What Are My Fertility Treatment Options?

Understanding the Process

Before looking at the fertility options, it's important to understand that not all treatments will work for everyone, and even if you are able to get pregnant, there are no absolute guarantees of a healthy baby. Science has come a long way in helping couples overcome fertility problems, but there are no guarantees.
Some fertility problems are easier to treat than others. Fertility issues are not just a woman's problem; they can affect men as well. The options available to you may also depend on age. In general, as women age, particularly after the age of 35, the chances of getting pregnant start going down and the risk of miscarriage goes up. If you are older than 35, your healthcare provider may recommend skipping some of the infertility steps, as your chances of becoming pregnant decrease each year.
In general, a healthcare provider will suggest that you and your partner try to get pregnant on your own "naturally" for at least 12 months. However, if you are over age 35, your healthcare provider may recommend fertility treatment if you have not been able to conceive after six months of trying to get pregnant. If it has been six months to a year of trying to conceive without success, you should get a complete fertility workup for you and your partner. Your obstetrician/gynecologist can do this, or you may want to see a reproductive endocrinologist.

Specific Fertility Treatment Options

Although treatment options will be determined based on several factors, one of the first and most important steps in determining the best treatment for you is to try to diagnose the underlying cause. Some possible causes of fertility problems for women include problems with ovulation, endometriosis, or polycystic ovarian syndrome (PCOS). Men may have sperm production disorders, ejaculatory disturbances, or immunologic disorders. In some cases, no cause may be determined and the infertility problem is considered "unexplained."
While the treatment option your healthcare provider recommends will depend on a number of factors, the various options that may be considered include:
  • Fertility medications, including oral or injectable drugs
  • Intrauterine insemination (IUI)
  • Assisted reproductive technology (ART), including:
    • In vitro fertilization (IVF)
    • Gamete intrafallopian transfer (GIFT)
    • Zygote intrafallopian transfer (ZIFT)
  • Donor options
  • Surrogacy
  • Adoption.
Let's take a closer look at what's involved with each of these fertility treatment options.
Fertility Medications
A number of fertility medications can be used alone or in combination to help increase your chances of becoming pregnant. Some of the most commonly used drugs include:
  • Clomiphene citrate (Clomid®, Serophene®): If your fertility workup indicates that the problems may stem from ovulation, then clomiphene may help increase your chances of conceiving. Clomiphene can help induce ovulation, correct irregular ovulation, increase egg production, and correct luteal phase deficiency. It comes as tablets that are taken on certain days of your cycle.
  • Follicle-stimulating hormone, or FSH (Gonal-f®, Bravelle®, Follistim®): All FSH preparations require injections just beneath the skin (subcutaneous injections) or into a muscle (intramuscular injections). These hormones are used for the treatment of ovulation disorders and to help stimulate follicle and egg production for intrauterine insemination. The injections are given on certain days of your cycle, and the dosage amount can be determined using blood tests and ultrasound monitoring to measure follicular growth.
  • Human menopausal gonadotropin, or hMG (Menopur®, Repronex®): These drugs are injected either subcutaneously or intramuscularly once or twice a day. They are used to stimulate the development of follicles in women who do not ovulate regularly. They can also help stimulate ovulation for intrauterine insemination, in vitro fertilization, and other assisted reproductive technology procedures.
  • Gonadotropin-releasing hormone agonists, or GnRH agonists (Lupron®, Synarel®): GnRH agonists are synthetic drugs. They cause FSH and luteinizing hormone (LH) -- two hormones that are important for ovulation -- to be released initially, and then, after continued use, quickly suppress these hormones. This causes a clean slate on which to create a controlled ovarian hyperstimulation cycle for IVF or other ART procedures.
GnRH agonists also prevent the eggs from being released prematurely, allowing your fertility procedure to be timed to maximize the chances of fertilization of the egg.
Short-acting GnRH agonists come in two forms, including Lupron, which is given as an injection just beneath the skin daily, and Synarel, which is a nasal spray that is used twice daily.
Several long-acting GnRH agonists are also available, but due to their long-acting nature, they are not typically used for IVF or ART.
  • Gonadotropin-releasing hormone antagonist (ganirelix acetate injection, Cetrotide®): This drug is given to help control hyperstimulation cycles for IVF or other ART procedures. It is given as an injection just beneath the skin starting on day 8 of your cycle and continued for several days. It is used in combination with other drugs that will stimulate the ovaries.
  • Bromocriptine mesylate and cabergoline (Parlodel®, Dostinex®): These oral medications come as tablets that are taken daily. They can be used in women who have hyperprolactinemia (overproduction of the hormone prolactin), which can cause fertility problems by interfering with the normal production of FSH and LH.
  • Progesterone: This is a natural hormone that is given after ovulation has occurred and is used to help improve the quality of the uterine lining. It can be taken by mouth, vaginal suppository, gel, or intramuscular injection.
  • Aspirin: This can be used alone or with heparin or low molecular weight heparin medications to help reduce the risk of recurrent spontaneous pregnancy loss and to prevent miscarriages.
  • Heparin or low molecular weight heparin: This can be used alone or with aspirin to help prevent pregnancy loss due to clotting disorders or elevated levels of certain antibodies called antiphospholipid antibodies.
It's important to note that many of these medications usually have a high cost, are complex, and are not immediately available at regular retail pharmacies. You may have to find a specialty pharmacy that can provide these medications.
Also, you may run across places outside of the United States that can provide these medications at a lower cost. Be aware, however, that it is illegal to import fertility drugs from outside the United States. These medications may not be approved by the U.S. Food and Drug Administration (FDA).
Intrauterine Insemination
Couples who have unexplained infertility, male factor infertility, or women with cervical mucus problems may benefit from intrauterine insemination (IUI). This procedure involves placing sperm into a woman's uterus when she is ovulating. IUIs are usually, but not always, done in combination with ovulation-stimulating drugs. Before this procedure, your healthcare provider will make sure there are no hormonal imbalances, infections, or structural problems.
An IUI can be done using your partner's sperm or a donor's sperm from a sperm bank. The procedure is fairly quick and is performed in your healthcare provider's office without any anesthesia. Although it can be uncomfortable, an IUI should not be painful.
(Click What's Involved With an IUI? for more detailed information on this procedure, including when and how it's done.)
Assisted Reproductive Technology
Assisted reproductive technology (ART) involves a few different types of medical treatments that are designed to help achieve pregnancy. The types of ART include the following:
  • In vitro fertilization (IVF)
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Embryo cryopreservation
  • Egg or embryo donation
  • Gestational carriers.
IVF is a complex procedure that involves:
  • Hyperstimulating the ovaries to cause many follicles/eggs to be produced
  • Removing the ripened eggs from the ovaries
  • Fertilizing the eggs with sperm
  • Incubating the eggs in a laboratory dish to allow the cells to divide
  • Replacing the developing embryo in the uterus at the appropriate time.
With an IVF procedure, the process is meticulously timed using a number of medications and hormones. Although an egg may be fertilized and an embryo is placed into the woman's uterus using IVF, it does not necessarily mean she will become pregnant and carry the baby to term. However, it can help increase the chances of a successful pregnancy for many couples, especially those who have blocked or absent fallopian tubes or those who have male infertility problems. 
(Click The Ins and Outs of In Vitro Fertilization (IVF) for a closer look at what's involved with this particular ART procedure.)
GIFT is a procedure that involves fertilization taking place in the fallopian tube. This should only be done when sperm levels are adequate and at least one fallopian tube is open and functional. The process is similar to IVF, up until the point of egg retrieval.
Egg retrieval with GIFT is usually performed under general anesthesia, and the eggs and sperm are immediately transferred into a catheter. The catheter is then used to place the eggs and sperm into the fallopian tube via a laparoscopic procedure. Unlike IVF, a GIFT procedure will not involve knowing whether fertilization has taken place, nor does it allow healthcare providers to evaluate embryo quality.
ZIFT is a procedure that combines IVF and GIFT. Fertilization takes place in a laboratory, and the fertilized eggs (called zygotes) are transferred into the fallopian tubes during a laparoscopy. Although it is known which eggs were fertilized using a ZIFT procedure, an evaluation of the dividing embryo is not possible.
(Click What Is Assisted Reproductive Technology (ART)? for an in-depth look at the various ART procedures that are available and what is involved with each method.)
Donor Options
Another option for some couples may include using a donor. There are several possible donor options, such as:
  • Donor eggs
  • Donor embryo
  • Donor sperm.
Egg donation may be a good option for women who have the following medical issues:
  • Premature ovarian failure (POF), which is defined as menopause that has occurred in women before the age of 40
  • Diminished ovarian reserve
  • Those who have previously failed multiple IVF attempts, particularly if poor egg quality is suspected
  • Genetically transmittable diseases or abnormalities that could affect their offspring.
In general, women who are older than 40 years of age have reduced fertility and a poor chance for success with IVF. This is largely due to the aging of the eggs. Women who are considering egg donation should be thoroughly examined to ensure that their health would not be significantly jeopardized by pregnancy. An examination of the potential egg donor is also critical to test for infectious diseases like syphilis or HIV, genetic problems, and psychological problems.
There is a difference between egg donation and embryo donation. Egg donation is when eggs from a donor are fertilized with your partner's sperm in a laboratory dish. The resulting embryo (fertilized egg in its early stages) is then transferred to your uterus. Embryo donation is an option if you and your partner require both egg and sperm donation, or if you are a single woman who cannot use your own eggs. Embryos are typically donated by couples who have successfully had their baby from IVF and want to help other couples.
Egg and embryo donation involves a complex synchronization of the development of the recipient's uterine lining with the growth of the donor's follicles and eggs. The main risk associated with this form of fertility treatment is having multiple babies, as egg donors are typically young (usually younger than 35 years old) and pregnancy rates are high for younger women's eggs, regardless of the age of the recipient.

Therefore, the number of embryos transferred is usually limited to no more than two or three for embryos that are two to three days past fertilization. For embryos that are at the blastocyst stage (five days past fertilization), the number transferred to a recipient should generally be no more than one or two embryos.
(Click Considering Donor Eggs and Embryos for more information on the process involved with this option for fertility.)
Donor sperm may be an option in the following cases:
  • When your husband/partner has no sperm or very poor semen analysis
  • When your husband/partner has certain genetic problems that could be inherited
  • For single women who want to have a biological child.
Couples can decide which sperm bank and donor they want to use. A full profile of the donor should be available to review, including their medical history, physical characteristics, ethnic background, and education and career history. Also, the donor should be tested for various diseases, including syphilis, gonorrhea, HIV, and AIDS, just to name a few.
The American Society for Reproductive Medicine (ASRM) recommends that healthcare providers use only frozen semen and that it should be frozen and stored for at least 180 days. The procedure involves inseminating the woman as close to the time of ovulation as possible. Ovulation can be monitored by testing the urine for an LH surge, which indicates that ovulation will occur soon.

An insemination can be done once or twice per menstrual cycle. This is a simple procedure using a catheter that can be passed to the cervical opening or into the uterus. 
(See Considering Donor Sperm for more details on this procedure.)
Although this is not usually everyone's first fertility treatment option, having a surrogate carry a baby for you may be something you want to consider as well. Some couples who have exhausted other fertility treatment options may finally decide that surrogacy is their best option. For other people, surrogacy may be their only option, particularly if a woman does not have a uterus, has an impaired uterus, or has a chronic health condition that would make it impossible to carry a child.
With traditional surrogacy, the surrogate is inseminated with the sperm from the infertile woman's partner. However, with gestational surrogacy, the intended mother or an egg donor provides an egg and the intended father or a sperm donor provides the sperm. The embryo is then transferred to the surrogate, who has no genetic connection with the child.
If you are thinking about using a surrogate, you and your partner may want to discuss some important questions associated with this. Some of these questions include:
  • Are we ready to be done with other fertility treatments?
  • Are we both ready for this option?
  • How do we feel about someone else carrying our child?
  • How will we explain the pregnancy and birth to others, including our child one day?
It can also be beneficial to talk to a mental health professional who specializes in infertility. He or she can help ensure you have considered many of the significant challenges that may come up with using a surrogate.
Although it may be a last resort for some couples, adoption can be one of the most fulfilling experiences of your life. However, coming to this decision is not an easy process for many couples. For those who have traveled a long road of fertility treatment, there is a substantial amount of grief that comes with the decision to adopt. Couples must first grieve the loss of the biological child they will never have who would have had Mommy's smile and Daddy's eyes.
It can be helpful to talk to a counselor during this time, as he or she can help you work through the many emotions that will come flooding in once you make the decision to stop fertility treatments. He or she can also help you determine if adoption would be a good choice for you and your partner.
There are many options for domestic and international adoption. Children who are eligible for adoption may come from various settings, such as foster care, an orphanage, or a temporary home setting. Once you have decided that adoption is a path you want to pursue, it's important to gather as much information as you can about it. Many hospitals, adoption agencies, and other organizations offer adoption preparation programs. Also, you may see if there is an adoptive parent support group near you to help you work through some of the obstacles you may face.
Before getting too far into the process of adoption, it's important to understand what your state laws and regulations require. It is also important to consider how long you are willing to wait for your child.

Regardless of the type of adoption you choose to pursue, you must have a home study or family study done. This involves education, preparation, and gathering information about the prospective adoptive parents. It can take from 2 to 10 months to complete, depending on agency waiting lists and other requirements. Each state will vary regarding the specific regulations and home study requirements.
After you complete a home study, you can begin the placement process. If you are interested in a foster care adoption, you can review information about a number of children who are waiting for families. Your adoption agency may have adoption events, a photo-listing service, or other methods to help you search for children who are awaiting adoption.
When using a licensed private adoption agency, the expectant parents may select your family from a list of prospective adoptive families. If you want to pursue an independent adoption, an attorney or facilitator may help you identify expectant parents, or you may locate them on your own if allowed by state law.
For those who want to pursue an intercountry adoption, you can review information about your prospective child and may have the chance to meet your child in his or her placement setting (orphanage or foster home).
All domestic adoptions must be finalized in court, although the specific process will vary from state to state. In general, a child must live with the adoptive family for at least six months before the adoption can finally be made legal. A social worker may visit many times during this period to ensure the child is well cared for and write up any reports needed for the court proceeding.

For intercountry adoption, the adoption procedure is just one of a series of required legal processes. In addition to state laws, you must follow the laws of the child's country of origin and U.S. citizenship and immigration services requirements.
While the process of adoption can seem overwhelming, for some couples, it can be the best option when other fertility treatments have been exhausted. Adoption allows you to have that child fill your family and your heart, while also giving an orphaned child a home and a family.
Last reviewed by: Arthur Schoenstadt, MD
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