Once a diagnosis is made, specific treatment for infertility will be determined by the specialist based on:
- Age, overall health, and medical
- Cause and extent of the disorder
- Tolerance and acceptance for specific medications, procedures, or therapies
- Expectations for the course of the disorder
The fertility specialist will make a personalized treatment plan, based on all these specific factors. He is likely to start with the simplest treatment that is suitable for the cause of infertility in a particular couple. Where a pregnancy is not achieved after a few cycles of treatment, another procedure will be selected.
Types of treatments:
Monitoring ovulation and timed intercourse
The time of peak fertility can vary considerably, even among women who have regular cycles. In some cases, physicians may need to explain the basics of the reproductive process, to monitor ovulation and recommend timed intercourse. Usually, the monitoring is done by vaginal ultrasound scan on day 12 of the cycle.
Optimal frequency of intercourse in another matter of explanation. Whereas abstinence intervals greater than 5 days may adversely affect sperm counts, abstinence intervals as short as 2 days are associated with normal sperm densities. A widely held misperception is that frequent ejaculations decrease male fertility. Recent studies observed that, in men with normal semen quality, sperm concentrations and motility remain normal, even with daily ejaculation. Surprisingly, in men with oligozoospermia, sperm concentration and motility may be highest with daily ejaculation (ASRM).
Ovulation induction (OI)
Medications that work in the same way as the body’s natural hormones are used to correct hormonal imbalances and stimulate ovulation.Ovulation induction can be used as a treatment on its own, or in combination with one of the other infertility treatments such as artificial insemination, or In Vitro Fertilisation (IVF).
Clomiphene and tamoxifen are used to stimulate ovulation in women with infrequent or irregular periods.
Women who do not respond to clomiphene, or have hormonal imbalances, can benefit from gonadotropin
treatment which acts to replace, or enhance, the hormones produced naturally by the body.
Gonadotropin treatment (medications that contain hormones such as FSH, LH, hMG or hCG) is used to stimulate
ovulation for timed intercourse or assisted conception procedures, including IUI and IVF.
- Medication that contains FSH (Gonal-f, Puregon, Menopur) stimulates the development of follicles in the ovary and helps produce eggs.
- Medication with hCG (human choriogonadotropin) facilitates the last step in the maturation of the developing eggs and triggers ovulation.
Surgery may be used to treat or repair a condition that is causing infertility. In some cases, the fertility specialist may choose to pursue other treatments first, reserving surgery as an option if those treatments aren´t successful.
In a laparoscopy, a small telescope inserted into the abdominal cavity allows internal organs to be visualized.
Endometriosis and adhesions are often diagnosed and treated with laparoscopy. Fibroids can also be removed by
During this procedure, a hysteroscope (a thin telescope) is inserted through the cervix so the physician can see
the uterine cavity. Generally, intrauterine adhesions or a septum are removed with hysteroscopic guidance
using special instruments.
Artificial Insemination and In Vitro Fertilization (IVF) are used in some specific cases. These techniques are also used in unexplained infertility, in which no medical cause for infertility can be found, or in cases when conventional treatment failed.
Alternative medicine may offer fertility benefits to some women. An integral part of traditional Chinese medicine, acupuncture involves inserting very thin needles into certain body points to improve health and well-being.
Some studies suggest that treatment with acupuncture induce ovulation in more than one third of patients with polycystic ovarian syndrome. Acupuncture also appears to be a useful tool for improving pregnancy rates with patients undergoing assisted reproductive technologies.
Male factor infertility
A small percentage of infertile men have a hormonal disorder that can be treated with hormone therapy. Drug therapy may include hormones, antibiotics, or another medication deemed appropriate. Vitamin supplements and antioxidants are of special interest, and there´s still much to learn about the role they play in fertility. Some studies suggest that carnitine, vitamin C and E and antioxidants might improve the rate of fertilization.
Surgical therapy in male infertility is designed to overcome anatomical barriers that impede sperm production and maturation or ejaculation. Surgical procedures to remove varicose veins in the scrotum (varicocele) can sometimes serve to improve the quality of sperm.
Assisted reproductive technology (ART)
The majority of male factor infertility cases are treated with an assisted reproductive technology. This type of treatment may include the following:
IVF, ICSI and other techniques