Infertility can be treated with medicine, surgery, Intra-Uterine Insemination (IUI), or Assisted Reproductive Technology (ART). Many times, these treatments are combined. Doctors recommend specific treatments for infertility based on factors including:
- Factors contributing to the infertility
- Duration of the infertility
- Age of the female
- The couple’s preference after being advised of success rates, risks, and benefits of each option.
Male infertility may be treated with medical, surgical, or assisted reproductive therapies, depending on the underlying cause. Medical and surgical therapies are usually managed by an urologist who specialises in infertility. A reproductive endocrinologist may offer Intra-Uterine Inseminations (IUIs) or In Vitro Fertilisation (IVF) to help overcome male factor infertility.
Some common medicines used to treat infertility in women include:
- Clomiphene citrate (Clomid®*) is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
- Human menopausal gonadotropin or hMG (Repronex®*, Pergonal®*) are medicines often used for women who don’t ovulate because of problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
- Follicle-stimulating hormone or FSH (Gonal-F®*, Follistim®*) are medicines that work much like hMG. They cause the ovaries to begin the process of ovulation. These medicines are usually injected.
- Gonadotropin-releasing hormone (Gn-RH) analog are medicines often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
- Metformin (Glucophage®*) is a medicine doctors use for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
- Bromocriptine (Parlodel®*) is a medicine used for women with ovulation problems because of high levels of prolactin. Prolactin is a hormone that causes milk production.
* Use of trade names and commercial sources is for identification only and does not imply endorsement by the Pillar Healthcare Ltd.
Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple babies have more problems during pregnancy. Multiple babies have a high risk of being born prematurely, and premature babies are at a higher risk of health and developmental problems.
Intra-Uterine Insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
- Mild male factor infertility
- Couples with unexplained infertility.
Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is In Vitro Fertilisation (IVF).
Success rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor, the woman’s age, is especially important.
ART can be expensive and time-consuming, but it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is a multiple foetus pregnancy. This is a problem that can be prevented or minimised by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo, rather than multiple embryos, greatly reduces the chances of a multiple foetus pregnancy and its risks such as pre-term birth.
Common methods of ART include:
- In Vitro Fertilisation (IVF), which literally means ‘fertilisation in glass’. IVF is the most effective and the most common form of ART.
- Zygote Intra-Fallopian Transfer (ZIFT) or tubal embryo transfer. This is similar to IVF. Fertilisation occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
- Gamete Intra-Fallopian Transfer (GIFT), involves transferring eggs and sperm into the woman’s fallopian tube. Fertilisation occurs in the woman’s body. Few practices offer GIFT as an option.
- Intra-Cytoplasmic Sperm Injection (ICSI) is often used for couples with male factor infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg as opposed to “conventional” fertilisation where the egg and sperm are placed in a petri dish together and the sperm fertilises an egg on its own.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her own egg. The child will be genetically related to the surrogate and the male partner.
Meanwhile, women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn’t become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilised by her partner’s sperm and the embryo is placed inside the carrier’s uterus.