Types of Infertility Treatment

Vilma Ruddock
Woman having consultation with doctor

There are several types of infertility treatment, each designed to correct or bypass a specific cause of infertility. The likelihood of getting pregnant with a treatment option depends on multiple factors, such your age and the severity of your fertility problem(s). Discuss with your doctor how an infertility treatment can help your diagnosis, as well as the pros and cons and cost of each type.

Fertility Hormones

Types of fertility drugs

When you are not ovulating or your ovulation is irregular, fertility hormones induce ovulation or regulate the pathway to ovulation. They stimulate the ovaries directly or through an increase in the pituitary hormones that regulate the menstrual cycle. The simplest drug, Clomiphene Citrate, or Clomid, is taken by mouth for five days, while other hormones require daily injections for several days.

According to the American Society for Reproductive Medicine (ASRM), the hormones cause immature eggs in the ovaries to grow and mature. Eggs can either ovulate spontaneously, or you are given another hormone, human chorionic gonadotropin (HCG), the hormone of pregnancy, to trigger ovulation.

Problems Hormones Treat

In addition to treating problems with ovulation, the most common cause of infertility according to the Office on Women's Health, hormones are also used:

  • When there is evidence the egg reserve in the ovaries has dwindled because of ovarian aging. Hormones may increase the chance of inducing these eggs to mature.
  • As part of other types of infertility treatment
  • When the cause of the infertility is not found (unexplained infertility)

Pregnancy Rate

Fertility hormones have the best success rate of all infertility treatments because problems of ovulation are the easiest to treat.

The success rate of hormone therapy depends on the cause of the ovulation problem, your age, and whether other infertility problems are present. The rates are lower for women over age 35 and for unexplained infertility.

Cost

Fertility drugs are the least expensive type of fertility treatments. According to the Advanced Fertility Center of Chicago, the United States national average costs are as follows:

  • Clomid costs only $10 to $100 per cycle. Additional blood tests and ultrasound monitoring increase the cost to $800 to $4,000.
  • The injectable drugs costs $1,000 to $3,500 per cycle. Add blood tests and ultrasounds, and the cost increases to $1,500-$6,000.

Pros

Use of fertility hormones is the oldest type of infertility treatment and the most effective, especially when used for specific causes of abnormal ovulation. In addition to achieving the highest pregnancy rates, they also are the simplest and least invasive type of infertility treatment.

Cons

Hormone medications can cause side effects, such as abdominal pain and bloating, which resolve shortly after ovulation. Clomid can cause other side effects, such as headaches and blurred vision, though symptoms don't last long.

According to the American Society for Reproductive Medicine review, one of the downsides of hormone treatment is the increased chance of multiple pregnancies, most of which will be twins. This is because the hormones can cause more than one egg to ovulate and fertilize each cycle, especially true for the injectable hormones. Some women, however, are happy with twins after years of trying to conceive without success.

Risks

If treatment with the injectable hormones is not managed carefully, a major risk is overstimulation and over-enlargement of the ovaries with multiple cysts. Ovarian hyperstimulation syndrome (OHSS) can cause symptoms such as abdominal pain, bloating, and nausea. In severe, sometimes life-threatening cases, cysts may rupture and bleed and cause worse symptoms, or fluid can collect in the abdomen or lungs.

Intrauterine Insemination

Doctor with woman patient

Intrauterine insemination (IUI) can be considered an assisted reproductive technology (ART) procedure that helps sperm to get to the egg. It places a concentration of washed, healthy sperm inside the cavity of your uterus, according to the Mayo Clinic.

By putting sperm closer to the fallopian tubes, IUI overcomes the barriers of the cervix, or avoids the natural loss of sperm in the vagina, cervix, and uterus. The procedure is done close to ovulation, and you may be treated with fertility hormones before, depending on the reason for the IUI.

Problems IUI Treats

IUI is most often suggested when:

  • A percentage of the sperm don't move well
  • The sperm count, concentration of sperm, or semen volume is low
  • There is a low percentage of normal sperm
  • The cervical mucus is insufficient or hostile to sperm
  • Donor sperm is needed to get pregnant
  • The cause of the infertility is not found (unexplained infertility)
  • A woman's age might be a factor

Pregnancy Rate

According to ASRM, IUI has a success rate of up to 20 percent and could be low as 4 percent. The pregnancy rate is lower if your partner has severe sperm problems, you are older than 35, or you have multiple fertility problems. IUI is most successful if it is used to treat mildly abnormal sperm motility or problems with the cervix or cervical mucus.

Cost

IUI is more expensive than hormone treatment alone but is less expensive than fertility surgery or in vitro fertilization (IVF) procedures. According to a survey by Resolve (The National Infertility Association), the average cost of an IUI cycle is $865, with a range of $275 to $2,457. The cost depends on the reason for the infertility and whether fertility hormones or donor sperm are used, or a surrogate carrier is inseminated.

Pros

Although pregnancy rates are lower for IUI than for in vitro fertilization (IVF), it is easier, less invasive, less risky, and cheaper. It is often suggested as a trial to see if pregnancy can occur and avoid the IVF process.

Cons

The main downside of IUI is the relatively low pregnancy rates, mainly because of the difficult problems it is often used to treat, such as low sperm count.

Risks

IUI is safe and has few risks or side effects. You might feel mild menstrual cramps during the procedure when the narrow catheter with the semen goes through your cervix into your uterus. You might also have a small amount of spotting afterwards. The risk of infection in the uterus or tubes from bacteria in the vagina or cervix is small.

Infertility Surgery

Surgeons working in operating room

Infertility surgery treats problems of the reproductive organs that interfere with fertility and include:

Problems Surgery Treats

During operative laparoscopy the surgeon can:

  • Open blocked tubes.
  • Reverse a tubal ligation.
  • Cut or remove scar tissue (adhesions) to the tubes, ovaries, and other areas of the pelvic cavity.
  • Remove ovarian cysts and treat areas of endometriosis.
  • Restore the normal position of the tubes to the ovaries so the tubes can access an ovulating egg.

During operative hysteroscopy, the surgeon can treat these intrauterine problems that can interfere with implantation of the embryo:

  • Remove polyps from the uterine cavity
  • Remove fibroids or scar tissue inside the uterus
  • Cut bands of tissue (septae) that divide the uterine cavity in women with developmental abnormalities of the uterus

A doctor might also strongly advise operative laparoscopy to remove a badly damaged or enlarged tube (hydrosalpinx) in preparation for IVF. This improves the chance of pregnancy and reduces the risk of an ectopic pregnancy after IVF, according to the textbook, Clinical Gynecologic Endocrinology and Infertility.

Pregnancy Rate

Pregnancies rates after tubal surgery range from 10 to 55 percent, according to a Global Library of Women's Medicine (GLOWN) review. Success depends on the tubal problem, the type of surgery done, and the experience of the surgeon.

Cost

Surgery can be expensive, and many insurance companies will not cover the cost of infertility surgery. However, the procedure might avoid the need for the more expensive and complicated in vitro fertilization procedure.

Pros

According to the GLOWN review, with the refinement of in vitro fertilization techniques, infertility surgery may not be the best option for certain conditions of the fallopian tube. Surgery, however provides a chance to avoid IVF for couples who have religious, ethical, or other objections to the procedure.

Cons

Tubal disease is difficult to treat, and infertility surgery procedures can be technically difficult. They can involve a few hours in the operating and recovery room, and there is the need for recovery from pain and the incisions post surgery. The low pregnancy rates compared to IVF, the expense of the procedures, and the lack of insurance coverage are also downsides to consider.

Risks

Surgery has a risk of injury to organs, bleeding, and a small risk of infection afterwards. There is also the risk of general anesthesia and an increased risk of ectopic pregnancy after surgery on the tubes.

In Vitro Fertilization

Sperms reach the egg

According ASRM, in vitro fertilization (IVF) is an assisted reproduction technology (ART) procedure that brings egg and sperm together in a lab dish after stimulating the ovaries with fertility hormones and retrieving the eggs. About three to five days after fertilization, the resulting early stage embryo is placed in the uterus for implantation.

Depending on the circumstances, IVF may involve the use of donor eggs, donor embryos, fresh or frozen embryos, donor sperm, a surrogate carrier, or other procedures such as:

  • Assisted hatching: A procedure to open the outer covering of the embryo, which helps it implant in the lining of the uterus. It is used when IVF produces embryos but implantation is not successful in previous cycles.
  • Intracytoplasmic sperm injection (ICSI): A single healthy-appearing sperm is injected into an egg. ICSI is used when the sperm count or the percentage of healthy sperm is low, or eggs did not fertilize during previous IVF cycles.

Other ART procedure variations on conventional IVF include:

  • Zygote intrafallopian transfer (ZIFT): The embryo is placed in a fallopian tube instead of the uterus and then travels there to implant.
  • Gamete intrafallopian transfer (GIFT) or Tubal Embryo Transfer (TET): Egg and sperm are placed in a fallopian tube and fertilization occurs in the tube. GIFT is currently less frequently used than in the past.

Problems IVF Treats

IVF is usually suggested when:

  • The fallopian tubes are damaged, blocked or missing.
  • There is no pregnancy after sufficient hormone treatment, IUI or infertility surgery.
  • Treatments for unexplained infertility fail to produce a pregnancy.
  • Male infertility abnormalities are moderate to severe.

Pregnancy Rate

The Centers for Disease Control (CDC) gives an overall ART pregnancy rate of 11 to 39 percent for all fertility centers in the United States. You can find statistics for individual fertility centers on the CDC website. According to the CDC and ASRM, however, it is "not meaningful to compare success rates" of fertility clinics.

A clinic's IVF pregnancy rate depends partly on the mix and severity of the infertility problems they treat and the level of experience of clinic personnel. The Jones Institute for Reproductive Medicine, the oldest IVF program in the United States, quotes the following success rates for their program:

  • Pregnancy rate per cycle: 15 to 44.4 percent
  • Live births per cycle: 11.5 to 34.4 percent

Many factors influence a couple's chance of getting pregnant with IVF, including:

  • The infertility diagnosis
  • A couple's age, especially the woman's
  • The quality of the egg, sperm, and embryo
  • Conditions of the uterus that might interfere with implantation

Cost

IVF is the most costly type of infertility treatment and is not covered by insurance companies in most states in the United States. According to the Resolve survey of IUI and IVF costs, the cost of an IVF cycle is $8,000 to $12,400. Expense depends on factors such as the amount and days of fertility hormones needed and if donor eggs or sperm, fresh or frozen eggs or embryo, or a surrogate carrier are used.

Pros

One clear advantage of an IVF cycle is being able to see that fertilization can occur. This is helpful when there is a question of whether the failure to conceive with specific treatment, such as fertility hormones, is a failure of fertilization. Knowledge of the ability to achieve fertilization is especially informative for unexplained and male factor infertility.

Technologists can also assess if the quality of the embryo formed is the reason for inability to achieve a viable pregnancy. In addition, they can perform preimplantation genetic diagnosis (PGD) before embryo transfer for couples with a genetic factor such as cystic fibrosis.

Cons

IVF procedures are more difficult, time consuming, invasive, and expensive than all other types of infertility treatment. The expense of IVF can be a burden, especially if it comes after a long trail of other treatments, or if more than one IVF cycle is needed. In addition, the daily injections and multiple visits to the doctor's office for lab tests, ultrasounds, and procedures can take a physical toll on a woman, as well as a psychological and relationship toll on a couple.

Risks

Risks of IVF include overstimulation of the ovaries from the fertility drugs and complications such as bleeding during egg retrieval or infection after embryo transfer to the uterus.

Male Infertility Treatment

Male infertility is more difficult to treat than female because there are fewer available treatments. According to the Mayo Clinic treatment options include:

  • Hormone treatment, when hormone levels or sperm count are low
  • Treatment for infections of the male reproductive tract
  • Treatment for erectile dysfunction or premature ejaculation
  • Surgery to correct dilated veins around the testicles (varicocele), a blocked vas deferens, or a vasectomy reversal
  • Assisted reproductive technology, including extraction of sperm from the testis or ICSI
  • Artificial insemination of female partner with donor sperm for men with low sperm or abnormal sperm quality, or sexual dysfunction

Overall Success of Treatment

The overall success rate of all treatments for infertility is about 50 percent, according to the American Association of Family Physicians. Your chance of success depends on your age, your diagnosis, and the type of infertility treatment you need. Talk to your doctor about the best type of treatment for your situation.

Types of Infertility Treatment