Best Infertility Treatments To Cure Problems in Pregnancies

Fertility treatment

Many women need special medical treatment to help them get pregnant. This kind of treatment is called fertility treatment. 

If you’ve been trying to get pregnant for 3 or 4 months, keep trying. It may just take more time, even longer than you think it should. You may want to think about fertility treatment

FIG 1.1 FERTILITY TREATMENTS 

You're younger than 35 and have been trying to get pregnant for at least a year.

You're 35 or older and have been trying to get pregnant for at least 6 months.

Talk to your health care provider if you think you may need fertility treatment.

Important Key Points to Refer

There are many kinds of fertility treatment that can help women get pregnant. Talk to your provider to find out if one is right for you.  

Fertility treatment can cause complications, like getting pregnant with twins or more, having premature birth and having a baby with birth defects.  

If you need fertility treatment, there are ways to help you get pregnant with just one baby. This can help reduce the risk of pregnancy complications. 

Things like smoking and weight can affect your fertility. Making certain changes in your life may help you get pregnant without fertility treatment.  

FIG 1.2 FERTILITY TREATMENTS PROCESS

Need fertility treatment

If you think you and your partner may need treatment to help you get pregnant, here's what you can do: 

Talk to your health care provider. You can see a prenatal care provider, like an obstetrician or a midwife, who takes care of pregnant women. Or you can see a fertility specialist (also called a reproductive endocrinologist). This is a doctor who’s an expert in helping women get pregnant. 

Tell your provider about your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in your families have had. Be sure to tell your provider if you’ve been pregnant before and about any children you’ve had.

Make changes in your life that may help you get pregnant without treatment. For example, things like smoking, being over- or underweight and taking certain medicines can affect your fertility and make it harder for you to get pregnant.  Even using a hot tub can affect fertility! You may be able to make changes in your life without fertility treatment that can improve your chances of getting pregnant. 

FIG 1.3 HUMAN EGG AND FERTILIZATION

Ovulation is when your ovary releases an egg into your fallopian tubes. The egg then travels down the tubes to your uterus. If you have sex and the egg gets fertilized by sperm, you’re pregnant.

To find out when you ovulate, write down when your period starts each month and how long it lasts. Or use our online ovulation calendar. Knowing when you ovulate helps you know the best times of the month to have sex with your partner to try and get pregnant. 

Your provider may give you and your partner medical tests to find out if you may need treatment. For example, your provider may: 

Want your partner to get his sperm tested to make sure it’s healthy. This is called a semen analysis. Your provider can tell him where to get this test. 

Give you some tests to make sure there are no problems with your fallopian tubes or uterus.  If your tubes are blocked or if there are problems with your uterus you may have trouble getting pregnant. You may be able to get treatment to fix these problems. 

After these tests, you, your partner and your provider can decide about fertility treatment.   

Fertility treatment cause 

Fertility treatment does help many women get pregnant. But it can cause certain problems, too. The most serious problem is that treatment can cause you to get pregnant with multiples. Some fertility treatments may cause you to release many eggs at the same time. Each of these eggs can become fertilized by sperm, which can make you pregnant with more than one baby.

Being pregnant with multiples can cause serious problems for you and your baby. The March of Dimes believes that if you’re getting fertility treatment, it’s important to try to get pregnant with just one baby. Talk to your provider about ways to help lower your chances of getting pregnant with multiples.

FIG 1.4 FEMALE ANATOMY AND FERTILITY TREATMENTS 

Even if you get pregnant with just one baby, some fertility treatments make your baby more likely to have problems than a baby born without fertility treatment. These include premature birth, low birth weight and birth defects. Talk to your provider about the risks of fertility treatment so you and your partner have all the information you need to decide if treatment is right for you. 

Fertility treatments kinds

There are several kinds of fertility treatment. You, your partner and your provider can decide which treatment gives you the best chance of getting pregnant and having a healthy pregnancy. Common treatments include: 

Surgery to repair parts of your or your partner’s reproductive system. For example, you may need surgery on your Fallopian tubes to help your eggs travel from your ovaries to your uterus.

Controlled ovarian hyper stimulation

In vitro fertilization

You can find out about other kinds of fertility treatments 

FIG 1.5 WOMEN AND PREGNANCY PROBLEMS 

Controlled ovarian hyper stimulation

Controlled ovarian hyper stimulation (also called COH) is a kind of fertility treatment that uses medicines to help your body ovulate (release an egg). If you’re having COH, your provider can adjust your treatment if she thinks you’re likely to release more than one egg. The medicines used for COH include:

Clomiphene citrate also called clomiphene. This medicine comes as a pill. It’s the most common medicine used to help women ovulate. You may have side effects from the medicine, like feeling sick to your stomach, feeling moody and having hot flashes and sore breasts.

Gonadotropins. You get this medicine in shots. Side effects include feeling bloated or having pain in your lower belly.

If you’re getting COH, have sex a few days before and the day that you ovulate. The more often you have sex during this time, the more likely you are to get pregnant. Your provider may recommend that along with COH you also have a treatment called intrauterine insemination (also called IUI). In IUI, your provider places sperm inside your uterus when you ovulate.    

FIG 1.6 FEMALE OVARY AND POLYCYSTIC OVARY

  

In vitro fertilization

In vitro fertilization (also called IVF) is a kind of fertility treatment called assisted reproductive technology (also called ART). ART is any kind of fertility treatment where both the egg and sperm are handled in a lab. 

IVF is the most common kind of ART. In IVF, an egg and sperm are combined in a lab to create an embryo (fertilized egg) which is then put into your uterus.  You may need IVF if: 

Your fallopian tubes are damaged and can’t be fixed by surgery.

You have endometriosis. This is when tissue from the uterus grows somewhere outside the uterus.

You have premature ovarian failure. This is when you stop ovulating and getting your period before you’re 35 years old.

FIG 1.7 IN VITRO FERTILIZATION 

Your partner has fertility problems.

The March of Dimes recommends that most women on IVF have just one embryo placed in the uterus. This is called single embryo transfer (also called SET). For women who’ve had certain health conditions, like chemotherapy to treat cancer, the March of Dimes supports having two embryos placed in the uterus. This is called double embryo transfer (also called DET). If your specialist recommends IVF, ask about the number of embryos to transfer to get the best results from your treatment. 

Infertility

In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss—2 or more spontaneous miscarriages.

Pregnancy is the result of a process that has many steps.

To get pregnant—

A woman’s body must release an egg from one of her ovaries (ovulation)

A man's sperm must join with the egg along the way (fertilize).

The fertilized egg must go through a fallopian tube toward the uterus (womb).

The fertilized egg must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.

FIG 1.8 INFERTILITY TREATMENTS USING IVF 

Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term. 

  

Is infertility a common problem shows your love badge showing image of a woman hugging herself: improve the health of women and babies. 

Yes. About 6% of married women 15 to 44 years of age in the United States are unable to get pregnant after one year of unprotected sex infertility.

Also, about 12% of women 15 to 44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status impaired fecundity.

Infertility woman's problem

No, infertility is not always a woman's problem. Both men and women contribute to infertility.

Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women’s condition. A CDC study analyzed data from the 2002 National Survey of Family Growth and found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime—this equals 3.3–4.7 million men. Of men who sought help, 18% were diagnosed with a male-related infertility problem, including sperm or semen problems 14% and varicocele 6%.

FIG 1.9 WOMEN'S PROBLEMS AND TREATMENT 

Causes infertility in men

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm concentration, motility movement, and morphology shape. A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Conditions that can contribute to abnormal semen analyses include— 

Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.

Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.

Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.

Environmental toxins including exposure to pesticides and lead.

FIG 1.9.1 TREATMENTS MAKE CURE

Causes infertility in women

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.

Ovarian Function presence or absence of ovulation and effects of ovarian -age:

Ovulation. Regular predictable periods that occur every 24–32 days likely reflect ovulation. Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to see the woman’s progesterone level. A woman’s menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of “full flow.”

A woman with irregular periods is likely not ovulating. This may be because of several conditions and warrants an evaluation by a doctor. Potential causes of anovulation include the following:

Polycystic ovary syndrome -PCOS. PCOS is a hormone imbalance problem that can interfere with normal ovulation. PCOS is the most common cause of female infertility.

Functional hypothalamic amenorrhea -FHA. FHA relates to excessive physical or emotional stress that results in amenorrhea absent periods.

Diminished ovarian reserve (DOR). This occurs when the ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, or unexplained causes. Ovarian reserves naturally decline with age.

Premature ovarian insufficiency (POI). POI occurs when a woman’s ovaries fail before she is 40 years of age. It is similar to premature (early) menopause.

Menopause. Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. It is often associated with hot-flashes and irregular periods.

Ovarian function. Several tests exist to evaluate a woman’s ovarian function.

No single test is a perfect predictor of fertility.

The most commonly used markers of ovarian function include follicle stimulating hormone (FSH) value on day 3–5 of the menstrual cycle, anti-mullerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.

Tubal Patency (whether fallopian tubes are open, blocked, or swollen):

Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis , or a history of abdominal surgery.

Tubal evaluation may be performed using an X-ray which is called a hysterosalpingogram (HSG), or by chromopertubation (CP) in the operating room at time of laparoscopy, a surgical procedure in which a small incision is made and a viewing tube called a laparoscope is inserted.

FIG 1.10 CAUSES OF INFERTILITY IN WOMEN

Hysterosalpingogram (HSG) is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency.

Chromopertubation is similar to an HSG but is done in the operating room at the time of a laparoscopy. Blue-colored dye is passed through the cervix into the uterus and spillage and tubal caliber (shape) is evaluated.

Uterine Contour (physical characteristics of the uterus)

Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohysterogram (SHG) or hysteroscopy (HSC) may be performed to further evaluate the uterine environment.

Things increase a woman's risk of infertility

Female fertility is known to decline with—

Age. Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35, and this leads to age becoming a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman's chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.

Aging decreases a woman's chances of having a baby in the following ways—

• Her ovaries become less able to release eggs.
• She has a smaller number of eggs left.
• Her eggs are not as healthy.
• She is more likely to have health conditions that can cause fertility problems.
• She is more likely to have a miscarriage.
• Smoking.
• Excessive alcohol use.
• Extreme weight gain or loss.
• Excessive physical or emotional stress that results in amenorrhea (absent periods).

Women try to get pregnant before calling their doctors

Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should see a health care provider after 6 months of trying unsuccessfully. A woman's chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility. So, women should talk to a health care provider if they have—

• Irregular periods or no menstrual periods.
• Very painful periods.
• Endometriosis.
• Pelvic inflammatory disease.
• More than one miscarriage.

It is a good idea for any woman and her partner to talk to a health care provider before trying to get pregnant. They can help you get your body ready for a healthy baby, and can also answer questions on fertility and give tips on conceiving. Learn more at the CDC's Preconception Health Web site. 

woman and her partner have fertility problems

Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.

Doctors treat infertility

Infertility can be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on—

• The factors contributing to the infertility.
• The duration of the infertility.
• The age of the female.

The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.

  

Some of the specific treatments for male infertility

Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by an urologist who specializes in infertility. A reproductive endocrinologist may offer intrauterine insemination (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.

Medicines are used to treat infertility in women

Some common medicines used to treat infertility in women include—

                                           

                                         FIG 1.11 FERTILITY PROCESS AND TREAT 

Clomiphene citrate is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.

Human menopausal gonadotropin or hMG are medicines often used for women who don't ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.

Follicle-stimulating hormone or FSH is medicines that work much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.

Gonadotropin-releasing hormone (Gn-RH) analog are medicines often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.

Metformin is a medicine doctor’s use for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.

Bromocriptine is a medicine used for women with ovulation problems because of high levels of prolactin. Prolactin is a hormone that causes milk production.

Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born prematurely (too early). Premature babies are at a higher risk of health and developmental problems.

Intrauterine insemination

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat—

Mild male factor infertility.

Couples with unexplained infertility.

Assisted reproductive technology

Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).

Assisted reproductive technology successful

Success rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor—the woman’s age—is especially important.

CDC collects success rates on ART for some fertility clinics. According to the CDC’s 2013 ART Success Rates, the average percentage of fresh, nondonor ART cycles that led to a live birth were—

• 40% in women younger than 35 years of age.
• 32% in women aged 35–37 years.
• 21% in women aged 38–40 years.
• 11% in women aged 41–42 years.
• 5% in women aged 43–44 years.
• 2% in women aged 44 years and older.

Success rates also vary from clinic to clinic and with different infertility diagnoses.

ART can be expensive and time-consuming, but it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is a multiple fetus pregnancy. This is a problem that can be prevented or minimized by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo, rather than multiple embryos, greatly reduces the chances of a multiple fetus pregnancy and its risks such as preterm birth.

Different types of assisted reproductive technology (ART)

Common methods of ART include—

In vitro fertilization (IVF), meaning fertilization outside of the body. IVF is the most effective and the most common form of ART.

Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer. This is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

Gamete intrafallopian transfer (GIFT), involves transferring eggs and sperm into the woman's fallopian tube. Fertilization occurs in the woman's body. Few practices offer GIFT as an option.

Intracytoplasmic sperm injection (ICSI) is often used for couples with male factor infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg as opposed to “conventional” fertilization where the egg and sperm are placed in a petri dish together and the sperm fertilizes an egg on its own.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

VIDEO 1.1 FERTILITY AND PREGNANCY 

Fertility

Fertility is your ability to produce a child. Infertility is when you have had 12 months of unprotected sexual intercourse and you have not become pregnant. Fertility can be affected by illness, how old you are, your weight, whether you or your partner smokes, or takes drugs, or even perhaps consume too much caffeine. Sexually transmissible infections (STIs) can also affect fertility.

Avoiding pregnancy

Using contraception the right way increases your chances of avoiding a pregnancy. There are many different forms of contraception including the oral contraceptive pill, a 'rod', intrauterine device (IUD), diaphragm and cervical cap, condom and the natural family planning method.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner.

Gestational Carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by her partner’s sperm and the embryo is placed inside the carrier's uterus.

Fertility is your ability to produce a child. Infertility is when you have had 12 months of unprotected sexual intercourse and you have not become pregnant. Fertility can be affected by many things and there are also ways to increase your chances of becoming pregnant. Not being able to conceive can be distressing but talking with your doctor, counselor or psychologist can help you to understand your options and decide what to do next.

When you are pregnant, a healthy and nutritious diet, managing your weight and being aware of the things that affect your pregnancy can help you to be the healthiest you can possibly be and reduce complications such as hypertension, pre-eclampsia and gestational diabetes.

Alternatively, there are times when you may want to avoid a pregnancy and there are many different forms of contraception to suit each woman's own needs.

Trying for pregnancy

When you start trying for a baby there are many things that can be helpful to know. This includes understanding about ovulation and when is the best time to try for conception, perhaps using an ovulation calculator or predictor kit, and also being the healthiest you can possibly be.

Fertility problems and emotions

Worry, sadness, distress, anger are common feelings experienced by women who are having fertility problems. Having fertility treatments such as in vitro fertilization (IVF) can further add to emotional distress. Talking to a doctor, counselor or psychologist can be helpful in coping with these emotions and deciding what to do next.

Pregnancy and health

Being the healthiest you can be when you are pregnant includes having a healthy and nutritious diet and including key nutrients like calcium and folate. Taking care of your pelvic floor muscles is another important aspect of pregnancy and future health.

Pregnancy and weight

Managing your weight while you are pregnant is not always easy. Knowing how much weight gain and what you can do to keep active is helpful. Hypertension, pre-eclampsia, gestational diabetes, and the need for an induced birth are all risks of gaining too much weight or being overweight in pregnancy, but there are many things you can do to help.

Pregnancy and ageing

Women are waiting longer to have their first baby mostly because timing or a woman's individual situation doesn't make it right quite yet. This is understandable, but it is important to know that increasing age can affect your pregnancy in different ways including increasing the chance of miscarriage, stillbirth and problems with the placenta.

Having trouble conceiving

Having trouble getting pregnant can be caused by many things including problems with ovulation, blocked fallopian tubes, endometriosis, PCOS, premature menopause, fibroids, thyroid problems and a condition called Turner syndrome. Depending on the cause there are a number of treatment options. 

Infertility treatment

There are many reasons a woman may have difficulty becoming pregnant. There are a number of things you can do to increase the likelihood of becoming pregnant including lifestyle changes, surgery, hormone treatment and Assisted Reproductive Technology (ART).

Gestational diabetes

Gestationaldiabetes is diabetes that develops during pregnancy and usually goes away after the baby is born. It is recommended that all women are screened for gestational diabetes between 24 and 28 weeks of pregnancy. Women who have had gestational diabetes are at increased risk of developing type 2 diabetes. To prevent or reduce your risk of developing gestational diabetes and further complications there are many things you can do.

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