A Beginner's Guide to Fertility Treatments

Do not index

Understanding Fertility: From Preservation to Treatment

Fertility encompasses a wide range of areas including fertility preservation, genetic testing of embryos to prevent diseases, and family-building options for couples or individuals wishing to become parents.

If you've been attempting to conceive for six months to a year without success, it might be time to consult with a fertility specialist (or reproductive endocrinologist) about potential fertility treatments. While many immediately think of in vitro fertilization (IVF), there are several other and less costly methods available within the full realm of fertility treatments.

For the purposes of this article, we will explore fertility treatments for individuals with female reproductive organs and a sperm-providing partner who have not conceived naturally.

Modern fertility methods of egg fertilization and implantation include medication, surgery, or a combination of both. The most common fertility treatments include:

Oral medications

Injectable medications (gonadotropins), often used with IVF

Intrauterine insemination (IUI)

The best treatment option depends on factors like age, goals, and any underlying conditions you or your partner might have. Alternatives also include using donated eggs, sperm, embryos, or employing a gestational carrier or surrogate.

Getting Started

When starting out on your fertility journey, you’ll likely have an initial consultation with a reproductive endocrinologist (REI) or a member of the clinic’s care team.

A call with a care team member will result in a general, comprehensive overview of the clinical process; an initial consult with the specialist will kickstart your treatment process.

The initial step the REI will likely take is a comprehensive fertility assessment to identify the most effective treatment options for you. This evaluation generally includes:

An examination of your medical and reproductive history to look for any factors that could influence fertility.

A physical examination to assess overall health.

A pelvic examination to check for abnormalities or issues with the reproductive organs.

Blood tests to detect any hormonal or health irregularities that might affect fertility.

An HSG (hysterosalpingography), which is an X-ray procedure used to view the inside of the uterus and fallopian tubes to ensure they are not blocked or damaged.

A sonogram, or ultrasound, to visualize the uterus and ovaries for any structural problems or other concerns.

Additionally, an assessment of your partner’s sperm health and mobility will be part of the health evaluation.

Oral Medication

Oral medications like Clomiphene citrate (Clomid) and Letrozole (Femara) are common first step in fertility treatments if fallopian tubes are unblocked and sperm quality is normal.

Clomid is used to stimulate ovulation by tricking the brain into boosting hormone levels, and is typically taken for five days during the menstrual cycle. Letrozole (used for conditions like PCOS) lowers estrogen levels to promote ovulation and is taken in a similar fashion.

Each has a distinct mechanism, but both aim to increase the odds of conception by ensuring more eggs are available during a cycle.

Injectable Medication

Injectable medications (known as gonadotropins) such as Menopur, Follistim, Ovidrel, Gonal-F, and Luveris are used to stimulate the ovaries by injecting into the fatty tissue around the abdomen or thighs.

These are synthetic forms of naturally occurring hormones like follicle stimulating hormone (FSH) and luteinizing hormone (LH), which can release multiple eggs during a cycle. Today, gonadotropins are typically used along with IVF to better control the number of embryos implanted and reducing the likelihood of multiple births.

In cases where IVF is not involved, such as for those who do not respond to oral medications or have specific fertility challenges, gonadotropins may still be used, sometimes in conjunction with IUI.

Intrauterine Insemination

Intrauterine insemination (IUI) is a common fertility treatment that may be considered if oral fertility medications are unsuccessful. IUI involves the direct injection of sperm into the uterus, which can significantly increase the chances of sperm meeting the egg.

Often, IUI is combined with fertility medications to increase the chances of successful fertilization. These medications might be oral or injectable like the ones mentioned above, which can induce the release of multiple eggs.

IUI Process

The procedure starts with the collection of sperm, which is then prepared through a process called 'sperm washing.' This process concentrates the sperm into a small volume and removes chemicals from the semen that may cause discomfort to the uterus. The washing process typically takes one to two hours. After washing, the sperm is placed into a thin catheter.

During the IUI procedure, a doctor inserts a speculum into the vagina to access the cervix, similar to a Pap smear examination. The prepared sperm is then injected directly into the uterus through the catheter. This method places the sperm closer to the egg than it typically would be in natural conception, increasing the likelihood of fertilization. The actual IUI procedure is quite brief, generally lasting only about five minutes, and is usually described as similar to a Pap smear in terms of discomfort.

In Vitro Fertilization

In Vitro Fertilization (IVF) is a more intensive fertility treatment that amplifies the efforts of oral medications and gonadotropins to maximize egg production. In IVF, eggs are surgically retrieved in a brief outpatient procedure, fertilized in a laboratory, and the resulting embryos are implanted into the uterus, typically one at a time.

Individuals may turn directly to IVF for several reasons, including blocked fallopian tubes, low sperm counts, severe endometriosis, or to utilize your previously stored eggs or embryos. Some might also consider IVF after three or more unsuccessful attempts with IUI.

The IVF cycle begins with taking oral contraceptive pills to synchronize the start of the cycle, followed by daily injections of gonadotropins for about 8-14 days that stimulate the ovaries to produce multiple eggs. These injections are usually self-administered with small needles and monitored through regular blood tests and ultrasounds.

Egg retrieval is performed under anesthesia—taking about 10-30 minutes—where eggs are extracted from the ovaries using a needle. These eggs are then fertilized with sperm in a lab to create embryos, which are cultured for three to five days. Depending on the treatment plan, embryos are either transferred to the uterus shortly after or frozen for future use.

Embryo transfer is a quick procedure that generally does not require anesthesia. In preparation for transfer, doctors may prescribe progesterone shots to enhance implantation success, increasing the chances of pregnancy. This comprehensive approach allows for multiple attempts or future pregnancies using frozen embryos.

Getting Started on Your Journey

Navigating the journey to parenthood through fertility treatments can be both challenging and hopeful. From simpler, less invasive options like oral medications and IUI, to more comprehensive approaches like IVF, each treatment offers a pathway tailored to individual needs and circumstances.

As you explore these options, it's important to consult with fertility specialists who can provide guidance based on your specific medical history and fertility goals. Remember, each step taken is a move towards realizing your dream of building a family, equipped with the best possible care and support.

To get started on your fertility journey with Sama, schedule a consult using the button below. We would be honored to support and guide you, every step of the way.