There Are Many Fertility Treatment Options for People Trying to Start a Family
Getting pregnant is supposed to be the easy and fun part of parenting. After all, teenagers seem to be able to do it while looking at their phones. However, most people are not ready to start a family while they are still on their parent’s phone plan. So that brings us to “adulting,” being responsible to the point where you plan a family with a partner you love, trust and want to parent with. For most people, this happens between their mid-twenties and early forties. This is a great time in your life to become parents but not always the optimal time to get pregnant. Roughly 10-12% of women will have trouble conceiving after one year of trying, this is the standard definition of infertility and time to look into fertility treatment options. For couples where the woman is over 35, the standard is six months of trying before investigating fertility treatments.
There are numerous options available for infertile couples, ranging from minimally invasive medications and procedures to IVF and gestational surrogacy. Most people start with minimally invasive interventions and work their way up to more invasive fertility treatment options if those don’t work. If the woman is under 35, and both partners are healthy, this is a great way to go. There is less stress on the woman’s body and the bank account. For women over 35, who have dwindling ovarian reserves, the infertility options presented are usually more aggressive. This is because there is no time to wait around to see if a treatment, like IUI with a 5-10% success rate in women over 35, is going to take before moving on to more aggressive treatment options.
Needless to say, the costs of treatments rises as you step up the levels of procedures. Some insurance policies will cover everything, some nothing to do with infertility, some testing only. Before you consult your fertility specialist you should check to see exactly what your insurance covers. If nothing else, you will probably be asked when you are filling out paperwork at the infertility center.
The major fertility treatment options are:
Fertility drugs: Clomiphene and gonadotropins are the most commonly used fertility drugs, they regulate your reproductive hormones and trigger the release of one or more eggs in each ovulation cycle. Most women try these drugs for 3-6 months, often with IUI, before moving on to the next step. The success rate with these drugs is between 15% and 30%. For women under 35 these drugs are a good first step in fertility treatments since a lot of fertility issues are tied to ovulation. Women under 35 also have more ovarian reserve so they have the time to spend trying less invasive and expensive options.
Surgery: If fertility testing uncovers a physical problem that surgery can correct this is an obvious first step. The most common surgical procedures on women are correcting genetic defects, opening blocked fallopian tubes, removing endometrial tissue and treating polycystic ovarian syndrome. These procedures are commonly performed using laparoscopy and laparotomy, using a small lighted camera inserted into small incisions in the abdomen. The success rate for pregnancies after surgery varies depending on the type of surgery, fallopian tube surgery is effective between 21% and 59% of the time, surgery for mild endometriosis is effective in about 40% of cases and ovarian drilling surgery for PCOS is about 50% effective. Effectiveness rates are judged on the ability of a woman to conceive within a year after the surgery.
Intrauterine insemination (IUI): The Intrauterine Insemination (IUI) procedure is a non-invasive treatment that is used as one of the early stages of fertility treatment, it is very effective if the problems are with the sperm or physical issues with the cervix. During IUI, the sperm is placed into the uterus which has no problem handling sperm but will cramp if seminal fluid is introduced. This is why only sperm swim up, seminal fluid never gets past the cervix. To eliminate that problem the sperm is “washed” to get rid of the seminal fluid and less active sperm. Only the top swimmers are introduced during IUI since these are the sperm most likely to be able to fertilize the egg. IUI can be done using a woman’s natural cycle or as a “stimulated” cycle where fertility drugs to stimulate ovulation are taken. These are the drugs mentioned above. With a stimulated cycle, there is a greater risk of multiples and of developing ovarian hyperstimulation syndrome but the risk for both are small. The IUI procedure starts once the sperm is washed and ready for insemination. The doctor uses an external ultrasound to monitor sperm placement. Once ideal placement is determined, the doctor inserts the catheter into the vagina and pushes it up to the cervix. Using the ultrasound screen as a guide, the doctor pushes the catheter through the cervical canal and points it toward the top of the uterus and the fallopian tube with the mature follicle resides. The sperm is injected through the catheter and into the uterus and the patient is advised to stay still for a few minutes. The process lasted only about 60 to 90 seconds and feels like a regular pap smear. Success rates for IUI are between 5% and 20% depending primarily on the age of the woman and the condition of her eggs.
In vitro fertilization (IVF): In in vitro fertilization (IVF) eggs are retrieved during an egg retrieval cycle and mixed with sperm in the lab. If any of the eggs are fertilized then the resulting embryos are transferred into the uterus using the same method described in IUI treatment. Often women are put on progesterone supplements after egg retrieval because the progesterone helps prepare the uterus for implantation. Generally, this supplement can be discontinued after pregnancy is established using an hCG test. The percentages of IVF cycles, in recent years, that lead to a live birth:
- 40 percent for women age 34 and under
- 31 percent for women age 35 to 37
- 21 percent for women age 38 to 40
- 11 percent for women age 41 to 42
- 5 percent for women age 43 and over
Intracytoplasmic sperm injection (ICSI): ICSI is a treatment that is used in conjunction with IVF when dealing with sperm problems. With ICSI, after eggs are retrieved instead of just mixing them with washed sperm and letting the little swimmers do their thing, a sperm is physically injected into an egg to facilitate fertilization. With this technique, 50-80% of eggs are successfully fertilized and can be transferred to the uterus. Pregnancy success rates are the same as IVF without ICSI. The ICSI procedure adds an additional cost to the IVF procedure but makes it possible for men with damaged sperm, and men who can’t ejaculate due to injuries, to have biological children.
Donor eggs and embryo: Donor eggs are eggs donated by another woman to be used in IVF. These eggs are healthy, because they come from women under 30, and are mixed with the male partner’s sperm to produce an embryo that is genetically related to him. The embryo is then implanted into the intended mother’s uterus or that of a gestational surrogate. Donor embryos are embryos that have been created by other couples, while they were going through fertility treatments, that they no longer need as their families are complete. The chances of giving birth to a child using donor eggs or embryos with:
- fresh donor eggs, about 50 percent.
- a frozen embryo from a previous donor egg cycle, about 38 percent.
- embryos created from frozen donor eggs, about 43 percent.
- frozen donor embryos, about 37 percent.
Gestational surrogacy: Simply put, gestational surrogacy is when a woman carries a pregnancy for another family. She is impregnated with an embryo produced by the intended parents (using the mother’s egg or a donor egg and the father’s sperm or donor sperm) and turns the baby over to them at birth. The gestational surrogate has no genetic link to the baby since her egg was not used to create the embryo. Not surprisingly, this is the most expensive option an infertile couple can select to help them start their family. Not only is there the payment for the medical procedures on the intended parents, there are also medical bills for the surrogate, insurance, legal issues and paying the surrogate for her pain and suffering. When the intended mother can produce a viable egg, but can’t carry a pregnancy to term, this is a great option. The baby is still the parent’s genetic child, it was only gestated by another woman. As with all other infertility treatments, a lot depends on the egg. Gestational surrogacy does not solve egg problems, it solves carrying problems. However, the age of the egg does determine the likelihood that the pregnancy will continue long enough to lead to a live birth. If the intended mother is using her own eggs, the chances of a live birth are:
- 49 percent for women age 34 and under.
- 33 percent for women age 35 to 37.
- 29 percent for women age 38 to 40.
- 19 percent for women age 41 to 42.
- 11 percent for women age 43 and over.
Since donor eggs come from women under 30, the chances when using a donor egg are around 50%. You might have to go through more than one IVF cycle with the surrogate but chances are very good, if you’re using a good quality egg, that gestational surrogacy will end with a baby.
Nobody ever wants to be that couple, the infertile couple desperately trying to conceive. However, if that is you, it’s good to know that there are so many fertility treatment options available today. From straightforward medication to stimulate ovulation to gestational surrogacy, where someone else carries you child, there’s a world of fertility treatment options available for those really desire a child of their own.