Topic Overview
What are fertility problems?
You may have
fertility problems if you have not been able to get pregnant after trying for
at least 1 year. Another word for this is infertility. Infertility may not mean
that it is impossible to get pregnant. Often, couples conceive without help in
their second year of trying. Some do not succeed, but medical treatments help
many couples.
Age is an important factor if you are trying to
decide whether to get testing and treatment for fertility problems. A woman is
most fertile in her late 20s. After age 35, fertility decreases and the risk of
miscarriage goes up.
- If you are younger than 35, you may want to
give yourself more time to get pregnant.
- If you are 35 or older,
you may want to get help soon.
What causes fertility problems?
Fertility problems
can have many causes. In cases of infertility:2
- About 50 out of 100 are caused by a problem
with the woman’s reproductive system. These may be problems
with her
fallopian tubes or
uterus or her ability to release an egg (ovulate).
- About 35 out of 100 are caused
by a problem with the
man's reproductive system. The most common is low sperm count.
-
About 5 out of 100 are caused by an uncommon problem, such as the man or woman
having been exposed to a medicine called
DES before birth.
- In about 10 out of 100,
no cause can be found in spite of testing.
Should you be tested for fertility problems?
Before you have fertility tests, try
fertility awareness. A woman can learn when she is
likely to ovulate and be fertile by charting her
basal body temperature and using home tests. Some
couples find that they simply have been missing their most fertile days when
trying to conceive.
If you are not sure when you ovulate, try
this
Interactive Tool: When Are You Most Fertile?
If these methods don't help, the first step is for both partners to have
some simple tests. A doctor can:
- Do a physical exam of both of you.
- Ask questions about your past health to look for clues, such as a
history of
miscarriages or
pelvic inflammatory disease.
- Ask about
your lifestyle habits, such as how often you exercise and whether you drink
alcohol or use drugs.
- Do tests that check
semen quality and both partners'
hormone levels in the blood. Hormone imbalances can be
a sign of ovulation problems or sperm problems that can be treated.
Your family doctor can do these tests. For more complete
testing, you may need to see a fertility specialist.
How are fertility problems treated?
A wide range
of treatments is available. Depending on what is causing the problem, you may
be able to:
- Take a medicine that helps the woman
ovulate.
- Have a procedure that puts sperm directly inside the
woman (insemination).
- Have a surgery that corrects a problem
caused by
endometriosis or blocked fallopian tubes.
-
Have a procedure that might increase the man’s sperm count.
If these options are not possible or don't work for you,
you may want to think about in vitro fertilization (IVF). During an IVF, eggs and
sperm are mixed in a lab so the sperm can fertilize the eggs. Then the doctor
puts one or more fertilized eggs into the woman’s uterus. Many couples try IVF
more than once.
Treatment for fertility problems can be stressful,
costly, and hard on your body. Before you start testing, make some decisions
about what you want to do. You may change your mind later, but it’s a good idea
to start with a plan.
- Learn all you can about the tests and
treatments, and decide which you want to try. For example, some couples agree
to try medicines but don't want surgery or other treatments.
- Find
out how much treatments cost and whether your insurance will cover them. If you
don't have insurance coverage, decide what you can afford.
Treatments for infertility can increase your chances of
getting pregnant. But they also increase your chance of having more than one
baby at a time (multiple pregnancy). Be sure to discuss the risks with
your doctor.
Fertility problems can put a lot of strain on a
couple. It may help to see a counselor with experience in infertility. Think
about joining an infertility support group. Talking with other people with the
same issue can help you feel less alone.
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Learning about infertility:
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Being diagnosed:
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Getting treatment:
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Personal considerations:
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Cause
Infertility
has
many causes that involve either the woman's, the man's, or both partners'
reproductive systems. Some causes include:
Rates of infertility and miscarriage increase with age. A
woman's fertility peaks in her late 20s and gradually begins to decline in her
early 30s. A more pronounced drop in fertility and increase in miscarriage risk
begins around her mid-30s, primarily due to the
aging egg supply. Male fertility also decreases with age, but it is a more
gradual decline than in women.
Symptoms
Infertility
does not cause physical symptoms. Infertility is a general term for a couple's
inability to get pregnant after 1 year of having sex 2 to 3 times a week
without using birth control methods.
For women over 35, some doctors will offer testing and
treatment after 6 months of trying to become pregnant.
What Happens
You can be considered
infertile if you have not been able to conceive after 1 year of sex without
using birth control. But some people who have an
infertility diagnosis do go on to become
pregnant.
- In couples who conceive a pregnancy without
treatment, 85% will conceive during the first year of trying to become
pregnant. Up to 93% of couples will become pregnant without treatment during 2
years of trying.2
- Infertile couples whose
fertility test results are normal are diagnosed with "unexplained infertility."
Of all couples with unexplained infertility who do not seek treatment, about
35% will naturally become pregnant within 3 years, and 45% do so within 7
years.1
Major factors that affect your chances of conceiving with
or without treatment include age, how long you have been trying to conceive,
and the cause of infertility.
- Female fertility normally decreases with age.
The older a woman is (particularly over age 35), the less likely she is to
become pregnant and the more likely she is to
miscarry. This is primarily due to the
aging of her egg supply. A woman who is over 40 and fails to ovulate despite
medicine, or who does not respond to
in vitro fertilization therapy, is encouraged to use
donor eggs.
- A couple's chances of conceiving are greatest within
their first 3 years of trying. After 3 years of sex without birth control,
pregnancy is considered unlikely without treatment.2
- If a clear cause of infertility can be determined
and if there is a promising treatment for that cause, pregnancy is more likely.
Treatment for unexplained infertility is less likely to be successful. But
medicines or assisted reproductive techniques may still be effective.
Some couples who have tried infertility treatment without
success become pregnant later without more treatment.
Personal concerns related to infertility include:
For more information, see:
-
Fertility Problems: Should I Be Tested?
-
Infertility: Should I Have Treatment?
What Increases Your Risk
Infertility
has
many causes that involve either the woman's, the man's, or both partners'
reproductive systems. Some factors that increase your
risk of infertility are within your control; others are not.
Risk factors you cannot control include:
- Age. Rates of infertility (not due to surgical
sterilization) in women increase with age and are about:1
- 7% in women ages 20 to 24.
- 9%
in women ages 25 to 29.
- 15% in women ages 30 to 34.
- 22%
in women ages 35 to 39.
- 29% in women ages 40 to 44.
- Problems with the male or female reproductive
system that were present at birth (congenital birth
defects).
- Exposure to
DES (diethylstilbestrol) before
birth.
- Moderate or severe
endometriosis, the growth of uterine lining
(endometrial) cells in other parts of the abdominal cavity (such as the ovaries
or fallopian tubes, the outer surface of the uterus, the bowels, or other
abdominal organs).
- Past exposure to very high levels of
environmental toxins, certain drugs, or high doses of radiation (including
cancer chemotherapy or radiation).
- Past infection with a sexually transmitted disease (such as
gonorrhea or
chlamydia) that has since damaged the reproductive
system.
Risk factors you may be able to control include:
- Tobacco or marijuana use, which reduces sperm counts and female
fertility.
- Drinking more than 2 to 4 alcoholic beverages daily for
several months, which decreases male fertility and causes injury to
sperm.
- Timing and frequency of intercourse—having sex every day or every other day during a woman's fertile period can improve the chance of pregnancy.
- Infrequent (every 10 to 14 days) ejaculation may temporarily lower sperm count.
- Eating a healthy diet, getting enough exercise, and staying at
a reasonable body weight. Being overweight or obese reduces fertility in both
men and women.
- Exercising intensely for months or years, which may
affect a man's sperm count and prevent a woman's ovulation.
- Increased temperature in a man's
scrotal area, which can damage sperm (common causes
are hot tub use and high fever).
- Prior surgical sterilization, such
as
vasectomy or
tubal ligation. Surgical sterilization reversal may be
successful, depending on the procedure used and how much time has passed since
the original surgery.
- Symptoms related to
polycystic ovary syndrome, a hormone imbalance that
interferes with normal ovulation. If a woman is overweight, sometimes even a
small weight loss may stimulate ovulation. If not, medicine may help.
When To Call a Doctor
Consult with your doctor about
infertility concerns if you:
- Want children but have been unable to become
pregnant after 1 year of having sex without using birth control.
- Are a woman older than 35 who has been unable to become pregnant
after about 6 months of sex without using birth control.
- Have had
three or more
miscarriages in a row.
Watchful Waiting
Before seeking medical help with conception,
increase your chances of becoming pregnant by practicing
fertility awareness. For more information, see the
suggestions in the Home Treatment section of this topic.
Who To See
Your doctor can help you evaluate a possible fertility
problem, provide some preliminary guidance, and discuss general testing and
treatment options. You can also use this appointment to provide a sperm sample
for evaluation, one of the first tests in a routine infertility workup. For
this type of help, you can consult:
For complete infertility testing, see an
obstetrician/gynecologist with specialized training
and experience in infertility. This doctor may be called a
reproductive endocrinologist or fertility specialist.
When looking for a specialist, ask what percentage of a doctor's practice is
infertility treatment and whether he or she has training in reproductive
endocrinology.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Tests for infertility usually start with simple tests for both
partners. In addition to an interview and physical exams, your initial
tests will check
semen quality and both partners'
hormone levels in the blood. Hormone imbalances can be
a sign of
ovulation problems or sperm production problems that can be
treated.
If your initial test results show no cause of
infertility, your doctor may recommend checking
fallopian tube function. Depending on your age and
other risk factors, you may then be offered further testing or you may begin
treatment with
superovulation,
intrauterine insemination, or both.
Testing can be stressful, costly, and sometimes painful. You may need only a few tests. Or you may need many tests over months and years. You and your partner will need to decide about having infertility tests.
Treatment Overview
Before you and your partner start
treatment for
infertility, talk about how far you want to go. For
example, you may want to try medicine but do not want to have surgery. While
you may rethink this end point during your treatment, it’s a good idea to have
an idea where you want to draw the line. Many couples do not think about this
in the beginning and become emotionally and financially drained from trying a
series of treatments.
Treatment for fertility can also be quite
expensive, and insurance often does not cover these expenses. If cost is a
concern for you, find out how much medicines and procedures cost and if your
insurance covers any costs. Talk with your partner about what you can afford.
Keep in mind that some infertility problems are more easily
treated than others. In general, as a women ages, especially after 35, her
chances of getting pregnant decrease and her risk of
miscarriage markedly increases.
If you
are 35 or older, your doctor may recommend that you skip some of the steps
younger couples usually take because your chances of having a baby decrease
with each passing year.
Also, understand that even if you are
able to get pregnant, no treatment can guarantee a healthy baby. On the other
hand, scientists in this field have made many advances that have helped
millions of couples have babies.
Your doctor will first try to
find why you have not been able to get pregnant. He or she will do tests to
look for a cause. Sometimes doctors do not find a problem with either the man
or the woman and don't know why a woman cannot get pregnant.
Treatment for female infertility
Problems with ovulating.If your doctor finds that you have a
problem with
ovulating, he or she may first recommend that you try
the medicine
clomiphene (such as Clomid, Serophene, Milophene). This
medicine (which you take as a pill) stimulates your ovaries to release eggs, so
it improves your chances of getting pregnant. It is often tried first because
it is considered safe and effective.
If you're not
ovulating because of a condition called
polycystic ovary syndrome (PCOS), your doctor might
suggest you take a drug such as
metformin in combination with clomiphene. For more
information, see
treatment of women who have polycystic ovary syndrome (PCOS).
Unfortunately, clomiphene does not always work.
Typically, hormone shots are the next medicine tried. You and your partner
can weigh the risks and benefits of proceeding to this next step. You start the
first series of daily shots at the beginning of your menstrual cycle. You will
probably have mild side effects, such as feeling sick to your stomach and
bloating. Some women have more serious side effects due to multiple, large
ovarian
cysts (ovarian hyperstimulation syndrome). While clomiphene increases your chance of
having twins or triplets (especially twins), women who take hormonal injections
are even more likely to have twins, triplets, or more babies.
Unexplained infertility. If your doctor cannot
find out why you and your partner have not been able to get pregnant, he or she
may start out by giving you clomiphene. The steps for treating infertility are
essentially the same as for women who have ovulation problems. The next step is
to try hormone injections. But at this step your doctor may recommend
insemination, putting the sperm directly into the
uterus, to improve your chances of getting pregnant. If these treatments don't
work, your next step is deciding whether to have IVF (in vitro fertilization).
Blocked or damaged tubes. Your doctor may do tests to check your
fallopian tubes. Blocked or damaged tubes can prevent
the egg from being fertilized by the sperm. If the blockage of your tubes is
slight, your doctor might recommend
tubal surgery to try to correct the damage. In these
cases, between 20% and 60% of women have successful pregnancies after the
surgery, depending on what part of the tube was blocked.3 But in many cases, doctors recommend skipping tubal surgery
and having IVF for more severe blockages. IVF is also often recommended first
for women over 34 (regardless of the type of blockage), because tubal surgery
and natural conception may use up precious time if in vitro fertilization might
be used later.
-
Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?
Endometriosis. If you have mild to
moderate
endometriosis that seems to be the main reason for
your infertility, your doctor may use
laparoscopic surgery to remove endometrial tissue
growth. If surgery does not work, or if you have severe endometriosis, you will
need to decide whether to try
in vitro fertilization, commonly called IVF. But understand that IVF
doesn't work as well for women with endometriosis as with other causes of
infertility.
For more information about endometriosis, see the
topic Endometriosis.
In vitro fertilization (IVF). Many couples who have problems getting pregnant arrive at a
common point: they must decide whether they want to try IVF. IVF is the most
common form of a group of similar procedures called
assisted reproductive technology, or ART. If you have
not already thought about
adoption, this might be a time to think about it. Some
couples decide at this point to spend their resources on adoption instead of
IVF. Other couples see IVF as the best option.
In IVF, the man's
sperm is mixed with the woman's eggs in a lab. Sometimes donor sperm or donor
eggs may be used. If the egg and sperm join, it is called fertilization. Your
doctor then puts one or more fertilized eggs (now called embryos) into your
uterus so that they can grow, just as in a normal pregnancy. (Usually, more
than one embryo is put in the uterus to increase your chances that one will
develop into a baby.)
IVF increases your chance of having more
than one baby at a time. Your chance of having twins with IVF is between 1 out of 3
to 1 out of 4. That means that 1 out of 3 to 4 women who become pregnant with
IVF has twins. The chance of having triplets or more is higher than normal but
much less than the chance of having twins. Your chances of multiple births
depend on how many embryos are placed in the uterus at one time.
Overall, in vitro fertilization (IVF) is emotionally and physically
taxing. You must have regular blood tests, daily hormone injections (some of
which are quite painful), and frequent monitoring by your doctor. You will
probably have side effects like bloating, weight gain, and nausea, and you risk
having serious side effects such as liver and kidney problems. The embryos may
not grow into babies and the IVF must be repeated.
The good news
about IVF is that about 1 out of 3 women per IVF cycle has a baby (or babies).4
IVF success depends on your doctor’s skill and experience and your age. For the
woman, the older you are, the less likely that IVF will work unless you use
donor eggs. Also, the cause of your infertility can affect the success of
IVF.
Treatment options that are not as common include
gamete or zygote intrafallopian transfer (GIFT or
ZIFT). GIFT is the transfer of eggs and sperm into a fallopian tube through a
small abdominal incision. ZIFT is the in vitro fertilization of an egg, which
is transferred to a fallopian tube through a small abdominal incision. These
procedures are rarely done in the United States. Nearly all couples choose IVF,
in which the fertilized egg or eggs are placed in the woman's uterus through
the cervix. IVF is less expensive than GIFT or ZIFT. It is also less risky,
because it is not a surgical procedure.
Treatment for male infertility
A
semen analysis will be done to see whether the sperm
are healthy and if the sperm count is sufficient. Your doctor might recommend
that you try insemination first. The sperm are collected and then concentrated
to increase the number of healthy sperm for insemination.
If
insemination does not work, your doctor may recommend that you try ICSI (say
"ICK-see"). ICSI stands for
intracytoplasmic sperm injection. In a lab, your
doctor injects one of your sperm into your partner’s egg. If fertilization
occurs, the doctor puts the embryo into your partner's uterus, just as in vitro
fertilization (IVF).
Your doctor may also recommend ICSI if you
have had a vasectomy or you have retrograde ejaculation. In retrograde
ejaculation the semen is ejaculated into the bladder instead of out through the
penis. In these cases, sperm can be taken from the
testicles so that they can be injected into an
egg.
Also for retrograde ejaculation, the sperm can be recovered
from the bladder, washed, and used for insemination.
In very rare
cases, infertility problems are caused by hormonal imbalances. Men are then
treated with medicine or hormones, such as
GnRH,
gonadotropins, and
bromocriptine, that help the hypothalamus and
pituitary gland start normal sperm production.
When healthy sperm
are not available or ICSI does not work, your doctor may recommend you use a
donor's sperm. Other couples might choose adoption.
For more
information on making the decision about treatment, see:
-
Infertility: Should I Have Treatment?
-
Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?
What To Think About
Both medicine and assisted
reproductive technology, such as IVF, increase your
risk of having twins, triplets, or more babies.
Complications of multiple pregnancy become more likely
with each additional fetus. For more information, see the topics
Multiple Pregnancy: Twins or More,
Preterm Labor, and
Premature Infant.
There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques. Talk with your doctor about these possible risks.
Other rare
complications—such as
ovarian hyperstimulation syndrome—can result from
hormone shots used to stimulate ovulation, usually for assisted reproductive
technology such as IVF.
Infertility treatment success is influenced by many factors, including your doctor's skill and experience, and the cause or
causes of your infertility.
Infertility treatment centers are not
widely available in some parts of the country, especially in rural areas. You
may need to travel for treatment.
When you review clinic success rates, be aware that clinics
treating more severe infertility problems may have lower success rates. So,
it's possible for a clinic with a lower success rate to have greater overall
expertise than clinics with higher success rates.
When you review
treatment success rates, remember that live birth rates are always lower than
ovulation and pregnancy rates. Miscarriages are common among all women and are
more likely in women with risk factors such as older age or a poorly controlled
chronic health condition.
Prevention
Some causes of
infertility are related to lifestyle or other health
conditions. To help protect your fertility:
- Avoid using tobacco (cigarettes) and marijuana,
which reduce fertility, especially by reducing sperm counts.
- Avoid
exposure to harmful chemicals.
- Avoid excessive alcohol use, which
may damage eggs or sperm.
- Limit sex partners and use condoms to
reduce the risk of getting a
sexually transmitted disease (STD). STDs that go
undetected and untreated can damage the reproductive system and cause
infertility. If you think you may have an STD, get treatment promptly to reduce
the risk of damage to your reproductive system. Make sure you know
how to use a male condom and/or
how to use a female condom.
- To reduce the possibility of hormone imbalances, stay at a body weight that is close to the
ideal for your height. This is
very important for men as well as for women.
If you have been diagnosed with cancer and hope to have
children in the future, talk to your doctor about
preventing cancer treatment–related infertility.
Home Treatment
To decrease your risk of
infertility and increase your chances of becoming
pregnant, use the following guidelines.
Track ovulation at home
- Estimate when you are
ovulating by practicing
fertility awareness, including:
- Try this interactive tool to
calculate your peak fertility.
- Try having sex every day or every other day during a woman's fertile period. This can improve the chance of pregnancy.
- If you
exercise strenuously most days of the week, reduce your level of activity. Very
strenuous exercise can cause women to ovulate less often.
Protect sperm count and quality
- Avoid alcohol, smoking, marijuana, and other illegal drugs. Any
one of these may affect fertility.
- If you use a vaginal lubricant
during sexual intercourse, select one that does not kill or damage sperm.
- Stay at a reasonable body mass index (BMI). This will increase the health of your reproductive system. A high
BMI has been linked to reduced semen quality and changes in a man's hormones
that may reduce fertility.
- If you exercise strenuously most days of the week, reduce your
level of activity. Very strenuous exercise may be a cause of lower sperm counts
in some men.
- High
scrotal temperatures decrease sperm count and
quality5, so avoid hot tubs and saunas.
- Try to control fever when you are ill. High fever has been known
to have an adverse effect on sperm for 2 to 3 months afterward (sperm take this
long to grow from germ cells to mature spermatozoa).
General measures
Now more than ever, it's smart
to get regular exercise, eat a healthy diet, reduce or stop caffeine intake,
and drink plenty of water. Women who are trying to get pregnant should avoid
using alcohol and medicines (including
nonsteroidal anti-inflammatory drugs[NSAIDs], such as
ibuprofen or aspirin).
For more information, see the Planning for a Healthy
Pregnancy section of the topic
Pregnancy.
Medications
Medicine or hormone treatments are
often the first steps in
infertility treatment. They are also used for in vitro
fertilization and other
assisted reproductive technologies.
Medication Choices
Medicines to stimulate ovulation
-
Clomiphene citrate (Clomid) stimulates
the release of hormones that trigger ovulation. Clomiphene is typically the
first choice of treatment for unexplained lack of ovulation because of how easy
it is to use. It's taken orally rather than injected, doesn't usually cause
severe side effects, and doesn't usually require daily
monitoring.
- If clomiphene does not work, your doctor might try
hormone shots. These shots, called
gonadotropins, directly stimulate the ovaries to
produce mature eggs.
- If you have
polycystic ovary syndrome, your doctor may suggest a
medicine to help start ovulation and restore regular menstrual cycles by
correcting
insulin resistance.
Medicines used for in vitro fertilization
Other medicines
-
Gonadotropin-releasing hormone (GnRH)
(for women and men with low levels of naturally produced gonadotropins)
increases the body's production of hormones needed for egg and sperm
production. A small pump worn by the user injects a tiny amount of this drug
into the body. The drug stimulates the pituitary gland to produce hormones that
trigger ovulation in women and sperm production in men.
-
Bromocriptine and cabergoline (for women and men)
reduces high prolactin levels. High prolactin levels can prevent ovulation in
women and can prevent the release of testosterone and production of sperm in
men.
What To Think About
Ask your doctor questions about medicines you are considering, including whether there are
long-term effects, how long the treatment lasts, how often you must be tested
while taking it, and whether there are any side effects that will affect your
daily life.
Multiple pregnancy risk
If you have irregular or
no ovulation, using medicine or hormones to stimulate ovulation will increase
your chances of pregnancy. But these treatments increase your risk of multiple
pregnancy, which poses health risks to both you and your fetuses. When
thinking about an infertility treatment:
Other rare complications—such as
ovarian hyperstimulation syndrome—can result from
hormone shots used to stimulate ovulation, usually for assisted reproductive
technology such as IVF.
Surgery
In some cases of
infertility, a structural problem can be treated
surgically, increasing the chances of natural conception.
For men, surgery can be used to try to reverse a
vasectomy, correct blockage of the reproductive tract,
or correct a
varicocele (an enlarged vein in the scrotum).
For women, surgery can be used to try to correct a
fallopian tube blockage, reverse a
tubal ligation, or remove growths from the
reproductive tract. Often a structural problem or
endometriosis growths (implants) found during a
diagnostic
laparoscopy are surgically repaired during the same
procedure.
Surgery Choices
To reverse a vasectomy or repair a varicocele
-
Vasectomy Reversal, reconnecting of the tubes (vas deferens)
that were cut during a
vasectomy
-
Varicocele Repair, cutting or bypassing of a vein that has expanded into a
varicocele
To correct problems with the fallopian tubes
-
Fallopian Tube Procedures, including sterilization reversal
-
Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?
To correct problems with endometriosis
-
Laparoscopic Surgery for Endometriosis
To correct problems with uterine fibroids
-
Myomectomy for Uterine Fibroids
To stimulate ovulation in women with polycystic ovary syndrome
-
Laparoscopic Ovarian Drilling, when weight loss and medicine have not stimulated
ovulation
What To Think About
When considering a surgical
infertility treatment, ask your doctor
questions about the surgical procedure, including how
many times the surgeon has performed the procedure, what your chances of
treatment success are, and how long your recovery time will be.
Other Treatment
Some couples have known
problems that are preventing the sperm and egg from traveling to the fallopian
tubes, fertilizing, and implanting in the uterus where they develop into a
fetus. Other couples have unexplained
infertility and want to increase their chances of
pregnancy. Insemination and assisted reproductive technology (ART) procedures
can improve their odds of pregnancy by introducing the sperm to the egg in the
woman's reproductive tract (insemination) or the laboratory (ART).
Insemination procedures flush the sperm through a
thin, flexible tube directly into a woman's
vagina, cervix, uterus, or fallopian tube. Insemination procedures put sperm
closer to the egg, to overcome fertility barriers such as low sperm count and
cervical mucus. They are also used with donor sperm and can be combined with
other fertility treatments, such as clomiphene or hormone shots.
Assisted reproductive technologies (ART) are
procedures to remove eggs from a woman's ovaries (or use donor eggs) and
fertilize them with sperm outside the body. One or more fertilized eggs are
then transferred to the woman's uterus or fallopian tubes. ART is used to treat
infertility caused by problems with fallopian tubes, ovulation, and sperm, as
well as endometriosis and unexplained infertility.
These expensive and complex procedures are typically used only after more
conservative treatment methods have failed.
In order to closely
time and control the success of an ART procedure, doctors commonly control the
ovaries with hormone treatment. First, one kind of hormone is used to "shut
down" the
pituitary gland, which in turn stops the
ovaries from making eggs (menopausal
symptoms are common). This is called pituitary down-regulation with a GnRH
analogue. Then, ovulation-stimulating medicines are used to trigger ovulation
on a schedule. This process is also used before some insemination procedures.
For more information, see the Medications section of this topic.
Complementary and alternative treatments include the use of
acupuncture and dietary changes as well as relaxation techniques and mind-body
medicine. Early studies are promising about acupuncture, which may be effective
for improving sperm quality and enhancing IVF success rates. It is important to
talk with your doctor before you use any complementary or alternative
treatments.
Other Treatment Choices
Insemination procedures include
artificial insemination (AI) and intrauterine insemination (IUI).
Assisted reproductive technologies include:
-
In vitro fertilization (IVF), mixing
eggs with sperm outside the body; one or more fertilized eggs are then
transferred to the uterus using a thin flexible tube (catheter) inserted
through the cervix.
-
Intracytoplasmic sperm injection (ICSI), injecting a
sperm into an egg and then using a catheter inserted through the cervix to
transfer the egg to the uterus.
Gamete or zygote intrafallopian transfer (GIFT or ZIFT)
is rarely used because success rates with IVF are as good or better.
For couples with sperm-related infertility, ICSI can be used to achieve
the fertilization stage of the in vitro fertilization process.
What To Think About
ART makes it possible to use
donor eggs or sperm when it isn't possible to obtain healthy eggs and sperm
from one or both partners. Insemination procedures make it possible to use
donor sperm.
Overall, IVF-related injections, monitoring, and egg
harvesting procedures are emotionally and physically demanding of the female
partner. Superovulation with hormones requires regular blood tests, daily
injections (some of which are quite painful), and frequent monitoring by your
doctor. Other complications, such as
ovarian hyperstimulation syndrome, can result
(although they are very rare) from hormone shots and assisted reproductive
technology such as IVF.
Before deciding on ART treatment,
consider the possible
emotional and social, financial, religious,
ethical and legal questions questions that may come up
for you and your partner.
-
Infertility: Should I Have Treatment?
-
Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?
For a comparison between ultrasound and laparoscopy for
egg collection procedures, see
ultrasound in assisted reproductive techniques.
If you have several
miscarriages or unsuccessful IVF attempts, talk to
your doctor about genetic testing.
Other Places To Get Help
Organizations
|
InterNational Council on Infertility Information
Dissemination
|
| P.O. Box 6836 |
| Arlington, VA 22206 |
| Phone: |
(703) 379-9178 |
| Fax: |
(703) 379-1593 |
| Email: |
inciidinfo@inciid.org |
| Web Address: |
http://www.inciid.org/ |
| |
|
The InterNational Council on Infertility Information Dissemination
(INCIID—pronounced "inside") is a nonprofit organization that helps individuals
and couples explore their family-building options. INCIID provides current
information and immediate support regarding the diagnosis, treatment, and
prevention of infertility and pregnancy loss and offers guidance to those
considering adoption or child-free lifestyles.
|
|
|
American Fertility Association
|
| 305 Madison Avenue |
| Suite 449 |
| New York, NY 10165 |
| Phone: |
1-888-917-3777 |
| Email: |
info@theafa.org |
| Web Address: |
www.theafa.org |
| |
|
The American Fertility Association is a national
nonprofit organization that helps women and men facing decisions related to
family building and reproductive health—from prevention and treatment of
infertility to social and psychological concerns. The mission of AFA is to
serve as a lifetime resource for men and women who need reproductive
information and support and to forward the causes of adoption and reproductive
health through advocacy, education, awareness building, and research
funding.
|
|
|
American Society for Reproductive
Medicine
|
| 1209 Montgomery Highway |
| Birmingham, AL 35216-2809 |
| Phone: |
(205) 978-5000 |
| Fax: |
(205) 978-5005 |
| Email: |
asrm@asrm.org |
| Web Address: |
www.asrm.org |
| |
|
This organization provides literature and information on
infertility.
|
|
|
Centers for Disease Control (CDC): Assisted Reproductive Technology.
|
| 1600 Clifton Road |
| Atlanta, GA 30333 |
| Phone: |
1-800-CDC-INFO (1-800-232-4636)
|
| TDD: |
TTY: 1-888-232-6348 |
| Email: |
cdcinfo@cdc.gov |
| Web Address: |
www.cdc.gov/ART/index.htm |
| |
|
The CDC's Division of Reproductive Health is dedicated to promoting optimal reproductive and infant health and quality of life. In accordance with U.S. federal law, the CDC's Division of Reproductive Health annually publishes pregnancy success rates for assisted reproductive technology (ART) clinics. This report includes a comprehensive listing of fertility clinics, help with interpreting success rates, frequently asked questions about ART, and a glossary of terms related to infertility treatment.
|
|
|
National Institute of Child Health and Human
Development
|
| P.O. Box 3006 |
| Rockville, MD 20847 |
| Phone: |
1-800-370-2943 |
| Fax: |
1-866-760-5947 toll-free |
| TDD: |
1-888-320-6942 |
| Email: |
NICHDInformationResourceCenter@mail.nih.gov |
| Web Address: |
www.nichd.nih.gov |
| |
|
The National Institute of Child Health and Human
Development (NICHD) is part of the U.S. National Institutes of Health. The
NICHD conducts and supports research related to the health of children, adults,
and families. NICHD has information on its Web site about many health topics.
And you can send specific requests to information specialists.
|
|
|
RESOLVE: The National Infertility
Association
|
| 8405 Greensboro Drive |
| Suite 800 |
| McLean, VA 22102-5120 |
| Phone: |
(703) 556-7172 |
| Email: |
info@resolve.org |
| Web Address: |
www.resolve.org |
| |
|
RESOLVE is a nonprofit organization that provides
support and information to people who are experiencing infertility. Its goal is
to increase awareness of infertility issues through public education and
advocacy. RESOLVE supports family-building through a variety of methods,
including medical treatment, adoption, surrogacy, and the choice of child-free
living.
RESOLVE provides helpful information on handling financial
costs and insurance coverage for infertility treatment.
|
|
References
Citations
-
Lobo RA (2007). Infertility: Etiology, diagnostic
evaluation, management, prognosis. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 1001–1037.
Philadelphia: Mosby.
-
Speroff L, Fritz MA (2005). Female infertility. In
Clinical Gynecologic Endocrinology and Infertility, 7th
ed., pp. 1013–1067. Philadelphia: Lippincott Williams and Wilkins.
-
Al-Inany H (2005). Female infertility, search date
April 2004. Online version of BMJ Clinical Evidence.
Also available online: http://www.clinicalevidence.com.
-
Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology (2008).
2006 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. Available online:
http://www.cdc.gov/ART/ART2006/508PDF/2006ART.pdf.
-
Speroff L, Fritz MA (2005). Male infertility. In
Clinical Gynecologic Endocrinology and Infertility, 7th
ed., pp. 1135–1173. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
- American College of Obstetricians and Gynecologists
(2008). Medical management of ectopic pregnancy. ACOG
Practice Bulletin No. 94. Obstetrics and Gynecology,
111(6): 1479–1485.
- American Society for Reproductive Medicine (2004).
Patient's Fact Sheet: Cancer and Fertility Preservation.
Birmingham, AL: Society for Reproductive Medicine.
- American Society for Reproductive Medicine Practice
Committee (2006). Multiple pregnancy associated with infertility therapy.
Fertility and Sterility, 86(Suppl 4):
S106–S110.
- El-Chaar D, et al. (2009). Risk of birth defects increased in pregnancies conceived by assisted human reproduction. Fertility and Sterility, 92(5): 1557–1561.
- Kumar A, et al. (2007). Infertility. In AH DeCherney
et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 917–925. New York: McGraw-Hill.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Sarah Marshall, MD - Family Medicine |
|
Specialist Medical Reviewer
|
Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology |
|
Last Revised
|
April 23, 2010 |