Treatment of infertility depends
aff
Treatment of infertility depends on the
cause, how long you've been infertile,
your age and your partner’s age, and
many personal preferences. Some
causes of infertility can't be corrected.
However, a woman can still become
pregnant with assisted reproductive
technology or other procedures to restore
fertility.
Treatment for men
Approaches that involve the male include
treatment for:
General sexual problems. Addressing impotence or premature
ejaculation can improve fertility. Treatment for these problems often
is with medication or behavioral approaches.
Lack of sperm. If a lack of sperm is suspected as the cause of a
man's infertility, surgery or hormones to correct the problem or use of
assisted reproductive technology is sometimes possible. In some
cases, sperm can be taken directly from the testicles or recovered
from the bladder and injected into an egg in the laboratory setting.
Treatment for women
Fertility drugs are the main treatment for
women who are infertile due to ovulation
disorders. These medications regulate or
induce ovulation. In general, they work like
natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) — to trigger ovulation.
Commonly used fertility drugs include:
Clomiphene citrate (Clomid, Serophene). This drug is taken orally and
stimulates ovulation in women who have polycystic ovary syndrome
(PCOS) or other ovulatory disorders. It causes the pituitary gland to
release more FSH and LH, which stimulate the growth of an ovarian
follicle containing an egg.
Human menopausal gonadotropin (Repronex, Menopur). This injected
medication is for women who don't ovulate on their own due to the
failure of the pituitary gland to stimulate ovulation. Unlike clomiphene,
which stimulates the pituitary gland, human menopausal
gonadotropin (hMG) and other gonadotropins directly stimulate the
ovaries. This drug contains both FSH and LH.
Follicle-stimulating hormone (Bravelle). FSH works by stimulating
maturation of egg follicles the ovaries.
Human chorionic gonadotropin (Ovidrel, Pregnyl). Used in
combination with clomiphene, hMG and FSH, human chorionic
gonadotropin (HCG) stimulates the follicle to release its egg (ovulate).
Gonadotropin-releasing hormone analogs. This treatment is for
women with irregular ovulatory cycles or who ovulate prematurely —before the lead follicle is mature enough — during hMG treatment.
Gonadotropin-releasing hormone (Gn-RH) analogs suppress pituitary
gland activity, which alters hormone production so that a doctor can
induce follicle growth with FSH.
Aromatase inhibitors. This class of medications, which includes
letrozole (Femara) and anastrozole (Arimidex), is approved for
treatment of advanced breast cancer. Doctors sometimes prescribe
them for women who don't ovulate on their own and who haven't
responded to treatment with clomiphene citrate. These drugs are not
approved by the Food and Drug Administration for inducing ovulation,
and their effect on early pregnancy isn't yet known.
Metformin (Glucophage). This oral drug is taken to boost ovulation.
It's used when insulin resistance is a known or suspected cause of
infertility. Insulin resistance may play a role in the development of
PCOS.
Bromocriptine (Parlodel). This medication is for women whose
ovulation cycles are irregular due to elevated levels of prolactin, the
hormone that stimulates milk production in new mothers.
Bromocriptine inhibits prolactin production.
Surgery
Depending on the cause, surgery may be a
treatment option for infertility. Blockages or
other problems in the fallopian tubes can
often be surgically repaired. Laparoscopic
techniques allow delicate operations on the
fallopian tubes.
If you have endometriosis, your doctor may
treat you with ovulation therapy, in which
medication is used to stimulate or regulate
ovulation, or in vitro fertilization, in which
the egg and sperm are joined in the
laboratory and transferred to the uterus.
Assisted reproductive technology (ART)
Each year thousands of babies are born in
the United States as a result of ART. An ART
health team includes physicians,
psychologists, embryologists, laboratory
technicians, nurses and allied health
professionals who work together to help
infertile couples achieve pregnancy.
The most common forms of ART include:
In vitro fertilization (IVF). IVF involves retrieving mature eggs from a
woman, fertilizing them with a man's sperm in a dish in a laboratory,
and implanting the embryos in the uterus three to five days after
fertilization.
Electric or vibratory stimulation to achieve ejaculation. Electric or
vibratory stimulation brings about ejaculation to obtain semen. This
procedure can be used in men with a spinal cord injury who can't
otherwise achieve ejaculation.
Surgical sperm aspiration. This technique involves removing sperm
from part of the male reproductive tract, such as the epididymis, vas
deferens or testicle. This allows retrieval of sperm if the ejaculatory
duct is blocked.
Intracytoplasmic sperm injection (ICSI). This procedure consists of a
microscopic technique (micromanipulation) in which a single sperm
is injected directly into an egg to achieve fertilization in conjunction
with the standard IVF procedure.
Assisted hatching. This technique attempts to assist the implantation
of the embryo into the lining of the uterus by opening the outer
covering of the embryo (hatching).
ART works best when the woman has a
healthy uterus, responds well to fertility
drugs, and ovulates naturally or uses donor
eggs. The man should have healthy sperm,
or donor sperm should be available. The
success rate of ART is lower after age 35.
Complications of treatment
Certain complications exist with the
treatment of infertility. These include:
Multiple pregnancy. The most common
complication of ART is a multiple fetus
pregnancy. Generally, the greater the
number of fetuses, the higher the risk of
premature labor. Babies born prematurely
are at increased risk of health and
developmental problems.
The number of quality embryos kept and
matured to fetuses and birth ultimately is a
decision made by the couple. If too many
are conceived, the removal of one or more
fetuses (multifetal pregnancy reduction) is
possible to improve survival odds for the
other fetuses.
Ovarian hyperstimulation syndrome (OHSS). If overstimulated, a
woman's ovaries may enlarge and cause pain and bloating. Mild to
moderate symptoms often resolve without treatment, but severe
cases — marked by abdominal swelling and shortness of breath —require emergency treatment. Younger women and those who have
polycystic ovary syndrome have a higher risk of developing OHSS
than do other women.
Bleeding or infection. As with any invasive procedure, there is a risk of
bleeding or infection with assisted reproductive technology.
Low birth weight. The greatest risk factor for low birth weight is a
multiple fetus pregnancy. In single live births, there may be a greater
chance of low birth weight associated with ART.
Birth defects. There is some concern about the possible relationship
between ART and birth defects. More research is necessary to
confirm this possible connection. Weigh this factor if you're
considering whether to take advantage of this treatment. ART is the
most successful fertility-enhancing therapy to date