When To Seek Infertility Treatment

Advances have led to more infertility treatment options

Thoughtful husband embraces his smiling wife after discussing potential fertility treatments with Scripps Heath.
A couple struggles to become pregnant for more than a year. Then, after getting medical help, they realize their dream of having a baby. It’s a story with a happy ending that is more common than ever today thanks to advances in infertility treatment.

“With continuing advances in reproductive medicine, many couples are able to overcome their fertility problems and conceive one or more children,” says Lila Schmidt, MD, an OB-GYN and fertility specialist at Scripps Mercy Hospital.

Many couples continue to struggle to conceive, however. One in eight couples have difficulty getting pregnant or staying pregnant, according to the National Institutes of Health.

“Infertility can cause emotional distress. But if you’re struggling with it, you need not lose hope,” Dr. Schmidt adds. “There are more safe and effective infertility treatment options than ever, including medication, surgical procedures and assisted reproductive technology, such as in vitro fertilization.”

What is infertility?

Most couples will achieve pregnancy within a year of trying. Infertility is defined as not being able to get pregnant after one year or longer of regular unprotected sex and not being able to maintain a pregnancy.

What causes infertility?

Fertility decreases with age. About one-third of couples where the woman is older than 35 years have fertility problems. Couples in where the male partner is 40 years old or older are more likely to have difficulty conceiving. Other factors for men and women include smoking and excessive use of alcohol.

When to get a fertility test

In general, a couple doesn’t need to seek medical help for infertility until they’ve tried to conceive for one year or have an obvious problem or a condition that is interfering with conception. However, since a woman’s age can affect her fertility, women over the of age 35 should have an evaluation if they’ve been trying to conceive for over 6 months. For women over 40 years old, it they should be seen immediately.

“A woman may wish to see a fertility specialist sooner if she has a history of irregular menstrual cycles, miscarriage, pelvic inflammatory disease, endometriosis, polycystic ovarian syndrome, uterine fibroids or other gynecological problems,“ says Brooke Friedman, MD, an OB-GYN and fertility specialist at Scripps Memorial Hospital La Jolla.

Infertility may be due to a single factor in either the male or the female. It may also be due to a combination of factors involving both partners.

“The first step toward a solution is to get a fertility evaluation,” says Dr. Friedman. “Through diagnostic testing, a fertility specialist can help create a personalized treatment plan that’s right for you.”

Fertility test for men

In about 30 percent of couples with infertility, a male factor is the primary cause of infertility.

Infertility in men is often due to a problem with sperm production or sperm delivery. “A semen analysis can help identify any problems with the male reproductive system,” Dr. Friedman says.

Fertility test for women

Women need a healthy and functioning reproductive system to get pregnant. Infertility in women is often due to problems with ovulation, which are often caused by hormone imbalances. Other problems include blocked fallopian tubes and physical problems with the uterus.

“Your physician may need to perform multiple tests to determine the exact cause of the problem,” Dr. Friedman says. These tests may include hormone blood tests, pelvic ultrasound, and a hysterosalpingogram, which is an X-ray test that checks to see if the fallopian tubes are open.

Infertility treatments

Infertility treatment options include medications to induce ovulation, intrauterine insemination (IUI) and in vitro fertilization (IVF). Your options will vary based on the cause of the problem.

Fertility medications

Fertility drugs may be prescribed to help induce ovulation if the problem is hormonal in nature. They can be used with other infertility treatments, such as IUI, which is a procedure where sperm is directly inserted through a woman’s cervix and placed near the top of the uterus. The goal is to increase the number of sperm that can reach the egg targets.

In vitro fertilization (IVF)

IVF is the most effective fertility treatment available that uses assisted reproductive technology (ART). ART refers to fertility treatments in which both eggs and embryos are handled outside the body.

With IVF, eggs are removed from a woman’s ovaries in an outpatient procedure under anesthesia and fertilized with sperm in a lab setting. The fertilized eggs, or embryos, are allowed to grow and develop for 5-6 days in the IVF lab. Generally, one embryo is then transferred back into the uterus to achieve pregnancy via the vagina. Your physician may suggest a variation of IVF based on the cause of infertility.

“Success can vary depending on factors, such as the woman’s age,” Dr. Schmidt says. “As a woman ages, the rate of success declines.”

IVF can sometimes be a lengthy and emotionally challenging process. It’s important to get support. IVF can be costly also, especially if the woman has to go through more than one cycle.

IVF sometimes involves the use of donor eggs, donor sperm or previously frozen embryos. A gestational carrier or surrogate may also be involved.

Egg freezing

Women today are often waiting until they’re in their 30s and 40s to have children. Single women or couples delaying childbearing have an advantage. They can turn to egg freezing to try to preserve their fertility and increase the chances of conceiving when they’re ready.

Surgery

For some conditions, surgery may be recommended. For women, procedures may include:

Hysteroscopy to treat fibroids, adhesions or uterine septum.
Myomectomy, including robotic myomectomy, to remove uterine fibroids
Reversal of a tubal ligation (tied tubes)
Laparoscopy to treat endometriosis, including robot-assisted surgery

Endometriosis causes the uterine lining to grow outside the uterus causing pain, irregular bleeding and sometimes infertility.

“This is an exciting time in reproductive medicine and new developments in research and technology promise even more advancements in achieving safe, healthy pregnancies,” Dr. Schmidt says.