Fertility treatments explained: medicines, surgery and insemination

Once the likely cause of a fertility problem is known, doctors can discuss treatment. This article gives an overview of the main options described by the NHS, MedlinePlus and the NICHD, and explains what to ask.

1. Introduction

The NHS says treatment for infertility depends on the cause and on what your local health service provides. The NHS says infertility is usually diagnosed and treated after a couple has tried to conceive for 2 years through regular unprotected sex ^{[1, 3]}. MedlinePlus lists the main routes as treating an underlying cause, medicines, assisted reproductive technology and surgery. It adds that options depend on the cause, how long a couple has been trying and age ^[2]. The NICHD says that most cases of infertility, 85 to 90 percent, are treated with conventional therapies such as medicine or surgery ^[4].

2. Medicines

Several medicines can help the body release an egg (ovulate). The NHS names clomifene and tamoxifen for ovulation problems, and metformin, which is particularly helpful for women with polycystic ovary syndrome (PCOS), a condition the NHS now calls polyendocrine metabolic ovarian syndrome. Gonadotrophins, which are hormones, can stimulate ovulation in women and may improve fertility in men. Other options include GnRH and dopamine agonists ^[1].

The NHS lists possible side effects such as nausea, being sick, headaches and hot flushes. It also says ovary-stimulating medicine is not recommended for unexplained infertility, because it has not been shown to improve the chance of pregnancy in that group ^[1]. Never start or stop fertility medicines without medical advice.

3. Surgery

The NHS describes several operations ^[1]:

• Fallopian tube surgery can remove scar tissue. Success depends on how much damage there is, and ectopic pregnancy, where an embryo grows outside the womb, is a possible complication.
• Keyhole (laparoscopic) surgery can treat endometriosis and remove certain fibroids (submucosal fibroids). For PCOS, when ovulation medicines have not worked, a procedure called laparoscopic ovarian drilling uses heat or a laser.
• Surgery for men can correct a blockage in the epididymis, part of the sperm-carrying tubes. Sperm can also be taken surgically when there is an obstruction, when the vas deferens (the sperm tube) is missing from birth, or after a vasectomy or failed reversal. It is usually an outpatient procedure under local anaesthetic, sometimes general, and any sperm collected is frozen for later use.

4. Assisted conception

Intrauterine insemination (IUI) is a treatment in which, the NHS explains, sperm is washed, the fastest-moving sperm are selected, and they are placed into the womb through a thin tube ^[1].

In vitro fertilisation (IVF) uses fertility medicine to stimulate egg production. The eggs are fertilised with sperm in a laboratory and the resulting embryo is returned to the womb ^[1]. The CDC groups IVF with other procedures that handle eggs or embryos under the name assisted reproductive technology (ART), and says treatments that handle only sperm, such as IUI, are not counted as ART ^[6].

5. Donor eggs and sperm

The NHS says donor eggs or sperm are available, and donor eggs are usually used with IVF. People who registered to donate after 1 April 2005 can no longer stay anonymous, and a child can learn the donor's identity at age 18 ^[1]. The NICHD notes that donated eggs or sperm, or another woman carrying a pregnancy, are options if other treatments fail ^[4]. Ask your clinic what rules apply to donors where you live.

6. Risks, costs and success

Treatment has risks. The NHS says IVF can lead to multiple pregnancy, including twins, which significantly raises risks for the mother and babies, and ectopic pregnancy is slightly more likely ^[3]. MedlinePlus says the most common complication of assisted reproductive technology is multiple pregnancy, and that limiting the number of embryos transferred can prevent or reduce it ^[5].

Private treatment can be expensive with no certainty of success. The NHS advises choosing a clinic licensed by the Human Fertilisation and Embryology Authority in the UK and asking for a fully costed treatment plan ^[1]. It also suggests checking success rates and waiting times before choosing a clinic ^[1]. It also says there is no evidence that complementary therapies are effective for fertility problems, and that NICE says more research is needed ^[1]. Whatever you try, tell your doctor about every treatment you use. It is also reasonable to ask a clinic how many embryos it usually transfers, how many cycles patients like you often need, what each stage costs, and what support or counselling is offered, because treatment can be emotionally and financially demanding.

7. When to see a doctor

Speak to a doctor or fertility specialist if you are thinking about treatment, because MedlinePlus says the choice of treatment depends on the cause, how long you have been trying and your age ^[2]. If you are having IVF, contact your clinic urgently for abdominal pain or bloating, nausea or vomiting, feeling faint or vaginal bleeding ^[7]. Seek emergency help, and do not drive yourself, for difficulty breathing, chest or upper back pain, swelling anywhere in the body, shoulder-tip pain or low tummy pain on one side, which can be signs of ovarian hyperstimulation syndrome or ectopic pregnancy ^[7]. Ask your clinic which warning signs to watch for after any procedure.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Fertility treatment ranges from medicines and surgery to IUI, IVF and donation. The right choice depends on the cause, age and personal circumstances, and success cannot be promised. The doctor decides which treatment suits you, so ask about the benefits, risks and costs of each option.