Three most common methods of infertility treatment for women are:fertility drugs, surgical treatments and Assisted Reproductive Technology (ART). The main factor that determines chosen treatment method is the underlying cause of infertility (click for more information). If there is a need, the fertility specialist might recommend for a combination of any of these treatment methods.
Infertility treatment can be a lengthy and challenging process. Patience, commitment and mutual support of couple under treatment are important factors that can influence success of the treatment. It is advisable to discuss with the doctor or fertility specialist about the pros and cons of the treatment prescribed. Most common infertility treatments for women are explained in this article.
Fertility drugs are usually used to treat infertility in women who suffer from ovulatory disorders. These drugs help to induce ovulation by functioning in the same way as natural hormones. Fertility drugs listed below are the most widely used ones:
Clomiphene Citrate (Clomid)
Clomiphene citrate (Clomid) tablets (taken orally) are usually used to treat women who suffer from poly cystic ovarian syndrome (PCOS). This drug stimulates the pituitary gland to produce more gonadotropins: follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones then help to induce ovulation.
Drugs that contain Follicle Stimulating Hormone (FSH)
These drugs are used to treat women whose ovaries are capable of producing eggs, but those eggs do not mature enough due to hormonal abnormalities. FSH drugs injected to a woman’s body stimulate a follicle (egg) to develop and mature.
FSH drugs can be also used to stimulate development of multiple eggs for in vitro fertilization (IVF).
Metformin is prescribed for women who suffer from insulin resistance. Insulin resistance can be one of the causes of polycystic ovarian syndrome (PCOS). Metformin is usually taken orally and it helps to boost ovulation. This drug is sometimes used in combination with Clomid or FSH drugs.
Gonadotropin releasing hormone (Gn-RH) analog drugs
Gn-RH drugs administered by injections or nasal spray, are used to treat irregular ovulatory cycles and premature ovulation. These drugs act on the pituitary gland to control ovulation.
Human Menopausal Gonadotropin (hMG) Drugs
This medicine is used to treat infertility in women who do not ovulate due to failure of pituitary gland. Human menopausal gonadotropin (hMG), which contains both follicle stimulating hormone (FSH) and luteinizing hormone (LH), directly stimulates ovaries for ovulation. hMG is administered by injections.
Prolactin is the hormone that stimulates milk production in women. High levels of prolactin in body can cause irregular ovulation cycles. Bromocriptine drugs can help to control prolactin levels, resulting in regular ovulation cycles.
The fertility specialist might choose surgery as a means of infertility treatment for women in following scenarios:
Damages or blocks to fallopian tube (click for more information) can cause infertility. These damages or blocks can be repaired through laparoscopic keyhole surgeries.
A surgery may be used to treat women suffering from endometriosis, if the medical treatment using drugs is ineffective. As in the case of fallopian tube repair, laparoscopy is the most common surgical method used to treat endometriosis.
As explained in fertility drugs section above, poly cystic ovarian syndrome (PCOS) can be treated with the aid of drugs. A surgery might be recommended, only if treatment using drugs is ineffective. The most common surgical procedure to treat PCOS is called laparoscopic ovarian drilling (LOD) which is a relatively non invasive procedure very similar to laparoscopy. Small surgical tools inserted through a key hole are used to burn away parts of ovarian follicles (which are malicious cysts). A less commonly used surgical method to treat PCOS is ovarian wedge resection which has very high risks associated with it, including scarring of ovary. It is advisable to get a second opinion, if the fertility specialist recommends for an ovarian wedge resection.
Assisted Reproductive Technology (ART)
Assisted Reproductive Technology (ART) is an advanced method used to treat infertility in both men and women. It is advisable to discuss with the fertility specialist about benefits and possible side effects of ART treatment. Most common ART treatments for women are explained below:
Intrauterine Insemination (IUI)
Intrauterine Insemination (IUI) is a process in which sperm collected from normal ejaculate of male partner, sperm retrieved from reproductive tract of male partner or donated sperm are directly placed into a woman’s uterus, close to the time of her ovulation. Doing so would increase chances of fertilization, since a concentrate of high quality sperm is placed into the uterus and it is relatively easier for sperm to travel from the uterus to fallopian tube and fertilize the egg, rather than travelling all the way from vagina to fallopian tube through the cervix. If the woman under treatment has ovulatory disorders, prior to IUI, fertility drugs may be prescribed for her to induce ovulation.
IUI is performed under any of the following scenarios:
- female partner has healthy fallopian tubes (without any blocks or damages) but suffers from cervical mucus defect, endometriosis or sperm allergy
- unexplained infertility
- male partner suffers from sperm disorders, blocks in vas deferens or ejaculatory duct, retrograde ejaculation, premature ejaculation or erectile dysfunction
Click here for more detailed information about IUI such as: success rate of IUI, factors that can influence success of IUI, cost of IUI, risks of IUI, things to take care of after IUI treatment etc.
In Vitro Fertilization (IVF) and embryo transfer
In Vitro Fertilization (IVF) is one of the most effective ART treatments. In IVF, fertilization of multiple eggs by sperm take place in a laboratory setting and one or more embryos formed are then transplanted into mother’s womb (uterus). This method is used to treat infertility in women suffering from damaged or blocked fallopian tubes, cervical mucus defect, endometriosis, ovulatory disorders, sperm allergy or unexplained infertility. IVF is also used to treat infertility caused by male factors such as sperm disorders, blocks in vas deferens or ejaculatory duct, retrograde ejaculation, premature ejaculation or erectile dysfunction.
In IVF, fertility drugs are used to stimulate production of multiple ovaries (eggs) in women. Once these eggs mature, the fertility specialist retrieves them from ovary through a minor surgical procedure. In a laboratory setting, each egg is then mixed with sperm collected from normal ejaculate of male partner or sperm retrieved from the reproductive tract of male partner. This would result in fertilization of multiple eggs and formation of multiple embryos. One or more healthy embryos are then transplanted into woman’s womb (uterus). A successful pregnancy is achieved when one or more of these transferred embryos gets implanted to the uterus lining and starts growing there. There is a possibility of having a multiple pregnancy (pregnancy with two or more foetuses); if more than one embryo is transferred to a woman’s womb by IVF. This has a few risks associated with it. It is advisable to discuss with the fertility specialist about it. Embryos that are left over from an IVF cycle can be freezed for future use, donated to other infertile couples or destroyed.
An advantage of IVF is that, it can also be performed using donated eggs and/or donated sperm. Click here for more detailed information on IVF such as: success rate of IVF, factors that can influence success of IVF, duration of IVF treatment, cost of IVF, how to finance IVF costs?, what are blastocyst transfer, assisted hatching and intracytoplasmic sperm injection (ICSI) in IVF?, risks of IVF, things to take care of after IVF treatment etc.
Gamete Intrafallopian Transfer (GIFT)
This treatment method is recommended under similar scenarios as in the case of in vitro fertilization (IVF). The difference is, to have a successful pregnancy through gamete intrafallopian transfer (GIFT); women should have healthy fallopian tubes without any damage or blocks. The process is similar to IVF. Mature eggs are retrieved from the female partner and eggs are then mixed with sperm collected from male partner, outside the body. Instead of allowing the fertilization to take place in a laboratory setting (as in the case of IVF), the mixed eggs and sperm are immediately transferred to woman’s one or both fallopian tubes where it fertilizes naturally. If the treatment works, the fertilized egg (embryo) will then travel down through the fallopian tube to the uterus and will get implanted to the uterus lining. GIFT can also be performed with donated eggs and/or donated sperm. However, GIFT is less commonly used than IVF for infertility treatment for women.
Zygote Intrafallopian Transfer (ZIFT)
Zygote intrafallopian transfer (ZIFT), also known as tubal embryo transfer (TET) is a process is similar to gamete intrafallopian transfer (GIFT). As in the case of GIFT, women should have healthy fallopian tubes in order to perform Zygote Intrafallopian Transfer (ZIFT). The difference between GIFT and ZIFT is that, in GIFT a mixture of eggs and sperm are placed into fallopian tubes and fertilization happens inside woman’s body, whereas in ZIFT a zygote (developing embryo which was fertilized in a laboratory setting) is placed into fallopian tube. If the treatment works, the zygote (embryo) will then travel down through the fallopian tube to the uterus and will get implanted to the uterus lining. ZIFT can also be performed with donated eggs and/or donated sperm.
Difference between in vitro fertilization (IVF) and ZIFT is: in IVF, embryo is transplanted into a woman’s uterus, where as in ZIFT, embryo is placed into a woman’s fallopian tube. ZIFT is not as commonly used as IVF.
Possible Adverse Effects of Infertility Treatment for Women
Multiple pregnancy (pregnancy with two or more foetuses) is considered to be a main risk associated with infertility treatments. Fertility drugs used for infertility treatment stimulate production of multiple ovaries. This would increase chances of fertilization of multiple eggs and formation of multiple embryos. Similarly, in treatment methods such as in vitro fertilization (IVF), one or more embryos may be transplanted into a woman’s uterus. This can result in multiple pregnancy. Multiple pregnancy can cause high blood pressure and diabetes in mother, premature labor and babies having low birth weight.
Other possible side effects of infertility treatments are: infections or damage to reproductive tract, ovarian hyper stimulation syndrome or over stimulation of ovaries (by fertility drugs), ectopic pregnancy (a condition in which a fertilized egg gets implanted to fallopian tube instead of uterus and starts growing there), allergic reactions to drugs, anxiety, sleep interruptions, mood swings, hot flushes andbirth defects in babies (chances of birth defects are very low).