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Obstetrics and Gynecology

Treating Inferility

Infertility is a condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control. Before being treated for infertility, you and your partner must be evaluated by a doctor.

For healthy, young couples having sexual intercourse, the odds are about 20 percent that a woman will become pregnant during any one menstrual cycle. This figure starts to decrease in a woman's late 20s and early 30s and decreases even more after age 35 years. A man's fertility also declines with age, but not as early.

If you are unable to become pregnant after a year of unprotected sex, your doctor can evaluate you and your partner. If you are older than 35 years or have certain medical problems, tests may be done earlier.

To treat infertility, your doctor may suggest medication, surgery, or assisted reproductive technologies or may refer you to a doctor who specializes in treating infertility. In some cases, treatments are combined to improve results. For instance, drugs and insemination may be used at the same time. Whether the problem is with one or both partners, a number of treatment options can be considered.

You should know the expected success rates of the treatment you use and how success is defined.

Ovulation Induction
If the woman does not ovulate (release an egg from one of her ovaries), she may be given medications to cause ovulation. Some women who ovulate need to release more eggs in order to get pregnant.

The medication used most often to cause ovulation is clomiphene citrate.

If pregnancy does not occur after treatment with clomiphene citrate, a medication called hMG may be given by injection. This drug stimulates the eggs to develop. Blood tests and ultrasound often are used to monitor the development of eggs.

A multiple pregnancy may occur with the use of these drugs. The risk is higher with hMG than with clomiphene citrate. Rarely, a condition called ovarian hyperstimulation syndrome may arise.

If the fallopian tubes are blocked, surgery may be done to open or remove them. Surgery also may be done to:

Assisted Reproductive Technologies
Assisted reproductive technologies (ART) involve processing human eggs and sperm or both to help an infertile couple conceive a child. This is done in a lab. Sometimes, ART treatments use donor eggs or donor sperm.

Insemination. With insemination, sperm is placed in a woman's uterus by means other than sex. In most cases, the sperm are treated in a lab to decrease the risk of infections and increase the chance of fertilization.

In Vitro Fertilization. With in vitro fertilization (IVF), sperm from the man are used to fertilize eggs from the woman in a lab. The fertilized egg then is placed in the woman's uterus to grow.

Gamete Intrafallopian Transfer. Gamete intrafallopian transfer (GIFT) is similar to IVF. Like IVF, eggs are removed from the ovaries using a needle and ultrasound guidance. Unlike IVF, eggs are fertilized in the woman's body, not in a lab.

Zygote Intrafallopian Transfer. Zygote intrafallopian transfer (ZIFT) is a combination of IVF and GIFT. With this procedure, the eggs from a woman's ovaries are fertilized in a lab and one or more embryos are placed in the fallopian tubes rather than the uterus.

Intracytoplasmic Sperm Injection. Intracytoplasmic sperm injection (ICSI) is most often done if there is a problem with the man's sperm. Healthy sperm are removed from the man's semen and eggs are retrieved from the woman. The sperm may be obtained through masturbation or using a special condom during intercourse. Sometimes sperm aspiration or testicular biopsy may be used if sperm cannot be obtained through masturbation.

In a lab, one sperm is injected into each egg's center.

Other Choices
You and your partner should give careful thought to all your options. You may want to think about other choices, such as adoption or childfree living. Discuss your feelings with your partner.


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