Infertility treatment depends on the cause, your age, how long you've been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.
Although some women need just one or two therapies to restore fertility, it's possible that several different types of treatment may be needed.
Treatments can either attempt to restore fertility through medication or surgery, or help you get pregnant with sophisticated techniques.
Fertility restoration: Stimulating ovulation with fertility drugs
Fertility drugs regulate or stimulate ovulation. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders.
Fertility drugs generally work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They're also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs. Fertility drugs may include:
- Clomiphene citrate. Clomiphene (Clomid) is taken by mouth and stimulates ovulation by causing the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
- Gonadotropins. Instead of stimulating the pituitary gland to release more hormones, these injected treatments stimulate the ovary directly to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin or hMG (Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle). Another gonadotropin, human chorionic gonadotropin (Ovidrel, Pregnyl), is used to mature the eggs and trigger their release at the time of ovulation. Concerns exist that there's a higher risk of conceiving multiples and having a premature delivery with gonadotropin use.
- Metformin. Metformin (Glucophage, others) is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin helps improve insulin resistance, which can improve the likelihood of ovulation.
- Letrozole. Letrozole (Femara) belongs to a class of drugs known as aromatase inhibitors and works in a similar fashion to clomiphene. Letrozole may induce ovulation. However, the effect this medication has on early pregnancy isn't yet known, so it isn't used for ovulation induction as frequently as others.
- Bromocriptine. Bromocriptine (Cycloset), a dopamine agonist, may be used when ovulation problems are caused by excess production of prolactin (hyperprolactinemia) by the pituitary gland.
Risks of fertility drugs
Using fertility drugs carries some risks, such as:
Pregnancy with multiples. Oral medications carry a fairly low risk of multiples (less than 10 percent) and mostly a risk of twins. Your chances increase up to 30 percent with injectable medications. Injectable fertility medications also carry the major risk of triplets or more (higher order multiple pregnancy).
Generally, the more fetuses you're carrying, the greater the risk of premature labor, low birth weight and later developmental problems. Sometimes adjusting medications can lower the risk of multiples, if too many follicles develop.
Ovarian hyperstimulation syndrome (OHSS). Injecting fertility drugs to induce ovulation can cause OHSS, which causes swollen and painful ovaries. Signs and symptoms usually go away without treatment, and include mild abdominal pain, bloating, nausea, vomiting and diarrhea.
If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more-severe form of OHSS that can also cause rapid weight gain, enlarged painful ovaries, fluid in the abdomen and shortness of breath.
Long-term risks of ovarian tumors. Most studies of women using fertility drugs suggest that there are few if any long-term risks. However, a few studies suggest that women taking fertility drugs for 12 or more months without a successful pregnancy may be at increased risk of borderline ovarian tumors later in life.
Women who never have pregnancies have an increased risk of ovarian tumors, so it may be related to the underlying problem rather than the treatment. Since success rates are typically higher in the first few treatment cycles, re-evaluating medication use every few months and concentrating on the treatments that have the most success appear to be appropriate.
Fertility restoration: Surgery
Several surgical procedures can correct problems or otherwise improve female fertility. However, surgical treatments for fertility are rare these days due to the success of other treatments. They include:
- Laparoscopic or hysteroscopic surgery. These surgeries can remove or correct abnormalities to help improve your chances of getting pregnant. Surgery might involve correcting an abnormal uterine shape, removing endometrial polyps and some types of fibroids that misshape the uterine cavity, or removing pelvic or uterine adhesions.
- Tubal surgeries. If your fallopian tubes are blocked or filled with fluid (hydrosalpinx), your doctor may recommend laparoscopic surgery to remove adhesions, dilate a tube or create a new tubal opening. This surgery is rare, as pregnancy rates are usually better with IVF. For hydrosalpinx, removal of your tubes (salpingectomy) or blocking the tubes close to the uterus can improve your chances of pregnancy with IVF.
The most commonly used methods of reproductive assistance include:
- Intrauterine insemination (IUI). During IUI, millions of healthy sperm are placed inside the uterus close to the time of ovulation.
- Assisted reproductive technology. This involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a lab, then transferring the embryos into the uterus after fertilization. IVF is the most effective assisted reproductive technology. An IVF cycle takes several weeks and requires frequent blood tests and daily hormone injections.
Nov. 24, 2016
- Frequently asked questions. Gynecologic problems FAQ137. Treating infertility. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq137.pdf?dmc=1&ts=20130521T1023327144. Accessed May 10, 2016.
- Frequently asked questions. Gynecologic problems FAQ138. Evaluating infertility. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq136.pdf?dmc=1&ts=20130521T1027034009. Accessed May 10, 2016.
- Infertility: Frequently asked questions. National Women's Health Information Center. http://www.womenshealth.gov/publications/our-publications/fact-sheet/infertility.pdf. Accessed May 10, 2016.
- Infertility FAQs. Centers for Disease Control and Prevention. http://www.cdc.gov/reproductivehealth/Infertility/. Accessed May 10, 2016.
- Assisted reproductive technologies: A guide for patients. American Society for Reproductive Medicine. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ART.pdf. Accessed May 10, 2016.
- Infertility: An overview — A guide for patients. American Society for Reproductive Medicine. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/infertility_overview.pdf. Accessed May 10, 2016.
- Kuohung W, et al. Overview of infertility. http://www.uptodate.com/home. Accessed May 10, 2016.
- Frequently asked questions. Gynecological problems FAQ013. Endometriosis. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq013.pdf?dmc=1&ts=20130305T1348596508. Accessed May 10, 2016.
- Kuohung W, et al. Causes of female infertility. http://www.uptodate.com/home. Accessed May 10, 2016.
- Kuohung W, et al. Evaluation of female infertility. http://www.uptodate.com/home. Accessed May 10, 2016.
- Kuohung W, et al. Overview of treatment of female infertility. http://www.uptodate.com/home. Accessed May 10, 2016.
- Hornstein MD, et al. Optimizing natural fertility in couples planning pregnancy. http://www.uptodate.com/home. Accessed May 10, 2016.
- Alcohol use in pregnancy. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/fasd/alcohol-use.html. Accessed May 10, 2016.
- Nisenblat V, et al. The effects of caffeine on reproductive outcomes in women. http://www.uptodate.com/home. Accessed May 10, 2016.
- Nelson LM. Clinical manifestations and evaluation of spontaneous primary ovarian insufficiency (premature ovarian failure). http://www.uptodate.com/home. Accessed May 11, 2016.
- Barbieri RL, et al. Clinical manifestations of polycystic ovary syndrome in adults. http://www.uptodate.com/home. Accessed May 11, 2016.
- Coddington CC (expert opinion). Mayo Clinic, Rochester, Minn. May 18, 2016.
- Asante A, et al. Fertility drug use and the risk of ovarian tumors in infertile women: A case-control study. Fertility and Sterility. 2013;99:2031.
- Snyder PJ. Clinical manifestations and evaluation of hyperprolactinemia. http://www.uptodate.com/home. Accessed May 11, 2016.
- Chen L, et al. Borderline ovarian tumors. http://www.uptodate.com/home. Accessed May 11, 2016.