Infertility Treatments For Women
|How Is Infertility Treated In Women?
In many cases treatment is not necessary. As many as 1 in 5 couples spontaneously become pregnant within 2 years without treatment. Of those who do choose treatment, nearly 90 percent are treated with conventional therapies like fertility drugs or corrective surgery to repair reproductive disorders. In a small number of cases couples will opt for assisted reproductive technology (ART), including options like in vitro fertilization (IVF) and egg donation. A fertility clinic will recommend specific infertility treatments based on:
Failure to ovulate is one of the most common causes of infertility in women. It is usually treated with infertility drugs that act like natural hormones to trigger ovulation (ovulation stimulation). The most popular drug is called clomiphene citrate (brand names Clomid and Serophene). It is similar to estrogen and is taken to stimulate two hormones (follicle stimulating hormone, FSH and luteinizing hormone, LH) to prompt the release of an egg. Clomiphene is taken as a pill for 5 days a month. One of the risks of the medication is an increased chance of becoming pregnant with twins or multiples. Additionally women who take clomiphene as well as the drug metformin for polycystic ovary syndrome (PCOS) or insulin resistance can ovulate more frequently. 80 percent of pregnancies that occur as a result of clomiphene do so within 3 months. If you don't become pregnant within the first 3 months, your dose of clomiphene will be increased. If this does not work, the next step may be to take injectable HCG (brand names Pergonal, Ovidrel, Pregnyl) or FSH (brand names Gonal-F, Bravelle, Follistim). Intercourse will need to be timed for 36 to 40 hours after the injection. These drugs carry a much higher risk of multiple births as well as less pleasant side effects like large ovarian cysts (picture).
Female infertility caused by gynecologic disorders like endometriosis, uterine fibroids and ovarian cysts is not automatically treated with surgery. Surgery is only usually suggested once fertility drugs have been tried and failed. The surgical options include:
Laparoscopy is a surgical technique (also called keyhole surgery) which is used for many different types of surgery. It can be used to investigate and treat gynecologic disorders like endometriosis, as well as remove ovarian cysts and unblock fallopian tubes. During the surgery a long thin tube (laparoscope) is inserted through the belly button (picture). The laparoscope may have various pieces of equipment attached to it, such as a camera for viewing and cutting tools. It is performed under general anesthesia and can take 1-2 hours, depending on the complexity of the case. The surgeon can combine it with laser surgery, electrocautery or curettage (scraping) to remove endometrial cysts, lesions or adhesions (picture). If the problem is to do with a blockage in one of the fallopian tubes, the surgeon may be able to dilate the tube or create a new opening. Tubal surgery is usually more successful if the blockage is nearer the ovaries than the womb. Where the blockage is severe the doctor may recommend removing the tube(s) altogether (salpingectomy) because it can improve your chance of pregnancy by In vitro fertilization (IVF).
Women with uterine fibroids may undergo a myomectomy which is a surgery that removes the fibroids but leaves the womb intact. About 40,000 myomectomies are performed every year in the United States. Several surgical techniques can be used to perform the operation, one involves laparoscopy, another involves hysteroscopy (where the surgical tools are inserted through the vagina). It can also be used to remove polyps and open blocked fallopian tubes. Very occasionally it is necessary to perform open surgery (laparotomy) because the fibroids are so large (picture). For more details see fibroids treatments. Also see read more about endometriosis treatment.
In all cases if conception has not occurred within 6 to 12 months, IVF treatment will normally be recommended.
ART is the use of high tech surgical procedures to help infertile couples conceive. IVF is the most common ART procedure. Others include zygote intrafallopian transfer (ZIFT) and gamete intrafallopian transfer (GIFT). All three techniques require retrieval of the eggs from the woman. ZIFT and GIFT are usually combined with intrauterine insemination (IUI), the artificial stimulation of the ovaries, followed by an injection of sperm directly into the womb. With IVF the woman's eggs are mixed externally with the sperm and then the complete embryo is implanted. First the woman is given powerful drugs to artificially boost her ovulation. Once her eggs are mature they are extracted with a long thin needle through the vagina. They are placed in a Petri dish and mixed with sperm from her partner. Hopefully they will become fertilized and start to divide. If they do, they will be placed directly into the woman's uterus within a few days of retrieval. A pregnancy test is taken 12 to 14 days later.
If regular IVF fails, or it is not an option for other reasons, you may consider egg donation. This is where the eggs of a donor are used instead of your own. The donor has to go through the IVF cycle as far as egg collection. After this, the fertilized eggs are placed inside your uterus and the IVF cycle is completed. For more details on this option see:
Embryo donation is where one couple donates their embryos to another infertile couple. Usually the donating couple has produced more embryos than they need in IVF and has no more use for them. Any resulting baby is considered the child of the woman who carries and gives birth to it - and not the child of the donating couple. Donor embryos are a much cheaper alternative to donor eggs.
When is the time to move on? There is no right time. The decision to give up trying for a baby is a highly emotional and personal decision to make. You may decide eventually that your body has been through enough, or that your relationship cannot handle any more strain. Once you have reached this point, the options are:
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For more from the man's perspective, see the following:
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