Fertility treatments involve various options, including medical procedures, surgical procedures, intrauterine insemination (IUI), in vitro fertilization (IVF), & more.
Infertility is defined by “the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed, and unprotected intercourse or therapeutic donor insemination”. Infertility is a complex disorder and affects both men and women worldwide, with important psychologic, economic, demographic, and medical implications. Although there are no reliable figures for the global prevalence of infertility, it is estimated that fertility problems affect 8-12% of couples worldwide. In the UK, the most frequent cause of infertility is ovulatory disorders (25%), tubal damage (20%), male factors causing infertility (30%), and uterine or peritoneal disorders (10%). In about 25% of the cases, the reason for infertility stays unexplained.
Treatments for Infertility
Fertility treatment is a medical treatment to enhance the ability to produce children. There exist many treatment options for couples who suffer from infertility problems, but which one is the one to choose depends on the cause. Besides, the question in whom appears the problem is also important since there are different fertility treatments options for both men and women.
Fertility Treatments for Women
When a woman is unable to achieve a successful pregnancy after 12 months, she probably needs a fertility treatment. About 10% of women, between 15 and 44 years of age, suffer from infertility.
To manage infertility in women, hormones are often the first choice for treatment. Ovulation disorders are caused by pituitary failure and can be treated with gonadotropin-releasing hormone or gonadotrophins with luteinizing hormone activity to induce ovulation.
Polycystic ovary syndrome (PCOS) is a group of disorders affecting 5 to 10% of women of reproductive age. There exist many treatment options for women with PCOS, but number one is a change in the lifestyle (in women with a BMI of 30 or over). Otherwise, clomifene citrate, metformin or a combination are preferred medications.
Fertility Treatments for Men
Infertility in men refers to a male’s inability to make a fertile female pregnant. About 1% of men are permanently sterile, and in 20% of men, the sperm quality is below the threshold. A wide range of problems can cause men infertility, but there exist as many fertility treatments as well.
Treatment with human chorionic gonadotrophin (HCG) and human menopausal gonadotrophin (HMG) increases sperm counts. Meanwhile, gonadotrophin treatment may improve fertility in men with hypogonadotropic hypogonadism.
Some studies found a beneficial effect on semen parameters in infertile men by vitamin E. Both selenium supplementations and glutathione have been reported to improve sperm motility. Antioxidants, therefore, maybe a good option for fertility treatment. Furthermore, alpha-blockers, mast-cell blockers, corticosteroids, and antibiotics may improve the semen density, semen parameters, sperm motility, pregnancy rates, and immunological male infertility.
However, not every treatment option has shown to improve male fertility. Two Randomized Controlled Trials investigating gonadotrophin therapy for idiopathic male factor fertility problems did not show a significant difference in pregnancy rates between gonadotrophin treatment compared with placebo or no treatment in couples with idiopathic male infertility. Treatment with androgens, kinin-enhancing drugs, bromocriptine, and anti-estrogens also appear to not have any beneficial effect on male fertility treatment.
The condition azoospermia means there is no sperm present in the ejaculate (semen). Surgical treatment such as epididymovasostomy with a postinfective caudal block, surgery for ejaculatory duct obstruction, and postinfective vasal blocks may improve the patency and pregnancy rates. Also, transurethral resection of ejaculatory ducts improves semen quality and increases the overall pregnancy rate in couples where the male partner has an ejaculatory obstruction.
Besides surgery treatment for azoospermia, there is also therapy available for varicoceles. A varicocele is an abnormal enlargement in the scrotum, that occurs when the valves within the veins do not work properly. However, surgery to treat varicoceles is available, most of the studies show no improvement in pregnancy rates after this therapy.
IUI, IVF, and ICSI Treatments
Intrauterine insemination (IUI): Intrauterine insemination (IUI) is a form of treatment where sperm is inserted into the uterine cavity around the time of ovulation. IUI has been used in women with unexplained infertility, endometriosis, male factor infertility or disability.
In Vitro Fertilization (IVF): In vitro fertilization (IVF) is the fertilization of eggs with sperm outside the body. Generally, IVF is used when other treatments, such as ovulation induction therapy, treatment of endometriosis, tubal diseases, severe male factor infertility, among others, have failed. The success of an IVF treatment depends on the ability to collect an adequate number of mature eggs.
Intracytoplasmic sperm injection (ICSI): In Intracytoplasmic sperm injection (ICSI) a healthy single sperm is selected from the male’s semen to inject directly into the egg. Once an embryo develops, it’s transferred into the uterus through IVF. Indications for ICSI are a severe deficit in semen quality, obstructive azoospermia, and non-obstructive azoospermia. It should also be considered for couples with the previous failure of IVF-treatment.
ICSI improves fertilization rates compared to IVF alone, but once fertilization is performed the pregnancy rate is not better than with IVF.
Other options for couples who cannot conceive: If the above-stated treatment options for couples who have trouble conceiving do not work, or when a couple does not want to start medical treatment, other options are available. For example, donor sperm, donor eggs, surrogacy, or donor embryos. Having said all of the above, one can always go for adoption.