If you’re considering fertility treatments, you may already know that there are many options out there—and there is no one-size-fits-all solution.
So where do you start, with all of the information and options available to you? This may not be a surprise, but the best place to begin is simply meeting with your doctor. Less is more when it comes to fertility treatments, and while you may still need more complex procedures or medications, your specialist can help guide you.
You’ll most likely start by meeting with your fertility specialist for a thorough history and some basic gold-standard tests. These tests often include blood work (to evaluate hormones that can show your ovarian health and egg numbers), a carefully performed transvaginal ultrasound, a hysterosalpingogram (HSG) to evaluate shape of the uterus and to see if the tubes are normal, and a semen analysis to evaluate semen volume as well as sperm concentration, movement, and shape.
After your tests, you’ll meet with your doctor again to go over the treatments that may work best for you. Here are the most common:
- Surgery. Sometimes a surgical fix can help fertility. For example, endometrial polyps have been shown to lower the chance for pregnancy. Their removal has been shown to restore fertility, often without the need for any further treatment.
The types of surgeries your doctor may discuss with you are usually minimally invasive, and may include hysteroscopy, where a narrow camera is placed into the uterine cavity, or laparoscopy, where a narrow camera is placed through the belly button into the abdomen. Many of these surgeries can be performed on an outpatient basis.
- Ovulation induction. When a woman ovulates each month, she usually releases one egg at a time, chosen by her body from a pool of available eggs. However, there are conditions that can lower your chance of ovulating naturally. Age can also be a factor. As a woman gets older, she has fewer eggs available at a time, and those eggs are less likely to be genetically normal.
Your doctor can prescribe medications to cause ovulation, or to help you release more than one egg at a time, improving your chance each cycle of releasing a normal egg for fertilization. These medicines are often anti-estrogens that temporarily block the estrogen receptor, like Clomid (clomiphene), or injections that directly stimulate egg growth and development in the ovary (often gonadotropins like Gonal-F, Follistim, Bravelle, and Menopur).
A different injection (usually hCG—Novarel, Pregnyl, and Ovidrel) is given to help make ovulation more predictable.
- In vitro fertilization (IVF). IVF is a process where eggs are removed from the ovary, fertilized in a laboratory, and incubated over 3 – 6 days. One or two embryos are chosen to be transferred into the uterus.
IVF is best for women with conditions like blocked tubes, endometriosis, and poor ovarian reserve (not many eggs available in the ovaries). It may also be a good option where there is a moderate or severe male factor (meaning there may be abnormally low sperm volume, concentration, movement, or an abnormal shape).
In order to produce a lot of eggs to be collected, gonadotropins are also used, at a higher dose than for ovulation induction.
This is the first in a series of guest posts from fertility doctor Dr. Mousa Shamonki. Have any questions or requests for more information? Let us know.