Fertility Factors and Basic Treatments
Review basic fertility treatments and what to consider when choosing one.
Problems with fertility are not uncommon. Around one in ten U.S. women has difficulty becoming or staying pregnant.
And infertility is not “just a woman’s problem”. Among heterosexual couples who experience it, 30 percent of the time, the issue lies with the male.
Factors that contribute to infertility
Many medical conditions may contribute to fertility problems. One of the most common is disrupted ovulation. That’s when no mature egg is being released into the uterus during the menstrual cycle. Without ovulation, no eggs can be released for fertilization. A quarter of women experiencing fertility problems face this issue.
Ovulation disruption can be caused by a number of things: age, low body weight, and premature ovarian insufficiency - sometimes called premature menopause - are just some of these factors.
Hormonal imbalances can also cause fertility issues. Thyroid disease, pituitary tumors, elevation of a hormone called prolactin, and poorly controlled diabetes can also hinder or halt regular ovulation.
If you have or suspect you have a hormonal issue, don’t hesitate to talk to your doctor about it. Depending on the situation, they may recommend medication and/or lifestyle changes.
If your doctors thinks the problem could be anatomical – something related to the structure of your body, like a blocked fallopian tube - a procedure called a laparoscopy may help determine the cause of infertility. This surgery – in which a thin tube with a small video camera on it is inserted into the abdomen - may include an examination of the outside or inside of the uterus, the fallopian tubes and the ovaries. If a woman has a disorder such as endometriosis or blockage of the fallopian tubes, surgical correction may be an option for those unwilling or unable to pursue In Vitro Fertilization (IVF). In terms of success rates and time to pregnancy, IVF is usually the better treatment option.
Basic fertility treatments
There are many types of treatments for infertility. Your reproductive endocrinologist, who is a fertility specialist, may start with a basic treatment, before moving to a more advanced one.
Ovulation induction, a process where a woman who has not been ovulating takes medications to help release eggs, which may improve the chances of becoming pregnant. Depending on the situation and the person taking them, medications may produce a single egg.
The term “ovulation induction” is sometimes used interchangeably with the term “ovarian stimulation”. But they can mean different things. While both refer to the use of medication to help release eggs, ovarian stimulation is the term used to describe the process when ovulation function is normal. Ovulation induction refers to situations where there is an ovulation disorder.
Common oral medications include Clomid and Femara (Letrozole). Injectable fertility drugs called gonadotropins may also be used. Gonadotropins contain follicle-stimulating hormone (FSH) or luteinizing hormone (LH) alone or together. These include Follistim, Gonal F and Menopur.
Make sure to talk with your doctor about the risks and benefits of taking medication, as they can increase the chances that you will give birth to multiples especially when gonadotropins are used. *Risks of multiples include miscarriage, placenta problems, pre-term delivery and other complications for mother and baby.
Intrauterine insemination (IUI)
This fertility treatment involves placing sperm into a woman’s uterus. The goal is to increase the amount of sperm that reaches the fallopian tubes, and in so doing, increase the chances of fertilization. IUI is often used to treat mild to moderate low sperm count or unexplained infertility. This treatment is less invasive and less expensive than IVF. However, it’s generally not as successful. Success rates depend on the underlying cause of infertility, though they may be as high as 20 percent per cycle over several cycles.
What to expect with IUI
IUI is performed around the time a woman is ovulating.
In the days leading up to the procedure, ultrasounds may be performed to monitor the development of the eggs. A woman may also choose to use a home ovulation predictor kit to monitor ovulation.
Before placing the semen in a woman’s body, it is collected and “washed” – filtered to separate the healthy sperm from the other fluids in semen to increase the odds of fertilization. This part of the process takes around two hours.
When the sperm is ready, a tube is inserted through the woman’s cervix into her uterus, where the sperm is then injected. This takes a few minutes and usually does not cause much discomfort. However, some women experience mild cramping afterward.
In general, the woman will be asked to come back for a pregnancy test two weeks following the procedure.
*See the Fertility Treatment and Multiples Risk article for a more indepth discussion of multiples risk for mother and baby.
By Kristin Nelson, Contributing Writer
Centers of Disease Control and Prevention. Infertility FAQs. Accessed October 26, 2020.
National Institutes of Health. What are some possible causes of female infertility? Accessed October 26, 2020.
American Society of Reproductive Medicine. Infertility: An Overview. Accessed October 26, 2020.
US Department of Health and Human Services, Office on Women’s Health. Infertility. Accessed October 26, 2020.
Last Updated: November 11, 2020