However, treating infertility goes beyond fertility treatments. Infertility treatment can also include surgical interventions, lifestyle changes, weight loss, or treatment of an underlying medical condition. Your infertility treatment plan will depend on the cause or causes behind your infertility, whether the problem is from the woman’s side, the man’s side, both sides, or remains unexplained. The good news is that 85 to 90% of couples dealing with infertility are treated with low-tech treatments, like medication or surgery. Less than 5% are treated by assisted reproductive technologies like IVF. Of those who receive fertility treatments, just under half will have a baby.
What Are Your Fertility Drug Options?
Fertility drugs are medications used to stimulate ovulation, but they can also be used to stimulate sperm production in some cases of male infertility. Ovulation disorders account for about 25% of female factor infertility cases. This is the most common reason for fertility drug treatment. That said, fertility drugs may also be used during an IUI cycle and are almost always used during IVF treatment, even if ovulation isn’t necessarily the cause of infertility for the couple. Fertility drugs can stimulate ovulation 80% of the time. (This isn’t the same as pregnancy success or live birth rates.) Common fertility drugs include Clomid, Femara, and gonadotropins.
Clomid (clomiphene citrate): A well-known fertility drug, Clomid is frequently the first drug used in treatment. Primarily, it’s used to treat female infertility, but it can be used to treat male infertility as well. About 40 to 45 percent of couples using Clomid to induce ovulation will get pregnant within six cycles of use. Femara (letrozole) and Arimidex (anastrozole): These medications may also be used to induce ovulation in women with ovulatory disorders, even though they aren’t “fertility drugs” officially. Studies have shown similar success rates as with Clomid, though some studies found a possible link between Femara and an increased risk of birth defects. Gonadotropins, including LH, FSH, and hCG: Gonadotropins include FSH, LH, or a combination of the two. Gonal-F and Follistim are likely the most well-known gonadotropins. They both contain the hormone FSH. hCG (human chorionic gonadotropin) may also be used, as it mimics LH in the body. These hormonal medications are typically used when clomiphene citrate fails, or if the pituitary gland can not create LH and FSH on its own. They may also be used during IVF cycles.
Other Medication Options
Ovulation stimulation may not be the only goal of infertility treatment. Sometimes, your doctor may want to suppress your body’s natural reproductive system. Or, your doctor may want to support the luteal phase of your cycle. (That’s the time after ovulation but before your period is due.) Other medications used to treat infertility may include:
Baby aspirin or injectable heparin (for blood clotting disorders, which can lead to recurrent miscarriage) Birth control pills (may be used before a treatment cycle, for a variety of reasons) Dopamine agonists, like bromocriptine (to treat hyperprolactinemia) GnRH agonists or GnRH antagonists (to suppress the reproductive system during IVF) Metformin (sometimes used during PCOS treatment, alone or along with fertility drugs) Progesterone (for luteal phase support)
Insemination or IUI Treatment
Intrauterine insemination, once known as artificial insemination, is a procedure that involves placing specially washed sperm directly into the uterus. This treatment may be used in some cases of male factor infertility, if there’s a problem with the woman’s cervical mucus, or in cases of unexplained infertility. IUI may also be used for donor sperm. The success rate of IUI is not very high —with one study showing 4 percent of women achieving pregnancy with a non-fertility drug cycle, and 8 to 17 percent success for IUI cycles that use fertility drugs to produce more, high quality eggs. The advantage of IUI is the cost, which is much lower than IVF. IUI isn’t the only form of artificial insemination, though it is the most common. Other reasons for using insemination include painful sex (that prevents having intercourse to have a baby) or lesbian couples who want to have a baby with donor sperm.
Surgical Fertility Treatments
In 35 percent of female infertility cases, problems are found with the fallopian tubes or problems with the lining of the pelvis and abdomen. Usually, this problem is diagnosed through a test called an HSG, or hysterosalpingogram. If the HSG shows possible blockage of the tubes, the doctor may perform laparoscopic surgery to evaluate the situation, and possibly repair the problem. If infection is present, treatment may require surgery and antibiotics. Sometimes, blockage or scarring is not repairable. In this case, IVF may be recommended. Another possible surgical treatment option is surgical hysteroscopy. This may be used in the case of adhesions inside the uterine cavity itself. Ovarian drilling is a possible surgical infertility treatment for PCOS-related infertility. Because of the risks involved, and the higher success rates of other treatments, it’s not used frequently. For women with endometriosis, laparoscopy may be used to remove endometrial deposits. This is more likely to be recommended in women having severe menstrual cramps or pelvic pain, and less likely to be used for infertility treatment alone. Laparoscopy may also be recommended if uterine fibroids are interfering with fertility. A new technology being tested and developed right now is uterine transplant. This would allow some women who would have had to use a surrogate to conceive to use their own body and a transplanted uterus. Uterine transplant is not available except through research studies right now. Some cases of male infertility may require surgery. For example, varicoceles is a common cause of male infertility and sometimes calls for surgical treatment. If sperm counts are very low or even zero, it may be possible to remove young sperm cells directly form the testes. These sperm are then matured in the lab and used for IVF with ICSI. Vasectomy reversal and tubal ligation reversal are also surgical infertility options.
Assisted Reproductive Technologies
Assisted reproductive technologies (ART) refer to fertility treatments that involve the handling of eggs or embryos. This includes IVF, GIFT, and ZIFT. IVF is the most common form of ART in use today. Less than 2 percent of ART procedures are GIFT, and ZIFT is used less than 1.5 percent of the time. In a typical IVF procedure, fertility drugs are used to stimulate the ovaries to produce eggs. Assuming all goes well at this stage, those eggs are then retrieved from the woman’s ovaries in an out-patient procedure. Next, the eggs are placed together with sperm, in a special cocktail of nutrients, and left alone until fertilization takes place. After fertilization, one to three embryos are placed inside the woman’s uterus. This is a very basic explanation of IVF treatment. There are many additional assisted technologies that may be used with IVF, including:
Assisted hatching Cryopreservation (freezing) of eggs, sperm, or embryos Intracytoplasmic Sperm Injection (ICSI) Pre-implantation genetic diagnosis (PGD) (also known as pre-implantation genetic screening, or PGS)
Third-party reproduction (more on this below)An option you may not know about is mini-IVF. The primary difference between IVF and mini-IVF is that fewer medications are used. The goal is to stimulate the ovaries only enough to get a few eggs and not several. Mini-IVF is less expensive than full IVF but slightly more expensive than IUI treatment. It may be more successful than IUI, and it comes with a lower risk of ovarian hyperstimulation syndrome. With GIFT (gamete intrafallopian transfer), the egg and sperm, or gametes, are not fertilized outside the body. Instead, they are placed together into one of the woman’s fallopian tubes. With ZIFT (zygote intrafallopian transfer), the zygote is placed in one of the fallopian tubes. This is usually done via laparoscopic surgery.
Surrogacy and Third-Party Gamete Donation
Sometimes, IVF alone isn’t enough. Some couples need to use another person’s eggs, sperm, embryos, or uterus in order to build their family. An egg donor may be recommended in cases of low ovarian reserves, primary ovarian insufficiency, or repeated unexplained IVF failure. An egg donor may also be used for a gay male couple, along with a surrogate. A sperm donor may be used in some cases of severe male infertility or if a single woman or lesbian couple wants to have a child. A sperm donor may be used during IUI or IVF treatment. An embryo donor may be used for any of the same reasons you might use an egg or sperm donor. Embryo donation IVF is less expensive than using an egg donor or going through conventional IVF with your own eggs. Whether you’re in need of an egg, embryo, or sperm donor, you may use a known-donor (a friend or relative), or find a donor through a fertility clinic or agency. (Never attempt to hire a donor through a web forum or social media posting. There are many scammers out there.) Hiring an attorney who specializes in fertility and family law is essential. Surrogacy is when a woman carries a pregnancy for a couple. This may be needed if a woman doesn’t have a uterus or has uterine problems that prevent carrying a healthy pregnancy. It is also used for unexplained repeated IVF failure. Gay male couples may use a surrogate to have a child as well. Depending on the kind of surrogacy, the biological parents may be the infertile couple, or an egg, sperm, or embryo donor may be used. Traditional surrogacy is when the surrogate is the biological mother. A sperm donor or the intended father may be the biological father. However, because of potential legal problems, this kind of surrogacy is usually discouraged.
Finding the Right Doctor
Your gynecologist is usually the first doctor you’ll see if you’re struggling to conceive, and she may also be willing to prescribe basic fertility treatments. For example, many women are treated with Clomid by their OB/GYN. However, more involved fertility cases require expertise. A reproductive endocrinologist (RE) is a fertility specialist. Reproductive endocrinologists work with both male and female infertility. They usually work in a fertility clinic, along with other fertility doctors, nurses, and technicians. Not every fertility clinic is equal. Before you choose a doctor, be sure they are the best choice for you. Other fertility specialists include andrologists, reproductive immunologist, and reproductive surgeon
Treating Underlying Diseases
No discussion about fertility treatment is complete without discussing treatment of underlying disorders and lifestyle changes to improve fertility. If an underlying medical issue is ignored, fertility treatment may be significantly less likely to be successful. For example, untreated diabetes, celiac disease, and thyroid imbalances can cause infertility. In some cases, treating these diseases will be enough to return natural fertility. Obesity is one of the most common causes of preventable infertility. Research has found that a 10 percent weight loss may be enough to restart regular ovulation in some women. Lifestyle choices and diet can also impact fertility. Some couples may choose to pursue alternative or natural fertility treatments alongside fertility treatments, or they may decide to only go with a natural approach. Success rates vary considerably. The vast majority of infertile couples will need fertility treatments in addition to any lifestyle changes or alternate therapies.
Risks and Side Effects
Risks and side effects vary depending on what fertility treatment is being used. Clearly, surgical fertility treatments will have different risks than Clomid. The most common side effects from fertility drugs include headache, bloating, and mood swings. In rare cases, side effects can be life threatening. Ovarian hyperstimulation syndrome (OHSS) is a risk with any fertility drug use. When mild, OHSS can lead to bloating and discomfort. In its severe form, if left untreated, OHSS can become life threatening. Serious OHSS when taking Clomid is rare, but 10 percent of women will develop it during IVF treatment. If you have any symptoms, contact your doctor. While your risk of conceiving twins on Clomid is around 10 percent, your odds for twins (or more!) with injectable fertility drugs are closer to 30 percent. Multiple pregnancy comes with many risks to both the mother and baby. IUI treatment comes with an increased risk of infection and ectopic pregnancy. Along with the risk of OHSS and multiples, IVF treatment risks include possible infection, ectopic pregnancy, bleeding, puncture to the bladder, bowel, or other surrounding organs; and premature delivery (even if you’re not carrying twins.) There are also risks from the anesthesia used during egg retrieval. IVF treatment may increase the risk of some birth defects, though this is debatable. It’s unclear if the risk is increased because of treatment or due to infertility itself. IVF with ICSI (which is when a sperm cell is directly injected into an egg) may increase the odds of a male child also being infertile. Some worry that fertility treatments increase your risk for cancer. According to the latest research, fertility treatments are mostly in the clear. However, infertility itself and never carrying a pregnancy or breastfeeding can increase your cancer risks.
Success Rates
Success rates depend on what treatment is being used, the cause for your infertility, how long you’ve experienced infertility, and your age. For example, a woman with PCOS being treated with Clomid at age 23 doesn’t have the same live birth success rate as a 42-year-old woman with low ovarian reserves. Be sure to discuss with your doctor their experience with cases like yours, and what he thinks your odds for successful treatment are. IVF treatment is often thought of as foolproof, but this isn’t true. IVF is not successful for everyone. Most couples will require a few cycles of IVF treatment to achieve pregnancy. One large study found that the odds for pregnancy success after three cycles are between 34 and 42 percent.
What if Fertility Treatment Fails?
There is so much hope when you begin a fertility treatment cycle. Everyone wishes for the first treatment cycle to be “the one.” Unfortunately, it doesn’t always work that way. In fact, it’s unlikely to happen that way. Remember that even couples with perfect fertility are unlikely to get pregnant on the very first month they try. If one cycle fails, don’t assume this means your future is bleak. Your doctor should discuss with you what the next step is after a negative pregnancy test. Some people assume if the first basic treatments fail, IVF is next. However, there are many variations and “levels” of fertility treatment before IVF is the next step. That said, for some couples, IVF is the first recommended treatment. What happens if you don’t conceive after many cycles of treatment? Some couples will choose to continue trying on their own. (This may or may not be possible, depending on the cause for infertility. But a small percentage of couples will get pregnant on their own even after infertility.) You have more options for building your family or making an impact in a child’s life. Other options include:
Adoption Being an awesome auntie or uncle to your family or friend’s children Foster parenting Living a childfree life
Paying for Fertility Treatments
How much you pay for fertility testing and treatment will depend on where you live, what kind of insurance you have, and what fertility specialists and clinics are available in your area. Most insurance companies in the United States of America cover basic fertility testing. They may or may not pay for fertility treatments. Coverage varies greatly, with some who can’t even get Clomid covered to others who have partial IVF treatment coverage. It’s also important to point out the cost of treatment will vary depending on what you need. Clomid may cost as little as $50 per cycle, while a cycle of injectable fertility drugs may be several hundred to a couple thousand dollars. On the other hand, the average IVF treatment is around $12,000. It can cost significantly more if you need more than basic IVF. How can you know if you have fertility treatment coverage? You should:
Look at RESOLVE’s state-by-state guide to find out what the law requires to be covered. Read your insurance policy very carefully. Call your insurance company and ask questions. Talk to the HR department of your company. (If your insurance coverage doesn’t include fertility treatments, you ask HR to consider adding that benefit.) Insurance isn’t your only option. You may also be able to get discounts, apply for grants, raise money through crowdfunding, and borrow money to pay for treatments
Coping With the Stress of Treatments
The fertility treatment process can be very stressful. If you’re feeling anxious and overwhelmed, you’re far from alone. Please reach out for support and take extra special care of yourself during this time. Support groups, counseling, and friends and family (even if they have no experience with infertility) can be a source of strength when you’re struggling. You may also find support online, on social media or in the fertility blogging community. Also, know it’s OK to take a break. While time can be a factor in some situations, ask your doctor before you assume you must keep pushing through.
A Word From Verywell
We want to encourage you to advocate for yourself. Ask questions, request more time to think through your options if you need more time, and make sure you understand the risks and success rates for any proposed treatment. Always be sure you understand your financial responsibilities before you sign on the dotted line, and don’t hesitate to consult with a reproductive lawyer or speak to a fertility counselor, especially when considering treatments like gamete donation or surrogacy. Remember, too, that it’s your right to switch doctors or get a second opinion, if that’s what feels right for you. (Note that some IVF refund programs don’t allow you to switch doctors until you complete the agreed-upon cycles. This is one reason to be sure you completely understand whatever you’re signing.) This part of your life will not last forever. There will be a time when fertility treatments are behind you. Whether or not you have a child from treatments, you will—with time—be able to move on and live a full, joyful life.
