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Infertility Treatments

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various treatments for infertility.

Infertility Treatments

Transcript

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various treatments for infertility.

Hi, I'm Dr. Roger Lobo with the American Society for Reproductive Medicine. Today we're talking about treatments for infertility.

One of the most common reasons for female fertility problems is anovulation when a woman is not making or releasing mature eggs. Anovulation is most often treated with medications that work in two ways. One is to stimulate a woman's own hormones to work more effectively. The second is to provide additional hormones called gonadotropins to stimulate the ovary directly. Both treatments stimulate the ovaries to produce and release eggs. Talk to your doctor to see which method is best for you.

For some patients, basic infertility therapies do not work, and other treatment options can be considered. In vitro fertilization, called IVF, is probably the best-known form of assisted reproductive technology or ART. With IVF a man's sperm and a woman's eggs are combined outside of the body in a laboratory dish. The embryos that develop are transferred to the woman's uterus to hopefully implant in the uterine lining and continue to develop.

"Physically IVF is probably the most difficult thing I've ever done to my body. We knew we wanted to have a baby and our last resort was really IVF. So the decision didn't come easily but it was really the only decision left to be made in our journey."

IVF is a delicate procedure and should be performed in specialty centers by experienced reproductive care clinicians. It involves many stages of preparation, including medications given to the woman to stimulate multiple eggs, retrieving and inseminating the eggs with her partner's sperm, and returning the embryos to her uterus.

ART also includes other procedures often used with IVF. A procedure called intracytoplasmic sperm injection or ICSI is often used for men with sperm abnormalities. In a very delicate procedure, a single sperm is introduced through the egg's outer shell into the area where it can more easily fertilize the egg.

Multiple eggs are usually produced in an IVF cycle. After fertilization, any embryos over the number that should be transferred can be cryopreserved or frozen for future use.

Third-party reproduction using another source of sperm, eggs, or embryos, may be an option when these are not biologically possible for a couple. Some may use a gestational carrier or a surrogate when a woman cannot physically carry a pregnancy.

"In situations where a woman is missing a uterus either because she was born without a uterus or because she had it surgically removed in the past, if she still has eggs that are functional it may be possible for her to go through a process where she gets those eggs extracted. Those eggs are then mixed with her partner's sperm in the laboratory, and the embryos that then develop can be inserted into another woman's body. So that other person, the gestational carrier, can actually carry the pregnancy for the patient."

A newer technology called pre-implantation genetic diagnosis or PGD allows for certain genetic conditions to be diagnosed in the embryo before being transferred. This is a very complex procedure and is currently recommended only for specific known genetic abnormalities.

For men with infertility, there are, unfortunately, fewer treatments available. Usually, for an abnormal semen analysis, a special type of insemination called intrauterine insemination is used. Sperm are washed and concentrated to provide more sperm in a small amount of fluid. When the woman's cycle timing is right for insemination, the small sample can be inserted through a catheter directly into her uterus.

Other treatments for infertile men may involve surgery such as correction of a varicocele.

When the basic infertility therapies do not work patients can begin to consider moving on to other treatment options.

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