved outcomes," he says. Male factor is the sole cause of infertility, he estimates, in about 20% of cases and is a combined cause in up to 40% of infertile couples.
It's important to have a basic and thorough fertilityfertility evaluation before having any treatment, especially aggressive ones, Ringler warns. Otherwise, you could jump into expensive, time-consuming treatments when the problem could have been relatively minor and treatable with less intervention.
As pregnancypregnancy rates have increased, Surrey adds, "we have been able to make significant advances in the number of embryos transferred," reducing the number whenever possible.
Transferring Fewer Embryos
The trend of transferring fewer embryos was reiterated in updated guidelines issued at the 2006 annual meeting of the American Society for Reproductive Medicine (ASRM). Under the revised guidelines, jointly issued by ASRM and SART, it is recommended that no more than two embryos be transferred in women under age 35, and that single-embryo transfer be considered. Previous guidelines recommended one or two in these women. The number recommended for older women varies by age and by how many days past fertilization the embryo is.
For instance, for women over age 40, transfer of no more than five embryos that are two or three days past fertilization are recommended and no more than three that are five or six days past fertilization.
Avoiding multiple pregnancies, ideally, is a goal of infertility treatment, Surrey says, because multiple births boost the chances of preterm labor and deliverylabor and delivery, and that can mean health problems for the infant. "For the patient, the concept of a twin pregnancy is a positive one, but health-wise, there is more risk," Surrey says.
In infertility clinics nationwide, there's a growing willingness to consider -- or in some cases embrace -- alternative or complementary techniques. "We commonly refer patients for complementary therapies, especially when what we are doing is not working," says Ringler.
Among the most frequently tried complementary techniques to achieve pregnancypregnancy are acupuncture and Chinese herbal medicine, but acupuncture is more accepted by traditional reproductive endocrinologists. "There are studies showing acupuncture before embryo transfer may increase the pregnancy rate," Ringler says.