Treatments for infertility

A treatment for infertility will depend on many factors, such as: the cause, the duration of the problem, the age of the partners and any specific wishes. Some of the causes of infertility cannot be treated. For some cases, there are alternative means of insemination that give a woman the possibility to remain pregnant.

The psychological effects must be recognized and discussed by both the partners and sometimes even a specialist's opinion is required.

New treatments can bring hope into some couples life. There are support groups that can help couples regain comfort and strength.

Non – surgical treatments for fertility are divided in 2 categories:

• - Restoring or bringing fertility
• - Assisted reproductive technology (ART)

Restoring or bringing fertility

For this, both men and women will have to make some steps.

The chances of getting pregnant increase with the frequency of sexual intercourse. The egg can survive up to 24 hours after ovulation and the sperm up to 3 days in the reproductive tract of a woman.

What a man has to do is:

Medication and behavioral therapies used to cure impotence and premature ejaculation will help improving the fertility.

Improving the quality of the sperm or fixing the problems that cause its lack often improves fertility. There are cases that need surgical intervention like varicocele to restore fertility. If the problem is caused by the sperm producing areas of the testicles, a drug treatment is recommended, though it has little benefit. Treatments with gonadotropins, the pituitary hormone, will help restoring fertility if the problem is caused by the pituitary gland. If the problem is an infection, than both partners have to take treatment. Problems with the testicles, prostate gland, seminal vesicle and urethra also can be treated.

The ovulation can be induced by fertility drugs

If a woman has ovulation disorders affecting her capacity of conceiving, the first recommended treatment is represented by fertility drugs, which tend to regulate or induce ovulation. Those drugs are designed to replace the effects of the natural FSH, follicle – stimulating hormone and LH, luteinizing hormone. Here are the most commonly used fertility drugs:

• - Clomiphene citrate (Clomid, Serophene). This medication stimulates ovulation in women with PCOS or other ovulation disorders. The pituitary gland releases more FSH and LH which stimulates the growth of an ovarian follicle that contains an egg.
• - HMG, human menopausal gonadotropins (Repronex, Pergonal) is a medication is for women with menstrual problems cause by the failure of the pituitary gland to stimulate ovulation. HMG and other gonadotropins stimulate directly the ovaries and not the pituitary gland like in the case of clomiphene, yet, this drug contains FSH and LH.
• - FSH (Gonal-F, Follistim, Bravelle) works by stimulating the ovaries. Basically, FSH is HMG without LH.
• - HCG, human chorionic gonadotropins, together with clomiphene, HMG and FSH stimulates the follicle to release the egg, process called ovulation.
• - Gn – RH, gonadotropins – releasing hormones is a treatment for women encountering irregular menstruation cycles or premature ovulation during HMG treatment. Gn-RH analogs deliver constant Gn-RH to the pituitary gland, which alters hormone production so the doctor can induce follicle growth using FSH.
• - Metformin (Glucophage). Is an oral medication taken to boost ovulation. It is used in cases of insulin resistance.
• - Bromocriptine is a medication that inhibits prolactin, the hormone responsible for milk production in new mothers and has effect on menstrual cycles, regulating them.
• - Letrozole (Femara) is a drug from the class of aromatase inhibitors, which are used for treatment of advanced breast cancer. Although the U.S. Food and Drugs Administration doesn't recognize his effect on ovulation and despite the manufacturer's warning to the doctors about the possible negative effects like miscarriage or birth defects, few doctors prescribe this medication to some women who can't ovulate on their own or who had no response to the clomiphene citrate.

The injectable fertility drugs increase the chances of multiple births. For this kind of treatments, the closely monitoring, blood tests for hormones levels and follicle size measurement through ultrasound, is required. Normally, the greater the number of fetuses is, the higher the risk of premature labor. Premature born children face an increased risk of health and developmental issues. Just as for triplets or twins.

Usually, couples concerning about having a child override the possibility of multiple pregnancy caused by those hormones shots. The possibility of multiple pregnancies can be reduced by withholding the HCG injection if the ultrasound examination shows that too many follicles have developed.

Before starting a fertility drugs treatment it is very important to discuss with the partner and the doctor the chance of multiple pregnancy and the possibility of multifetal pregnancy reduction because this technique can be very challenging and may create emotional problems to many couples.

Although it hasn't been confirmed, there is a slight possibility that between fertility drugs treatments and the increased risk for ovarian cancer there is a link.

Surgery

Some problems causing infertility, like blockages or scar tissues in the fallopian tubes can be treated surgically using laparoscopy.

If endometriosis is the cause for the infertility, it is harder to treat. Using ovulation therapy, the doctor will concern on the regulation of your ovulation and in vitro fertilization may be an option because though the hormones like those found in the birth control pills don not have the same effect on fertility as they do on the ovulation.

ART assisted reproductive technology

ART has changed the optics on fertility treatment. Every year, this technology helps thousands of couples procreate. Physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals work together to help infertile couples achieve pregnancy.

ART methods:

• - IVF, in vitro fertilization consists in retrieving eggs from the future mother, fertilizing them with the father's sperm in the laboratory and 3-5 days later planting the embryo in the uterus. This is the most effective technique of ART and it is often chosen the first to use on couples that encounter fertility problems caused by fallopian tubs blockages, endometriosis, unexplained infertility, cervical factor infertility, male factor infertility and ovulation disorders.
• - Electroejaculation helps obtaining semen by stimulating ejaculation with electric impulses. This procedure can help men who are not able to ejaculate due to spinal cord injury.
• - Surgical sperm aspiration technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm in case of blockages.
• - ICSI (intracytoplasmic sperm injection) technique is used especially in couples who have previously failed to achieve pregnancy using standard techniques. A single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. This is called micromanipulation. ICSI is a very good technique for improving fertility in men with low sperm concentrations.
• - Assisted hatching technique helps the implant of an embryo in the lining of the uterus.

ART, though very efficient when the eggs are naturally ovulated or healthy from a donor and when the sperm is healthy or, as in the case of egg, comes from a donor, gradually diminishes after the age of 32.

Treatment complications

In case of infertility treatment, it is likely that sometimes complications may appear:

• - The case of multiple pregnancy, one of the most common complication of ART. The direct cause is actually not the ART technique that has been used, but the decision of the future parents to keep all the fetuses even if they are septuplets or octuplets instead of choosing multifetal pregnancy reduction for improving the chances of survival and better evolution for the other fetuses.
• - OHSS, ovarian hyperstimulation syndrome produces ovary enlargements causing pain and bloating. If the symptoms are mild they disappear naturally, yet, in case of pregnancy, the recovery may be slower. In some cases, abdominal swelling and shortness of breath may appear as a symptom of fluid accumulation in the abdominal cavity and chest causing low blood pressure and deplete blood volume. Severe cases need emergency treatment. The risk of OHSS is increased in younger women an in those with polycystic ovary syndrome.
• - Birth defects. More research is needed to establish whether there really is a connection between ART and birth defects. Though ART is the most commonly used technique for improving fertility, it is recommended to asses the benefits and the possible negative effects before taking a decision.
• - The main cause for low birth weight is the multiple pregnancy. Yet, in case of a singular pregnancy, the low birth weight is associated to ART.
• - There is a risk of bleeding and infection as in any invasive procedure.

• Infertility Overview
• Male Infertility
• Women Infertility
• Infertility Causes
• Infertility Symptoms
• Infertility Prevention
• Infertility Treatment
• Dealing with Infertility
• Infertility Articles