It’s a myth that relaxing or “giving it time” will overcome infertility. Fertility problems are medical in nature and can often be treated. Worldwide, more than 3 million babies have been born through in vitro fertilization (IVF). Other treatments are successful, too. At least half of couples who seek help will get pregnant.
Most couples should visit a doctor after a year of trying to conceive. This is the main red flag. If a woman is over 35 or has an irregular menstrual cycle, and has been trying for 6 months, it’s best to see a doctor as soon as possible. Her partner should, too.
The most common problems for women’s fertility include:
In some cases, timing is the main challenge. You can use at-home ovulation tests to predict the best time for sex. They spot a rise in hormones before the ovaries release an egg. You may need to take the test again over several days. These tests are not the same as those your doctor gives you.
If your doctor finds you don’t ovulate normally, medication can help. The most common choice is clomiphene. About half of women who take it will get pregnant, usually within three cycles. Be aware that you are more likely to get pregnant with twins (or more!) because it makes the ovaries release more than one egg at a time.
If you don’t get pregnant after taking clomiphene for 3 to 6 months, your doctor may recommend fertility hormone shots to encourage ovulation. A wide range of these drugs is available, and they work well. About half of women who ovulate get pregnant taking them. These medications can also make you more likely to carry twins or more.
In some women, scars prevent eggs from traveling down the fallopian tubes. It can happen if you have endometriosis (the overgrowth of tissue that lines the uterus, growing in areas it should not) or if you have had pelvic infections or surgeries in the past. Doctors can attempt take out that scar tissue with surgery, which could boost your odds of having a baby.
Intrauterine insemination (IUI) is a popular procedure for many fertility problems. Doctors place the man’s sperm into the woman’s uterus, but not into the egg itself, while she ovulates. You may also need to take drugs to prompt your body to ovulate. IUI is less expensive and simpler than IVF (in vitro fertilization), but pregnancy rates are much lower.
Fertile women can choose IUI using sperm from a donor. It may take several tries, but pregnancy rates are over 80%. You and your partner may want to see a counselor first, to make sure you’re both ready to raise a child who is not biologically related to the father.
This option offers hope when other infertility treatments don’t work. It directly combines the egg and sperm in a lab. Doctors then place the growing embryos in the uterus. IVF can be unpleasant and expensive, with an average cycle costing $12,400. In 2012, pregnancy rates per IVF cycle ranged from 10% for women ages 43-44 to 47% for women under 35.
Doctors can inject the sperm directly into the egg in a lab. This technique, called “ICSI” (intracytoplasmic sperm injection), helps when a man’s sperm count is very low or his sperm don’t move well. When the fertilized egg is ready, it goes into the woman’s uterus through the normal IVF process.
Women who are over 40, have poor egg quality, or have not had success with previous cycles may consider an egg donor. This involves combining the man’s sperm with another woman’s donated eggs. If the procedure works, the woman becomes pregnant with a child who is biologically related to her partner but not herself.
To boost the odds of success, it’s common to transfer two to four embryos at a time. But this means the woman may get pregnant with twins, triplets, or even quadruplets. Carrying multiples raises the risk of miscarriage, anemia, high blood pressure, and other complications during pregnancy. It also makes premature birth more likely. Talk about this with your doctor.
In standard IVF, doctors transfer embryos to the womb when they reach the two- to eight-cell stage. But in this procedure, the embryos grow for 5 days first. Doctors call them “blastocysts” at that stage, and they choose the healthiest one or two to move to the woman’s uterus. This removes the possibility of triplets and still keeps a high success rate.
If you have not had success with IVF or want for a less expensive option, you might consider using donor embryos. These come from couples who have finished the process. The transfer costs less than standard or donor egg IVF. If successful, the woman will get pregnant, though the baby will not be biologically related to her or her partner.
When a woman cannot carry her own pregnancy to term, some work with another woman who agrees to be a gestational surrogate. Specialists use IVF to make embryos with a woman’s eggs and her partner’s sperm. The surrogate is the one who goes through the pregnancy after IVF. But her DNA is not involved. The baby will be the biological child of both husband and wife.
Ask plenty of questions about their procedures and costs. Make sure they offer the latest technologies and involve patients in decisions. The CDC keeps a database of IVF success rates for U.S. clinics. But don’t make up your mind based on numbers alone. Infertility treatment is a long-term process, and you want to feel comfortable with your choice.
A few lifestyle changes can make a difference. If you smoke, quit. Smoking lowers fertility for men and women and dims pregnancy rates. In one study, men who stopped smoking saw their sperm counts climb 800%. Also, check your diet. Is it as healthy as possible? Ask your doctor about supplements. Some vitamins and minerals may improve the odds.
It has shown promise for many conditions. Now, some couples are trying this popular form of traditional Chinese medicine to address infertility. Research suggests it may improve sperm quality and blood flow to the uterus, help smooth out irregular ovulation, and boost IVF success rates.
If treatments become too heavy of a burden -- physically, emotionally, or financially -- it may be time to consider alternatives. An infertility counselor can help you and your partner explore the options. Many couples find satisfaction living without children. Others choose to build their family through adoption. Costs range from nearly nothing, if you go the foster care route, to as much as $40,000 for a private one.
Reviewed by Nivin Todd, MD on April 21, 2015
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