My partner and I have a fertility problem. What are our treatment options?
Your impulse may be to immediately begin with the most advanced and expensive treatments, such as in vitro fertilization (IVF), thinking you'll get pregnant faster. But less expensive therapies, such as fertility drugs or surgery, are very effective. About 90 percent of couples are treated with drugs or surgery only.
You have a number of choices, so work with your doctor to come up with a treatment plan, starting with the least invasive options first. Here's a rundown of your treatment options, from the least to the most invasive.
Fertility drugs: If your hormones are out of balance or in short supply, these drugs – for women and men – can get your reproductive system back on track. They might even help if the cause of your fertility problem is unknown. And you can take them in conjunction with another treatment, such as intrauterine insemination (IUI).
Intrauterine insemination: If your partner's sperm just need help getting to your egg, placing a concentrated sample of sperm directly in your uterus at the proper time can improve your odds of getting pregnant. IUI can be done with or without fertility drugs.
Surgery: If you have blocked fallopian tubes, endometriosis, fibroids, anatomic problems with reproductive organs, or ovarian cysts, a type of minor surgery done with a thin tube (a laparoscope) can help diagnose the problem or clear the way for you to conceive. Surgery also can be more extensive and require an incision in your abdomen. But in many cases surgery is unnecessary, and your chances of pregnancy may be greater with other treatment options.
Assisted reproductive technology (ART): If the problem is a low sperm count, blocked fallopian tubes, or if other factors are preventing the egg and sperm from uniting and other treatments have failed, your doctor may recommend a high-tech procedure in which eggs or embryos and sperm are handled outside the body. In vitro fertilization (IVF) is the ART technique used for almost everyone with fertility problems. Some IVF procedures use a special fertilization technique called intracytoplasmic sperm injection (ICSI).
In rare cases, gamete intrafallopian transfer (GIFT) or zygote intrafallopian transfer (ZIFT) can help you conceive. Occasionally your age or ovary function may require you to use an egg donor. You might even consider using a gestational carrier, or surrogate, if there's a problem with your uterus or if being pregnant would endanger your health.
How will we pay for fertility treatment?
Fertility treatment isn't cheap – the average cost of assisted reproductive techniques such as IVF is $12,400 for a single cycle, according to the American Society for Reproductive Medicine (ASRM). This amount varies depending on how much medicine you need, where you live, and whether your clinic offers programs involving refunds or multiple cycle discounts. Many health insurance plans don't cover fertility therapies, so check your policy carefully before you do anything.
Currently 15 states require insurers to offer plans covering infertility diagnosis and treatments:
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- Arkansas
- California
- Connecticut
- Hawaii
- Illinois
- Louisiana
- Maryland
- Massachusetts
- Montana
- New Jersey
- New York
- Ohio
- Rhode Island
- Texas
- West Virginia
But policies can vary among these states. For example, certain states cover fertility drugs but not assisted reproductive technology. Check the ASRM website for information about your state's laws.
If your policy doesn't cover the treatment you need, you may have to pay the entire cost up front. Some banks and lending institutions offer loans specifically designed for fertility treatments, and many clinics offer package pricing as well as refunds if treatment is unsuccessful.
But be aware that clinics offering "risk-sharing" refund plans often require high initial fees and usually have very strict criteria for eligibility. For example, if you're older or need more advanced ART techniques, you may not qualify for some of these programs.
Reputable clinics remind patients that there are no guarantees with fertility treatments. And sometimes complications can arise during IVF treatment and cause a cycle to be canceled.
No matter which clinic you choose, make sure you ask about the cancellation policy. You want one that charges you only for services performed and will refund the cost of canceled treatments.
What are my chances of getting pregnant with fertility treatment?
Many women who have trouble getting pregnant are prescribed clomiphene citrate, an oral fertility drug that induces ovulation. About 35 percent of women who take clomiphene citrate become pregnant over the course of treatment (usually three to six cycles).
When fertility drugs to cause ovulation or increase egg production are combined with IUI, the pregnancy rate is between 10 and 20 percent per treatment cycle.
For women age 34 and under, about 46 percent of IVF cycles result in pregnancy. That number drops to:
- 38 percent for women age 35 to 37
- 29 percent for women age 38 to 40
- 19 percent for women age 41 to 42
- 9 percent for women age 43 and over
About 22 percent of all ART treatments result in a baby, and the rates go up to about 46 percent for couples who use donor eggs.
Making certain lifestyle changes, such as quitting smoking, limiting alcohol and caffeine, improving your diet, and losing weight if you need to can go a long way toward improving your odds of getting pregnant. (A dad-to-be's diet matters too.)
But your success depends largely on the severity of your fertility problem, your age, and your health history. Women older than 40 generally have a harder time getting pregnant than younger women.
Meanwhile, don't gloss over the emotional stress involved. Find a willing friend, support group, or professional to talk to before, during, and after your treatment. See therapists' top 10 tips for coping with a fertility problem.
You can also swap stories and advice about fertility tricks and treatments in the BabyCenter Community. Many practices also offer support groups and even referrals for massage or acupuncture to help with your stress level and improve your chances of success.
My doctor mentions success rates for various fertility treatments. What do these numbers mean, and are they reliable?
Throughout your treatment, you'll hear statistics about everything from your chances of having twins to your likelihood of an ectopic pregnancy. The most important ones to pay attention to are the pregnancy rate (the odds that the treatment will help you get pregnant) and the live birth rate (the odds that the treatment will result in the birth of a baby). The live birth rate is always lower than the pregnancy rate because it factors in the possibility of a miscarriage or other loss.
Keep in mind that success rates are national averages based on the total number of treatment cycles and don't take into account the number of attempts made with each method. Your doctor may suggest that you try something else after three to six tries with any treatment because some experts believe that what hasn't worked by your third round is less likely to work at all. But each couple's treatment is handled individually, and it's certainly not unheard of to have six IVF attempts.
Also, keep in mind that the success rates clinics give you can be extremely misleading. When you research clinics, consider how they screen their clients. To boost success rates, some clinics won't treat women older than 40 or couples with complicated problems. Other clinics may try to improve pregnancy rates by transferring more embryos than the ASRM recommends. For example, some will transfer four or five embryos to a woman in her mid 30s although the recommended number is two or three.
Finally, don't assume that bigger clinics are better. The U.S. Centers for Disease Control (CDC) has found that in general, the percentage of cycles resulting in live births is similar among all clinics, regardless of clinic size, whenever women's own fresh (not frozen) eggs or embryos are used. However, success rates may be higher at larger clinics for treatments that involve donor eggs or embryos. See the CDC's most recent report on fertility clinics.
Learn as much as you can about a clinic's reputation and expertise by talking to former patients and doctors outside the clinic. Also be sure to ask the clinic for patient references and call them.
