Fertility Problems

Some couples have known problems that are preventing the sperm and egg from traveling to the fallopian tubes, fertilizing, and implanting in the uterus where they develop into a fetus. Other couples have unexplained infertility and want to increase their chances of pregnancy. Insemination and assisted reproductive technology (ART) procedures can improve their odds of pregnancy by introducing the sperm to the egg in the woman's reproductive tract (insemination) or the laboratory (ART).

Insemination procedures flush the sperm through a thin, flexible tube directly into a woman's vagina, cervix, uterus, or fallopian tube. Insemination procedures put sperm closer to the egg, to overcome fertility barriers such as low sperm count and cervical mucus. They are also used with donor sperm and can be combined with other fertility treatments, such as clomiphene or hormone shots.

Assisted reproductive technologies (ART) are procedures to remove eggs from a woman's ovaries (or use donor eggs) and fertilize them with sperm outside the body. One or more fertilized eggs are then transferred to the woman's uterus or fallopian tubes. ART is used to treat infertility caused by problems with fallopian tubes, ovulation, and sperm, as well as endometriosis and unexplained infertility.⁸ These expensive and complex procedures are typically used only after more conservative treatment methods have failed.

In order to closely time and control the success of an ART procedure, doctors commonly control the ovaries with hormone treatment. First, one kind of hormone is used to "shut down" the pituitary gland, which in turn stops the ovaries from making eggs (menopausal symptoms are common). This is called pituitary down-regulation with a GnRH analogue. Then, ovulation-stimulating medicines are used to trigger ovulation on a schedule. This process is also used before some insemination procedures. For more information, see the Medications section of this topic.

Complementary and alternative treatments include the use of acupuncture and dietary changes as well as relaxation techniques and mind-body medicine. Early studies are promising about acupuncture, which may be effective for improving sperm quality and enhancing IVF success rates. It is important to talk with your doctor before you use any complementary or alternative treatments.

Other Treatment Choices

Insemination procedures include artificial insemination (AI) and intrauterine insemination (IUI).

Assisted reproductive technologies include:

• In vitro fertilization (IVF), mixing eggs with sperm outside the body; one or more fertilized eggs are then transferred to the uterus using a thin flexible tube (catheter) inserted through the cervix.
• Intracytoplasmic sperm injection (ICSI), injecting a sperm into an egg and then using a catheter inserted through the cervix to transfer the egg to the uterus.

Gamete or zygote intrafallopian transfer (GIFT or ZIFT) is rarely used because success rates with IVF are as good or better.

For couples with sperm-related infertility, ICSI can be used to achieve the fertilization stage of the in vitro fertilization process.

What To Think About

ART makes it possible to use donor eggs or sperm when it isn't possible to obtain healthy eggs and sperm from one or both partners. Insemination procedures make it possible to use donor sperm.

Overall, IVF-related injections, monitoring, and egg harvesting procedures are emotionally and physically demanding of the female partner. Superovulation with hormones requires regular blood tests, daily injections (some of which are quite painful), and frequent monitoring by your doctor. Other complications, such as ovarian hyperstimulation syndrome, can result (although they are very rare) from hormone shots and assisted reproductive technology such as IVF.

Before deciding on ART treatment, consider the possible emotional and social, financial, religious, ethical and legal questions questions that may come up for you and your partner.

Should I have infertility treatment?

Should I have a tubal procedure or in vitro fertilization for tubal infertility?

Should I consider adoption as an alternative to infertility treatment?

For a comparison between ultrasound and laparoscopy for egg collection procedures, see ultrasound in assisted reproductive techniques.

If you have several miscarriages or unsuccessful IVF attempts, talk to your doctor about genetic testing.