Infertility Treatments

Infertility has many treatment options, depending on cause of the infertility, financial considerations and emotional stamina.

Treatments may include:

Female infertility surgery:

• Therapeutic hysteroscopy. Hysteroscope is passed through the cervix into the uterine cavity. This procedure can remove uterine polyps, fibroids, scar tissue and a septum (tissue dividing the uterus in two).
• Therapeutic laparoscopy. The laparoscope and other devices are placed into the pelvic cavity through tiny incisions in the abdomen. Laparoscopy can be used to remove scar tissue or endometriosis tissue with a laser, electricity or surgical scissors. Laparoscopy can repair fallopian tubes that are blocked at the end that faces the ovary.
• Laparotomy microsurgery. Working through an incision in the pubic area, the surgeon uses magnifying glasses or a microscope while removing or destroying scar tissue, endometriosis or repairing fallopian tubes.
• Falloposcopy. Obstructions, scarring and damage inside the fallopian tubes can be seen and often corrected with falloposcopy. The procedure involves inserting a tiny camera-equipped catheter through the cervix and uterus into the fallopian tube. It is mostly used for diagnosis.
• Myomectomy, or the surgical removal of fibroid tumors from the uterus, can be done through abdominal incisions or with instruments inserted through the cervix.
• Transcervical balloon tuboplasty. For women with two blocked fallopian tubes. It is a noninvasive procedure in which two catheters are inserted into the cervical canal and, once stabilized, a contrast medium is injected through the catheters, to reconfirm proximal occlusion. Once proximal occlusion is confirmed, another catheter is advanced through the catheter up to the obstructed area and is inflated with a contrast medium or saline solution to dilate the occluded area. Dilation is repeated in both tubes until they are open again.

Male infertility surgery:

• Varicocele repair. The varicocele is tied off through an incision in the lower abdomen. Sperm counts improve in about 70 percent of cases within six months.
• Sperm duct microsurgery. Sperm duct microsurgery removes obstructions in the system that carries sperm to the penis. Some patients wait as long as two years after surgery for sperm motility to normalize.
• Sperm harvesting. For men with erectile dysfunction or other performance problems, healthy sperm often can be extracted surgically from the sperm ducts, or through electroejaculation, a procedure where electrical current can induce ejaculation.

Assisted reproductive technologies (ART) are infertility treatments that take place in a laboratory. The following factors affect success rates:

• Egg quality, which decreases with the woman's age.
• Sperm quality.
• Skill of the treatment team.
• The woman's overall health.
• Genetics.

Here are the more common ART treatments:

In vitro fertilization (IVF)

Fertilization occurs in a laboratory, rather than the fallopian tube. If fertilization occurs, the pre-embryo is put in the woman's uterus. The procedure stimulates the woman's ovaries to release several eggs. The woman is put under general anesthesia. Eggs are removed from the ovaries by guiding a needle through the wall of the vagina.

Sperm is added to the eggs when they mature. The embryo is then put into the uterus by a catheter (long, slender tube with a syringe on one end). Any remaining embryos can be frozen. IVF accounts for more than 90 percent of ART cycles done in the United States.

Gamete intrafallopian transfer (GIFT)

Conception occurs in the fallopian tube. Sperm quality must be good and one fallopian tube must be open and functional. The woman is put under general anesthesia. Eggs and sperm are injected into the fallopian tube during laparoscopy.

Zygote intrafallopian transfer (ZIFT)

This is a combination of IVF and GIFT. Eggs are extracted similarly to IVF, and fertilized in a laboratory dish. The next day, before the fertilized eggs begin cell division, they are placed in the fallopian tubes by laparoscopy. A zygote is a fertilized egg that has not begun growing by cell division.

Tubal embryo transfer (TET)

In this process, a fertilized egg has started dividing and growing before being put in the fallopian tube. This transfer usually occurs about 24 hours after fertilization.

Other techniques that may be used are:

• Intracytoplasmic sperm injection uses a microsurgical needle to inject a single sperm directly into the egg.
• Microinsemination concentrates sperm into a small drop of fluid and places it around the eggs to increase chances of fertilization.

Intrauterine insemination (IUI)

Because of its relative simplicity and low cost, many couples choose IUI before trying IVF and other high-tech procedures.

The woman takes fertility drugs to start ovulation. Twenty-four to 48 hours later, the man produces a semen sample, which is then "washed" in a centrifuge, a special instrument that spins to make liquids separate. This sperm washing removes a hormone-like substance called prostaglandin, which normally is filtered out by the cervical mucus. Prostaglandin would cause severe cramping if it entered the uterus. The washed sperm is injected with a catheter through the cervix into the uterus. The procedure is painless, and if it works, the woman is pregnant 14 days later.

Donor insemination

Most donors have unusually high sperm counts. Sperm banks usually give couples descriptions of the donors, including height, weight, build, hair and eye color, education level, ethnic and religious background, and hobbies. Donor sperm is frozen until needed. Some couples recruit a friend or relative to donate sperm, but even in these cases, the donor must pass a medical screening.

More on Infertility

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This article was reviewed and updated June 2007.