When parenthood becomes a dream deferred:
Treatment options for infertility

While a portion of the millions of people deemed infertile turn to adoption, many seek medical intervention to circumvent their fertility problems. A wide range of treatment options are available to combat both male and female infertility, from medications to induce ovulation to in vitro fertilization. We have gathered information about the options available as well some new techniques and tools that are still in the investigative stage.

Where to start

A thorough examination of both partners allows physicians to pinpoint the cause of fertility problems. Appropriate treatment options are determined by a variety of factors including the underlying cause of the problem. Most fertility specialists define infertility or subfertility as the inability to achieve pregnancy after a year of trying to conceive. For older women, however, fertility assessment is often recommended sooner.

Treatment options fall into two main categories—medical fertility therapy and assisted reproduction. The medical approach uses hormone therapy to induce ovulation. Clomiphene citrate and gonadotropin therapy, which uses synthetic forms of pituitary hormones, promote egg development and are used for women who ovulate irregularly.

Assisted reproduction can take many different forms, from the relatively low tech of intrauterine insemination in which sperm are washed to remove seminal fluid and placed by catheter into the uterine cavity to the high tech of in vitro fertilization and assisted hatching. According to the Society for Reproductive Medicine, between 85 and 90 percent of infertility cases are treated with medication or surgery, such as procedures to unblock fallopian tubes.

In vitro fertilization (IVF) is a complex process that involves a series of steps:

• Medications are used to stimulate the growth of mature eggs in ovaries.
• The eggs are retrieved from the ovaries by the physician.
• Sperm is collected from the partner or donor and is then prepared for the insemination process.
• The eggs and sperm are placed in a sterile Petri dish and kept in an environment that encourages fertilization.
• Once embryos begin to develop, a chosen number are transferred back to the woman’s uterus where they can develop and create a pregnancy.

Within IVF, there are different techniques to improve the chances of developing healthy embryos that will implant in the uterus. Assisted hatching involves the creation of a small hole in the outer layer of the embryos to improve their ability to attach to the uterine lining. In blastocyst culture, the embryos are allowed to mature for a longer period outside the womb.

Gamete intrafallopian transfer (GIFT) requires the collection of eggs and sperm which are then placed in the woman’s fallopian tube where fertilization would take place naturally versus uterine placement in IVF. Zygote intrafallopian transfer (ZIFT) is slightly different, with eggs being fertilized outside the body, but then placed in the fallopian tube. These techniques are often used for patients with mild endometriosis or low sperm count.

When fertilization is the root problem, doctors turn to a technique called intracytoplasmic sperm injection (ICSI). Each egg is injected with a single sperm before implantation. There is also a technique known as transmyoendometrial embryo transfer in which the cervix is bypassed during embryo transfer. This approach can be helpful in cases where cervical abnormalities are an impediment.

What are the risks and how could they affect you and your baby?

The most well known complication of assisted reproduction is multiple pregnancy which can cause maternal health problems and premature delivery and the host of problems associated with prematurity. Medications that stimulate ovulation can produce multiples, as can IVF where several embryos are implanted with the hope that at least one will result in a full term pregnancy.

Recent research has found that for women in their mid-30s to early 40s, transferring a single, good quality blastocyst resulted in pregnancy for approximately half the women in the study, double the national average of women in the same age group who underwent traditional IVF. The single transfer also minimizes the risk of multiple births.

Faster sperm, a fertility diet and other new frontiers in fertility

Researchers in China have found that defective forms of a protein called epithelial ion channel lowers sperm’s ability to fertilize an egg. The hope is that this information can be used to better diagnose male infertility and tailor treatment to overcome this defect.

At the University of California, Irvine, researchers are hoping to increase the success rate of IVF by using a laser trap they have developed to catch the faster swimming sperm, which are more likely to succeed in fertilization, and separate them from the slower moving ones.

English scientists have discovered that the hormone kisspeptin can help boost the amount of lutenizing hormone a woman produces. A higher level of lutenizing hormone can stimulate the ovary to produce an egg. Researchers hope that kisspeptin may be able to induce normal reproductive function in women who ovulate irregularly due to low hormone levels.

Making diet and lifestyle changes may also help increase fertility. Physicians at the Harvard School of Public Health found that for every two percent of total calories a woman gets from trans fats rather than carbohydrates, her risk of infertility increases 73 percent. If trans fats were consumed in place of omega-6 polyunsaturated fats (found in corn, safflower, sunflower, soybean and cottonseed oil), the risk rose 79 percent.

Know your options, count on our support

PinnacleCare Members can turn to their personal Advocate for objective, scientifically grounded information about the latest diagnostic tools and treatment options. They also have facilitated access to leaders in the treatment of infertility and the compassionate support of their Advocate as they work to achieve parenthood.