Treatment for Infertility: Female
Treatment for infertility should first address any underlying medical condition that may be contributing to fertility problems. Drugs, surgery, or both may be used to treat these conditions. Surgery may also be used to repair blockage in fallopian tubes. Choosing a good fertility clinic is important in the success of treatment. Women above 35 may want to begin exploring their options if they do not become pregnant within 6 months to a year. The preferred clinic should always provide the live-birth rate and not just pregnancy success rate. Statistics should include high-risk women, such as those who are older or fail to produce eggs. Advanced fertility procedures and medications are extremely expensive and often not covered by insurance. Women who are undergoing cancer treatments and who want to become pregnant should see a reproductive specialist to discuss their options. According to the American Society of Clinical Oncology's guidelines, the fertility preservation method with the best chance of success is embryo cryopreservation. This procedure involves harvesting a woman's eggs, followed by in vitro fertilization and freezing of embryos for later use. Other treatments under investigation include egg preservation, collecting and freezing unfertilized eggs, removing and freezing a part of the ovary for later reimplantation, and using hormone therapy to protect the ovaries during chemotherapy.
Several approaches are used to treat infertility:
Lifestyle changes: There are no dietary or nutritional cures for infertility, but a healthy lifestyle is important. Some issues relating to ovulation may be reversible by changing behavioral patterns.
- Body weight control: Women with normal body weight have more chances of fertility success. Women who are either over or underweight are at risk for fertility failure, including a lower chance for achieving success with fertility procedures.
- Quit smoking: Smoking may increase the risk for infertility in both men and women, especially in women.
- Avoid excessive exercise: Moderate and regular exercise is essential for good health. But if the excessive exercise is causing menstrual irregularity change the practice.
- Quit or limit caffeine and alcohol.
- Stop any unnecessary medications.
Planned sexual activity at the time of ovulation: Planning sexual activity and monitoring basal body temperature can increase your chances of getting pregnant. The basal body temperature rises and falls according to the hormonal changes in the body. The chances for fertility are considered to be highest between days 10 and 17 in the menstrual cycle (1 being the first day of the period). However, cycles are individualistic. By studying the temperature patterns after a few months, couples can begin to anticipate ovulation and plan their sexual activity accordingly. Immediately after ovulation the body temperature increases sharply in about 80% of cases. But a scheduled sexual activity can make stress on the relationship and should be avoided.
Frequency of Intercourse: Some doctors say that having sex more than 2 days a week adds no benefits. Moreover, frequent sexual activity lowers sperm count per ejaculation. Other studies have indicated, however, that having intercourse every day, or even several times a day, before and during ovulation, improves pregnancy rates. Although sperm count per ejaculation is low, a constantly replenished semen supply is more likely to result in a fertilized egg.
Dealing with Stress: Managing stress and emotions, this is very important for the success of treatment. There are almost no sure ways to predict which couples will eventually conceive. Some couples with multiple problems will overcome great odds, while other, even being fertile, fails to get pregnant. Decide in advance how many and what kind of procedures will be emotionally and financially acceptable and attempt to determine a final limit. Fertility treatments are expensive. A successful pregnancy often depends on repeated attempts. It should be kept in mind that multiple births are sometimes the outcome for successful pregnancy. A pregnancy that results in a multiple birth introduces new complexities and emotional problems. Determine alternatives like adoption, donor sperm or egg, or having no children as early as possible in the fertility process. This can reduce anxiety during treatments in case conception does not occur.
Fertility restoration: Fertility drugs, which regulate or induce ovulation, are the main treatment for women who are infertile due to ovulation disorders. They work like the natural hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to trigger ovulation. But these fertility drugs carry some risks including multiple pregnancy and ovarian hyperstimulation syndrome. Multiple pregnancies may be associated with the risk of premature labor, low birth weight and later developmental problems. In ovarian hyperstimulation syndrome, the ovaries are hyperstimulated in response to medication which may cause unnecessary side effects like abdominal pain and distention, gastrointestinal problems and shortness of breath.
There are several fertility drugs for abnormal LH and FSH production. These drugs include:
- Clomiphene citrate (Clomid, Serophene): This oral medication stimulates ovulation in women who have PCOS or other ovulation disorders. It stimulates the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg. Clomiphene citrate also improves fertility in normally ovulating women, and is often used as an initial treatment for unexplained infertility.
- Gonadotropins: These treatments stimulate the ovary directly. To increase the odds of a pregnancy, gonadotropin medications are used in combination with intrauterine insemination. Gonadotropin medications include: Human menopausal gonadotropin, or hMG, (Repronex, Menopur), Follicle-stimulating hormone, or FSH, (Gonal-F, Follistim, Bravelle), Human chorionic gonadotropin, or HCG, (Ovidrel, Pregnyl).
- Metformin (Glucophage): This oral drug is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin improves insulin resistance, normalizing the insulin level and making ovulation more likely to occur.
Fertility restoration Surgery: Several surgical procedures can correct problems or otherwise improve female fertility.
- Tissue removal: Endometrial tissue or pelvic adhesions are removed with lasers or ablation, which can improve your chances of achieving pregnancy.
- Tubal reversal surgery (microscopic): This surgery restores the fertility in woman who has undergone tubal ligation surgery (contraception).
- Tubal surgeries: Laparoscopic surgery is performed to remove adhesions, dilate a tube or create a new tubal opening. Tubal surgery is more successful when the blocked or narrowed part of the tube is closer to the ovary than to the uterus. Tubal blockage close to your uterus may increase your risk of ectopic pregnancy. In these and other severe cases of blockage or hydrosalpinx, removal of your tubes (salpingectomy) can improve your chances of pregnancy with in vitro fertilization. If none of these treatments work, in vitro fertilization (IVF) is the only treatment option. IVF bypasses the tubes, and thus the blockage. It is important to note that removing the blockages does not always solve the fertility problems and women who have blockages removed may still need IVF.
Treating the underlying medical conditions:
- PCOS: PCOS treatment depends on the severity of the condition. Insulin is believed to be a factor in many women with PCOS. In mild cases, reducing fat and carbohydrate diet, along with aerobic exercise can give results. Severe PCOS can be treated by drug therapies. Ovulation induction drugs can help the ovaries to release eggs. Insulin-regulating drugs such as metformin may correct ovulatory problems. Some severe cases require surgery. The outer layer of the ovary can become thickened and may interfere with ovulation. Laser ovarian drilling is a surgical method that yields the same results as a wedge resection. Laparoscopic ovarian drilling may help thin the outer layer in places.
- Hyperprolactinemia: Both drug and surgical methods are used to treat hyperprolactinemia, a condition with elevated prolactin levels. Bromocriptine is used to reduce excessive prolactin levels. Clomiphene induces ovulation. A very risky procedure is the surgery which removes tumors.
- Immunological infertility: The male immune system can react to its own sperm as if they were invading cells and can be caused by an infection, cancer or a vasectomy or cervical mucous can kill sperm or the uterus can reject the embryo. Treatment for this disorder ranges from drug therapy to assisted reproduction. Steroids like Cortisone, Prednisone, Dexamethasone can reduce the body's immune system response. Antibiotics are used when it is believed the condition is a result of a bacterial infection. Assisted reproductive technologies like intrauterine insemination (IUI), intratubal insemination (ITI) or in vitro fertilization (IVF) are used in more extreme cases.
- Fibroid Tumor: Surgical treatments such as hysteroscopy, laparoscopy and myomectomy are used to diagnose and treat fibroids. Drug therapies such as GnRH agonists can reduce the size of the fibroids by suppressing the secretion of estrogen, but recurrence is noticed when the treatment is withdrawn. Low dose oral contraceptives can also be used to help control the growth of the fibroid.
- Endometriosis: Depending on the severity of the condition, drug treatment, surgery of assisted reproduction is used. The least invasive treatment uses drugs or other GnRH agonists. The drugs work by suppressing the pituitary gland and the secretion of hormones that may be causing the endometriosis. These are contra-indicated if you are trying to conceive. Surgical procedures such as laparoscopy or laparotomy can remove edometrial implants or adhesions or scarring that result from endometriosis. Clomiphene or gonadotropins following the procedure can help recruit multiple follicles, induce ovulation and increase the chances of conception. In vitro fertilization (IVF) is recommended when the fallopian tubes have been damaged. However, the more severe the endometriosis is, the lower the chance of conception.
- Anovulation: This is a condition when the ovulation is absent in females. Anovulation can result from several factors including hormonal imbalances, age and early menopause. Treatments for anovulation range from non-invasive methods such as drug therapy to more involved processes like surgical procedures. The variety of treatments varies depending on the cause of their infertility. Ovulation inducing drugs, in vitro fertilization (IVF), ovarian wedge resection and laparoscopic ovarian drilling or donor eggs can be preferred depending on the condition.
- Amenorrhea: Is the absence of menstruation. It usually indicates a defect in the system and warrants investigation. If the woman’s amenorrhea stems from hyperprolactinemia, they may prescribe bromocriptine, which can suppress prolactin production. Other treatments include ovulation induction with clomiphene and/or surgery.
Assisted reproductive technologies: Assisted reproductive technologies (ART) are medical techniques that help couples conceive. ART such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) can be the final decision if any other treatments are not working. Fertilization may occur either in the laboratory or in the uterus.
Less commonly used ARTs include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). GIFT requires the woman to have a functional fallopian tube and is performed in a single procedure. The woman's eggs and the sperm are combined in a catheter and immediately inserted into the woman's fallopian tube, rather than mixing oocytes and sperm in the laboratory. ZIFT has a very poor success rate and is rarely used these days. Embryo cryopreservation is a procedure in which multiple oocytes are removed from a woman, fertilized, and then frozen for future use. This technique allows multiple transfers to occur with only one cycle of stimulation and retrieval. Often times, older women may require donor oocytes in order to become pregnant. If none of these procedures prove successful, gestational surrogacy may be considered in the case of women with healthy eggs who cannot carry a pregnancy to term.