Fertility Problems

Before you and your partner start treatment for infertility, talk about how far you want to go. For example, you may want to try medication but do not want to have surgery. While you may rethink this end point during your treatment, it’s a good idea to have an idea where you want to draw the line. Many couples do not think about this in the beginning and become emotionally and financially drained from trying a series of treatments.

Treatment for fertility can also be quite expensive, and insurance often does not cover these expenses. If cost is a concern for you, find out how much medications and procedures cost and if your insurance covers any costs. Talk with your partner about what you can afford.

Keep in mind that some infertility problems are more easily treated than others. In general, as a women ages, especially after 35, her chances of getting pregnant decrease and her risk of miscarriage markedly increases.

If you are 35 or older, your doctor may recommend that you skip some of the steps younger couples usually take because your chances of having a baby decrease with each passing year.

Also, understand that even if you are able to get pregnant, no treatment can guarantee a healthy baby. On the other hand, scientists in this field have made many advances that have helped millions of couples have babies.

Your doctor will first try to find why you have not been able to get pregnant. He or she will do tests to see where the problem lies. Sometimes doctors do not find a problem with either the man or the woman and don't know why a woman cannot get pregnant.

Treatment for female infertility

Problems with ovulating. If your doctor finds that you have a problem with ovulating, he or she may first recommend that you try the medication clomiphene (Clomid, Serophene, Milophene). This medicine (which you take as a pill) stimulates your ovaries to release eggs, thereby improving your chances of getting pregnant. It is often tried first because it is considered safe and effective.

Clomiphene has more side effects than hormonal shots, such as Pregnyl and Profasi, but clomiphene costs less, has a lower risk of ovarian hyper stimulation syndrome, and is less likely to result in a pregnancy with more than one baby.

If you're not ovulating because of a condition called polytheistic ovary syndrome (PCOS), your doctor might suggest you take a drug called metformin in combination with clomiphene. For more information, see treatment of women with polytheistic ovary syndrome (PCOS).

Unfortunately, clomiphene does not always work. Typically, hormone shots are the next medication tried. You and your partner can weigh the risks and benefits of proceeding to this next step. You start the first series of daily shots at the beginning of your menstrual cycle. You will probably have mild side effects, such as feeling sick to your stomach and bloating. Some women have more serious side effects due to multiple, large ovarian cysts (ovarian hyper stimulation syndrome). While clomiphene increases your chance of having twins or triplets (especially twins), women who take hormonal injections are even more likely to have twins, triplets, or more babies.

Unexplained infertility. If your doctor cannot find out why you and your partner have not been able to get pregnant, he or she may start out by giving you clomiphene. The steps for treating infertility are essentially the same as for women who have ovulation problems. The next step is to try hormone injections. However, at this step your doctor may recommend insemination, putting the sperm directly into the uterus, to improve your chances of getting pregnant. If these treatments don't work, your next step is deciding whether to have IVF (in vitro fertilization).

Blocked or damaged tubes. Your doctor may do tests to check your fallopian tubes. Blocked or damaged tubes can prevent the egg from being fertilized by the sperm. If the blockage of your tubes is slight, your doctor might recommend tubal surgery to try to correct the damage. In these cases, between 20% and 60% of women have successful pregnancies after the surgery, depending on what part of the tube was blocked.6 However, in many cases, doctors recommend skipping tubal surgery and having IVF for more severe blockages. IVF is also often recommended first for women over 34 (regardless of the type of blockage) because tubal surgery and natural conception may use up precious time if in vitro fertilization might be used later.

* Should I have a tubal procedure or in vitro fertilization for tubal infertility?

Endomorphisms. If you have mild to moderate endomorphisms that seems to be the main reason for your infertility, your doctor may use laparoscopic surgery to remove geometrical tissue growth. If surgery does not work, or if you have severe endometriosis, you will need to decide whether to try in vitro fertilization, commonly called IVF. However, understand that IVF doesn't work as well for women with endometriosis as with other causes of infertility.

For more information about endomorphisms, see the topic Endomorphisms.

In vitro fertilization (IVF). Many couples who have problems getting pregnant arrive at a common point: They must decide whether they want to try IVF. IVF is the most common form of a group of similar procedures called assisted reproductive technology, or ART. If you have not already considered adoption, this might be a time to think about it. Some couples decide to spend their resources on adoption instead of IVF at this point. Other couples see IVF as the best option. Of course, this is a decision that takes a lot of soul searching.