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Infertility Factors and Basic Treatments

Review basic infertility treatments and what to consider when choosing one.

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Numerous medical conditions may contribute to fertility problems. Thyroid disease, pituitary tumors, elevation of a hormone (called prolactin) and poorly controlled diabetes may result in menstrual abnormalities and lead to problems getting pregnant.

Hormonal imbalances can also cause fertility issues. These imbalances can hinder regular ovulation, or ovulation altogether. About 25 percent of women with fertility problems have issues with ovulation. Without ovulation, no eggs can be released for fertilization. Depending on the type of hormone issue, a specialist may recommend medication  and/or lifestyle changes.

If an anatomical issue is suspected, laparoscopy may help determine the cause of infertility. This 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 infertility treatments

There are many types of treatments for families who have issues with fertility. Your reproductive endocrinologist, who is a board certified fertility specialist, may start with a basic treatment, before moving to a more advanced treatment.

Ovulation induction

Ovulation induction uses medications to help release eggs, which may improve a woman’s chances of becoming pregnant. Medications may produce a single egg for treatments such as intrauterine insemination (IUI) or multiple eggs for assisted reproductive technology (ART).

Common oral medications include Clomid, Serophene and Femara (Letrozole). Gonadotropins are injectables that contain follicle-stimulating hormone (FSH) or luteinizing hormone (LH) alone or together; these include Follistim, Gonal F, Menopur and Repronex.

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. *Risks of multiples include miscarriage, placenta problems, preterm 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 to increase the chances of fertilization. It 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. However, generally pregnancy rates for IUI are from 8 to 22 percent per cycle.

What to expect with IUI

IUI can be performed with or without medication. If a woman has irregular ovulations, she may take medications to induce ovulation in conjunction with IUI. To monitor the development of the eggs, ultrasounds and blood tests may be performed. Ultrasounds may be used to check the thickness of the uterus, as well. To monitor ovulation, a woman may also choose to use a home ovulation predictor kit.

Sometimes gonadotropins (or injectables) are given while a woman is taking an ovulation medication. However, many fertility specialists do not recommend using gonadotropins with IUI, as up to 30 percent of pregnancies are associated with a higher order of multiple gestations (beyond twins). With natural pregnancies, the risk of multiple gestations is 1 to 2 percent. As always, talk to your fertility specialist about what type of medication may be right for you.

Around the time a woman is ovulating, the IUI procedure is performed. Before placing the semen in a woman’s body, it is collected and “washed.” This is done to remove all seminal fluid from the semen, which can cause a woman to experience extreme cramping. This part of the process takes around two hours.

When the semen 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

Sources

American Society for Reproductive Medicine. ReproductiveFacts.org. Oral medicines for inducing ovulation. Accessed July 20, 2017.
National Institutes of Health. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. Accessed July 20, 2017.
American Society for Reproductive Medicine. Intrauterine insemination (IUI). Accessed July 20, 2017.
American Society for Reproductive Medicine. Infertility: An overview. Accessed July 20, 2017.

Last Updated: July 18, 2017