As you consider starting or expanding your family, you may find that getting pregnant does not happen as quickly as you had hoped. When fertility issues arise, it can be an emotional rollercoaster. However, modern medicine offers many options for overcoming infertility and helping couples conceive. The variety of fertility treatments available can also be overwhelming to navigate. To determine in choosing which fertility treatment is most appropriate and effective for your unique situation, you must understand the differences between them. This guide provides an overview of the most common fertility treatments, including intrauterine insemination, in vitro fertilization, egg or embryo donation, and fertility drugs. With the facts about each option, you can work with your doctor to choose a path forward to build your family. Though the road may not always be easy, fertility treatments offer hope.
Fertility Treatments & Fertility Preservation
As a woman concerned about your fertility, there are several treatment options to consider with your doctor. The appropriate course of action depends on factors like your age, medical history, and personal preferences.
- Fertility drugs and hormonal therapy: For women with ovulation issues, fertility drugs and injections can stimulate ovulation and increase egg production. These medications, like clomiphene and gonadotropins, are often a first line of treatment. Success rates are 20-50% per cycle, depending on factors like age.
- Intrauterine insemination (IUI): In this procedure, sperm is inserted directly into the uterus during ovulation to increase the chances of conception. It is often combined with fertility drugs and has a 10-20% success rate per cycle.
- In vitro fertilization (IVF): IVF involves stimulating the ovaries to produce multiple eggs, retrieving the eggs, fertilizing them in a lab, and transferring the resulting embryos into the uterus. This advanced treatment has the highest success rates at 30-50% per cycle but is also the most expensive option.
- Fertility preservation: For women who want to delay pregnancy, egg freezing (oocyte cryopreservation) and embryo freezing (embryo cryopreservation) can preserve fertility for later use. These methods have allowed many women to conceive in their 30s, 40s, and beyond.
Discussing the pros and cons of each treatment with your doctor can help determine the optimal approach based on your priorities and prognosis. With the right course of action, many hopeful parents are able to achieve their goal of starting a family.
In Vitro Fertilization (IVF): The Most Well-Known Option
In vitro fertilization (IVF) is likely the most well-known fertility treatment option. IVF involves combining eggs and sperm in a laboratory to facilitate fertilization. Once an embryo develops, it is then transferred to the uterus.
- Egg retrieval. To begin, fertility drugs are administered to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are retrieved through a minor surgical procedure.
- The eggs are then combined with sperm in a laboratory to achieve fertilization and embryo development. This may take between 3 to 5 days.
- Embryo transfer. Usually, two to four embryos are selected and transferred to the uterus using a thin catheter through the vagina and cervix. Any remaining embryos of sufficient quality can be frozen for future use.
- Pregnancy test. Roughly two weeks after the embryo transfer, a blood test can detect if pregnancy has occurred. If positive, an ultrasound at 6 to 8 weeks can confirm the presence of a gestational sac and heartbeat.
Globally, IVF has a success rate of around 30 percent for women under 35. The success rate does decrease with age, but new technologies are helping to improve outcomes. IVF is a complex process, but with the right fertility care team, it provides hope for building a family when natural conception proves challenging. If you’re considering IVF, consult with a reproductive endocrinologist to review your options and next steps. Together, you can determine if IVF, or another treatment, is the right choice based on your unique situation.
Intrauterine Insemination (IUI): A Less Invasive First Step
A Less Invasive First Step
Intrauterine insemination (IUI) is a popular first-line treatment for infertility that is less invasive and less expensive than other assisted reproductive technologies (ART) like in vitro fertilization (IVF). IUI involves placing specially washed sperm into a woman’s uterus when she is ovulating to increase the chances of pregnancy.
For IUI, the male partner will provide a semen sample to be washed and concentrated in a lab. The concentrated sperm is then inserted directly into the uterus using a thin flexible catheter. This procedure maximizes the number of motile sperm placed close to the fallopian tubes, increasing the odds of conception.
IUI only requires minimal sedation and has a quick recovery with minor cramping. It can be performed in a doctor’s office and typically costs between $300 to $1000 per cycle. IUI has a 10-20% chance of success for each cycle, with most pregnancies occurring within 3 cycles. Some factors that can influence IUI success rates include:
- Maternal age – Younger women typically have higher success rates.
- Cause of infertility – IUI has the best outcomes for infertility due to cervical mucus problems, menstrual problems, mild male factor infertility, and unexplained infertility.
- Use of fertility drugs – Using drugs like clomiphene citrate or gonadotropins to stimulate the ovaries can increase the number of mature follicles and improve pregnancy rates.
For many couples, IUI is an accessible first step that is less physically, emotionally and financially taxing than other ART procedures. Although multiple cycles may be required, IUI offers an opportunity to achieve pregnancy in a natural way and at a lower cost. If after 3-6 cycles of IUI you are still not pregnant, it may be time to consider moving on to IVF for better success rates. But starting with IUI, the simpler option, is often the smart choice.
Intra-Cytoplasmic Sperm Injection (ICSI)
Intra-Cytoplasmic Sperm Injection (ICSI) is an assisted reproductive technology (ART) procedure in which a single sperm is injected directly into an egg. ICSI is often used when there are concerns about fertilization due to low sperm count or quality.
- During ICSI, eggs are retrieved from the ovaries as in standard IVF. However, instead of allowing sperm to fertilize the eggs on their own, a single sperm is selected and injected into each egg.
- The fertilized eggs (now embryos) are then cultured in a laboratory for 3-5 days before the best quality embryos are selected for transfer into the uterus.
ICSI has a good chance of success, with fertilization and pregnancy rates comparable to those of traditional IVF. According to Zora Health data, ICSI has an average fertilization rate of approximately 65-75% and a live birth rate of around 30-40% per embryo transfer.
- ICSI requires surgical egg retrieval, so there are risks associated with anesthesia and the procedure. However, the risks are very small when performed by an experienced specialist.
- There is a small increased risk of genetic abnormalities in children born from ICSI compared to natural conception. However, the vast majority of ICSI children are born healthy.
- ICSI is more expensive than traditional IVF due to the additional laboratory procedures required. The cost will depend on medications needed and the number of cycles required.
In summary, ICSI can be an effective fertility treatment option, allowing couples to conceive a child that is genetically related to both parents. By directly injecting sperm into eggs, ICSI helps overcome problems with fertilization and increases the odds of a successful pregnancy. When deciding on a fertility treatment, consider your specific situation and infertility diagnosis as well as the pros and cons of each option. An infertility specialist can help determine if ICSI is right for you.
Difference between the 3 treatments
Intrauterine Insemination (IUI)
Intrauterine insemination, or IUI, is a fertility treatment where sperm is inserted directly into a woman’s uterus. During IUI, specially washed and concentrated sperm are injected into the uterus at the time of ovulation to increase the chances of pregnancy. IUI is often used for unexplained infertility, mild male factor infertility, and women with ovulation problems.
The IUI procedure is very quick and non-invasive. First, ovulation is monitored using ultrasound and blood tests. Once ovulation has occurred, the sperm sample is inserted into the uterus using a thin, flexible catheter. This maximizes the chances of sperm reaching the egg. IUI has a 10-20% success rate per cycle and most couples will try 2-3 cycles before moving on to more advanced treatments.
In Vitro Fertilization (IVF)
In vitro fertilization or IVF is an assisted reproductive technology where eggs are retrieved from a woman’s ovaries and fertilized by sperm in a lab. The resulting embryos are then transferred into the uterus. IVF is used to treat infertility caused by damaged or blocked fallopian tubes, ovulation disorders, male factor infertility, or unexplained infertility.
The IVF process starts with fertility drugs to stimulate the ovaries to produce multiple eggs. Eggs are then retrieved through a minor surgical procedure. In the lab, the eggs are fertilized by sperm and incubated for 3-5 days. 1-2 healthy embryos are selected for transfer into the uterus. Any remaining high-quality embryos can be frozen for future use. IVF has a success rate of 40-60% per cycle for women under 35. Multiple cycles may be required to achieve pregnancy.
IVF is more invasive and expensive than IUI but also has a higher success rate. For some couples, it represents the best option to achieve pregnancy and start a family. By understanding the differences between IUI, IVF and other fertility treatments, you can work with your doctor to choose the option that is most suitable based on your unique situation.
Egg Freezing: For Future Fertility Preservation
What Is Egg Freezing?
Egg freezing, or oocyte cryopreservation, is a method of preserving a woman’s fertility for the future. Eggs are harvested from the ovaries, frozen unfertilized, and stored for later use. When a woman is ready to become pregnant, the eggs can be thawed, fertilized, and transferred to the uterus as embryos.
Who Should Consider Egg Freezing?
Egg freezing is ideal for women who want to preserve their fertility for various reasons, including:
- Medical treatments like chemotherapy that can damage the ovaries and eggs. Freezing eggs beforehand allows for a chance of pregnancy in the future.
- Lack of a current partner but wanting the option of having biological children later on in life. Frozen eggs can be used with a future partner when the time is right.
- Delaying pregnancy to focus on education, career, finances or other life goals. Egg freezing stops the biological clock, enabling pregnancy at an ideal time in the future.
The Egg Freezing Process
- Ovarian stimulation: Injectable fertility drugs are given to stimulate the ovaries to produce multiple eggs in one cycle. This typically takes around 10-14 days.
- Egg retrieval: Eggs are retrieved from the ovaries through an ultrasound-guided needle inserted through the vagina. Sedation or anesthesia is used. Most women resume normal activities within a day or two.
- Freezing: The retrieved eggs are flash frozen using a technique called vitrification and stored at sub-zero temperatures using special cryogenic equipment.
- Future use: When ready to become pregnant, the eggs are thawed and fertilized using IVF. After a few days of development, embryos are transferred to the uterus.
- Success rates: Egg freezing has become very effective, with survival rates over 90% and pregnancy rates around 50-70% per transfer using frozen eggs. Success depends on a woman’s age at the time of freezing and egg quality.
Egg freezing provides women more freedom and flexibility over their reproductive choices. By taking steps to preserve fertility today, the chance to have a biological child in the future remains open. With high success rates and low risks, egg freezing is an empowering option for women to consider.
Surrogacy: Using a Gestational Carrier
Surrogacy Using a Gestational Carrier
Surrogacy involves using a gestational carrier to carry and deliver a baby for you and your partner. The most common types are:
- Gestational surrogacy: The surrogate carries an embryo created with the intended parents’ egg and sperm. She has no genetic relationship to the child.
- Traditional surrogacy: The surrogate’s own egg is fertilized, so she is the biological mother. This type is less common due to legal complexities.
The Surrogacy Process
- Find a surrogacy agency to help match you with a surrogate. They will facilitate the legal contract and manage the medical process.
- Choose between an agency’s pre-screened surrogates or advertise for an independent surrogate. Consider factors like health, experience, and personality.
- Negotiate a surrogacy contract outlining each party’s rights and responsibilities before starting the medical process.
- Sync the surrogate’s cycle with the intended mother’s or donor’s cycle. The embryo is then transferred to the surrogate.
- During the pregnancy, the surrogate will attend regular checkups and updates will be provided to the intended parents.
- After delivery, legal proceedings will establish the intended parents as the child’s legal guardians.
The surrogacy success rates are quite high, around 75% for fresh embryo transfers in the US and UK. However, surrogacy can be expensive, often costing over $100,000 in total. The legal complexities also differ in each country and territory.
If you seek an alternative path to pregnancy, surrogacy may offer you the opportunity to have a child who is biologically related to you and your partner. With professional support, open communication, and a carefully considered legal contract, surrogacy can be a rewarding experience for all parties.
Fertility Drugs: To Stimulate Ovulation
What Are Fertility Drugs?
Fertility drugs are medications used to stimulate ovulation and increase the chances of pregnancy. The most common fertility drugs are clomiphene citrate (Clomid) and gonadotropins (Follistim, Gonal-F). These work by stimulating the ovaries to produce multiple eggs in one cycle, instead of the usual one egg.
How Do Fertility Drugs Work?
- Clomiphene citrate blocks estrogen receptors in the brain, causing the pituitary gland to increase production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones stimulate the ovaries to produce multiple eggs.
- Gonadotropins are synthetic versions of FSH and LH. They are injected to directly stimulate the ovaries to produce multiple eggs.
- The pregnancy success rate per cycle of clomiphene citrate is around 10-20% for women under 35. For gonadotropins, the rate is around 20-30% per cycle for women under 35. Rates are lower for older women.
- Cumulative success rates—the chances of becoming pregnant over multiple cycles—are higher, around 50-70% for both medications.
Potential Side Effects
- Side effects of clomiphene citrate include hot flashes, nausea, bloating, and mood changes. Gonadotropins can cause similar side effects plus redness and irritation at the injection site.
- A rare but serious risk of gonadotropins is ovarian hyperstimulation syndrome (OHSS), in which the ovaries become swollen and painful. Severe OHSS requires hospitalization and can be life-threatening.
- The cost for clomiphene citrate is usually under $100 per cycle. Gonadotropin treatment can cost $3,000-$5,000 per cycle, depending on the medication and dosage. Insurance coverage varies, but many plans cover at least part of the cost of fertility treatments.
Fertility drugs are a common first step in treating infertility and helping many couples conceive. By understanding how these medications work and their success rates, side effects, and costs, you can determine if fertility drugs may be the right option for you. Speak to a fertility specialist for a full assessment and recommendation on the treatment that will maximize your chances of pregnancy.
Artificial Insemination: Increasing Your Chances Naturally
Artificial insemination (AI) is a procedure where sperm is inserted directly into a woman’s uterus, fallopian tubes, or cervix to increase the chances of pregnancy. For couples struggling with infertility, AI can be an effective way to conceive naturally before pursuing more advanced treatments.
How AI Works
During the procedure, a semen sample from your partner is washed and concentrated. Then, using a syringe, the sperm is injected into the reproductive tract. This places the sperm closer to the egg, increasing the likelihood of fertilization. AI is often done using the intrauterine insemination (IUI) method, where sperm is injected into the uterus. IUI has a 10-20% chance of success for women under 35.
Candidates for AI
AI can be suitable for couples in which:
- The male partner has a low sperm count or decreased sperm motility. By inserting sperm directly, more have a chance to reach the egg.
- Cervical mucus hostility is preventing sperm from passing through the cervix. AI bypasses the cervix.
- Unexplained infertility has been diagnosed after basic testing. AI may overcome certain obstacles before moving on to advanced treatments.
- Donor sperm is being used. AI ensures the sperm is placed in the optimal location for fertilization.
The AI Process
- Initial consult: Discuss medical history and options with your doctor to determine if you’re a candidate for AI. Conduct any necessary testing.
- Cycle monitoring: Track your menstrual cycle to determine when ovulation will occur. This pinpoints the optimal time for insemination.
- Semen collection: Your partner provides a semen sample, usually 1-2 days before ovulation. The sample is washed and concentrated.
- Insemination: The sperm is injected into the reproductive tract, guided by an ultrasound. The procedure takes just a few minutes and has minimal discomfort.
- Pregnancy test: Take a home pregnancy test about two weeks after insemination to determine if it was successful. See your doctor for a blood test to confirm.
AI provides an accessible first step for many couples facing fertility challenges. When performed at the proper time during ovulation, it can be very effective at assisting you in conceiving naturally before pursuing more invasive treatments. Discuss with your doctor if AI may be right for your situation.
Donor Eggs or Sperm: For Those Needing Donor Gametes
If you or your partner have unviable or irretrievable eggs or sperm, donor gametes may be an option to consider for fertility treatment. Donor eggs or sperm can be used with intrauterine insemination (IUI) or in vitro fertilization (IVF) to help achieve pregnancy.
Finding an Egg or Sperm Donor
- Work with a fertility clinic to review donor profiles and select candidates based on factors like physical attributes, medical history, and personality.
- Donors go through rigorous screening and testing to minimize risks.
- Donor sperm is often frozen for at least 6 months before use for quarantine and testing. Fresh or frozen donor eggs may be used.
- Anonymous or open-identity donors are options. Anonymous donors cannot be identified, while open donors may be known to any offspring at age 18 or older, depending on regulations.
Using Donor Gametes in Treatment
- IUI: Donor sperm is inseminated into the uterus. Fresh or frozen donor eggs are fertilized with partner’s sperm before transfer.
- IVF: Donor eggs are retrieved, fertilized in the lab with partner’s sperm, and resulting embryos are transferred to the uterus. Excess embryos can be frozen for future use.
- Success rates are typically higher with donor eggs (over 50%) versus donor sperm (10-30% per IUI cycle), due to egg quality.
- Using donor gametes does not make you any less of a parent. You will still carry and care for the child.
- Counseling and support groups can help you work through concerns.
- Discuss with your doctor issues like anonymity, health risks, and informing offspring of their genetic origins.
- Costs vary but typically range from $5,000 to $30,000 per donor egg cycle and $500 to $1,000 per vial of donor sperm.
In summary, with the help of donor eggs or sperm, many who thought pregnancy was out of reach can find success with fertility treatments like IUI or IVF. But such an important decision deserves careful consideration of all implications before moving forward. Speaking with others who have used donor gametes may provide valuable insight into this life-changing choice.
Laparoscopic Surgery: To Correct Anatomical Problems
Diagnosing the Problem
If you have been trying to conceive for 6-12 months without success, laparoscopic surgery may be recommended to evaluate and possibly correct anatomical problems that could be contributing to infertility. Laparoscopy uses a thin, flexible tube with a camera called a laparoscope to view the reproductive organs and look for any abnormalities. The most common issues identified are endometriosis, fibroids, scar tissue, ovarian cysts, or blockage of the fallopian tubes.
Laparoscopy is a minimally invasive outpatient procedure with small incisions. You will be under general anesthesia during the 30 to 90 minute surgery. The laparoscope is inserted through an incision in the belly button, and the reproductive organs are examined. If any problems are found, the surgeon can often correct them during the same procedure using small instruments. For example, endometriosis tissue can be removed, ovarian cysts drained or removed, and fallopian tube blockages repaired.
Recovery and Success Rates
Recovery time is typically a few days to 2 weeks. Most women can return to normal activities within a week. Success rates depend on the specific issue being addressed, but laparoscopic surgery to unblock fallopian tubes or remove endometriosis tissue can improve fertility in up to 70% of women. The procedure itself has a very low complication rate of around 2%. For women over 35, time is of the essence, so laparoscopy may be recommended sooner to maximize the chance of conceiving.
In summary, laparoscopic surgery is a very effective way to both diagnose and treat common anatomical fertility issues. If you have been struggling to get pregnant for an extended period, talking to your doctor about doing a laparoscopy could be the key to finding and fixing the problem, allowing you to move on to less invasive treatments or even conceive naturally. The minimally invasive nature of the procedure means little down time, but the potential benefits to your fertility can be huge.
Complementary and Alternative Treatments: Acupuncture and Herbal Medicines
Acupuncture is an ancient Chinese medical practice that uses needles to stimulate pressure points on the body. The goal is to restore the flow of life energy or qi (pronounced “chee”). Acupuncture is thought to increase blood flow to the ovaries and uterus, which may improve fertility.
Studies on acupuncture and fertility have shown mixed results. Some research indicates acupuncture may improve fertility by:
- Regulating menstrual cycles in women with irregular periods.
- Improving blood flow to the ovaries and uterus.
- Reducing stress and promoting relaxation. Stress is known to negatively impact fertility.
- Improving sperm quality and motility in men.
The acupuncture treatment for fertility typically involves one or two sessions per week for several months. The needles are inserted at strategic points in the body that are thought to influence fertility. The treatments are usually combined with herbal medicines for maximum benefit.
While acupuncture is considered very safe when performed by a licensed practitioner, some risks include soreness, bruising, and infection at the needle sites. The success rates of acupuncture for fertility treatment alone are generally lower than medical assisted reproductive technologies. However, when combined with IVF or IUI, studies show acupuncture may help improve success rates.
If you’re considering acupuncture to enhance your fertility, look for an acupuncturist with experience treating infertility. Acupuncture may increase your chances of conceiving, especially when combined with medical treatment. At the very least, it can help you relax and cope with the stress of trying to get pregnant. For the best results, start acupuncture treatments at least three months before any assisted reproductive procedures.
FAQ: What Is the Success Rate of Fertility Treatments?
Success Rates Vary By Treatment Type
The likelihood of getting pregnant and having a live birth with fertility treatments depends on several factors, including a woman’s age and the specific type of treatment. According to the Society for Assisted Reproductive Technology, the average live birth rate for all ART treatments combined is around 30% in the U.S. However, success rates can vary significantly based on the procedure.
- Intrauterine insemination (IUI), in which sperm is placed directly into the uterus, has a 10-20% chance of pregnancy per cycle for women under 35. For those over 35, the rates are lower at around 5-10% per cycle.
- In vitro fertilization (IVF) has a higher chance of success, around 30-40% per cycle for women under 35. For women 38-40, the success rate is 20-30% per cycle. IVF with frozen embryos (FET) has slightly lower chances, around 25-35% for women under 35.
- Using donor eggs or embryos, the live birth rate is around 50% per cycle for most women. The age of the egg donor is a significant factor in success rates.
- Other advanced treatments like preimplantation genetic testing (PGT) or surrogacy may have higher or lower chances depending on individual circumstances.
In general, younger women have the best prognosis for fertility treatments due to higher egg quality and quantity. However, many factors are involved, and success is never guaranteed. The most important thing is to discuss expectations and options with your fertility specialist based on your unique situation. While the waiting and uncertainty can be difficult, many couples are eventually able to conceive and have a healthy baby with the help of fertility treatments.
As you can see, you have many options to consider in your fertility journey. Discussing the pros and cons of each treatment with your doctor is critical to finding what will work best based on your medical needs and personal preferences. While some treatments like IVF may seem more intensive, they also have the highest success rates. IUI and fertility drugs are more affordable but may require repeated cycles. Surrogacy and adoption are alternatives if pregnancy is not possible or desired.
The path to parenthood looks different for each person. With patience, perseverance and an open mind, you can explore various avenues to build your family. Staying informed about the latest research and technological advancements will help guide you to the right solution. Wishing you the very best as you take this important next step. The joys of motherhood will make all the effort worthwhile.
Anna Haotanto is the Founder of Zora Health and a passionate advocate for women’s empowerment. Anna’s personal experiences with egg-freezing, PCOS and the challenges of fertility have fueled her mission to provide high-quality information, financing, and support to help women and couples navigate their fertility journeys with confidence. She is also recognised for her achievements in finance, entrepreneurship, and women’s empowerment, and has been featured in various media outlets. You can also follow her on Linkedin or Instagram.
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