How to Evaluate Fertility Treatment Options
Learn about the cause of fertility issues and steps you can take to help evaluate treatment options that work for you.
In the United States, about 1 in 8 couples younger than age 45 have trouble getting pregnant or carrying a pregnancy to term. Fertility challenges can also impact LGBTQ individuals or those who are single by choice. Female factors cause about a third of fertility problems; with male issues, another third. The other cases are caused by a combination of the two or by unexplained issues.
For women, most common causes of fertility issues involve:
- Problems with ovulation (the release of eggs)
- Poor ovarian reserve
- Blocked fallopian tubes
- Anatomical abnormalities of the uterus
- Endometriosis (a condition in which endometrial tissue grows outside the uterine cavity abnormally).
For men, fertility issues often revolve around the amount or health of the man’s sperm. His sperm count, movement and shape may be evaluated. Depending on the results, other tests may be in order.
What can I do if I suspect I have a fertility issue?
If you think you may have fertility issues, these steps may help determine the cause and help you consider options for a treatment plan:
- See a fertility specialist (also called a reproductive endocrinologist). This provider can help evaluate your options and create a treatment plan based on your situation.
- Have a complete diagnostic evaluation. If you have a partner, they should have an evaluation, too. Tests for fertility issues may include imaging tests, procedures and lab tests. Imaging tests and procedures help determine how reproductive organs work. Lab tests examine samples of blood or semen.
- If treatment is right for you, consider treatment options that make sense given your age, underling medical condition and family building goals.
Is age a contributing factor?
Age is one of the most important factors in fertility issues. A healthy woman in her 30’s with no underlying fertility issues has around a 20 percent chance of getting pregnant every month. However, as a woman ages, the quality and quantity of her eggs decline. A woman’s fertility starts to decline, especially after age 35.
A woman’s age can also contribute to lower birth rates and increased risk for miscarriage. Also, the older a woman is, the lower the rate of live birth pregnancy when using her own eggs with in vitro fertilization (IVF).
For women younger than age 35 who use their own eggs with IVF, 47.6 percent of cycles will result in a live birth. For women ages 38-40, this success rate declines to almost 21.7 percent and down to 3.1 percent for women older than age 42. However, someone who decides to undergo IVF using donor eggs is likely to have the same success as a younger woman, as it is the age of the egg that matters. The current success rate of an IVF cycle using donor eggs is quite high — over 49.4 percent.
Other than age, what else should I consider when determining a treatment option?
- Treatment success rates. For in vitro fertilization (IVF), the success rate for U.S. women of all ages is about 30 percent but as noted above is impacted by age. For intrauterine insemination (IUI), the success rate is lower than IVF and may depend on the cause of infertility.
- How many cycles you may need. You may need more than one cycle or more than one treatment type. Treatments may have limitations so if you are considering multiple rounds of IUI, consider IVF. You may need to consider donor IVF or other options if you’ve been unsuccessful with multiple rounds of IVF.
- Total cost of treatment. A single round of IUI is much less expensive than a round of IVF. However, IUI has a lower success rate than IVF and may require multiple cycles. Since IVF has a higher success rate, your total cost of treatment may be lower with that approach.
It’s important to understand the facts. During this process, your provider can talk you through your options and help you determine the right fertility treatment for you.
By Kristin Nelson, Contributing Writer
Society for Assisted Reproductive Technology. National summary report. 2018. Accessed April 3, 2020.
Resolve: The National Infertility Association. Accessed April 3, 2020.
American Society for Reproductive Medicine. Age and fertility. Accessed April 3, 2020.
Womenshealth.gov. Infertility fact sheet. Accessed April 3, 2020.
Last Updated: April 18, 2020