Last week marked National Infertility Awareness week: April 21- 27, 2019.

For this post, I would like to focus on the solutions for infertility. Fertility treatment looks different for every family. Options should be thoroughly discussed with a qualified healthcare provider.

While the outcome may not be clear, I would like to emphasize the importance of Hope. Infertility can cause a wide range of emotions including heartache, frustration, and grief. The inability to start or add to your family on your own terms can be devastating. Know that you are not alone. There is medical and emotional help available.

Treatment Options

The following is a brief overview of some of the procedures you may encounter, should infertility treatment become an available option.

Surgery

Your doctor will conduct a thorough history, physical examination, and ultrasound. Per the findings, he/she may recommend surgery to correct any abnormalities. The factors listed in my previous post is a good overview of potential reproductive abnormalities that may be present. The most common surgical procedures performed at this point are laparoscopy, hysteroscopy, and abdominal myomectomy.

Laparoscopy is performed in the abdomen or pelvis through small incisions with the assistance of a laparoscope attached to a camera. This procedure can either be used to inspect, diagnose, or to surgically correct an abnormality. This can look like removing scar tissue, endometriosis, or a damaged fallopian tube. This is typically an outpatient procedure.

Hysteroscopy is an inspection of the uterine cavity through the cervix by a hysteroscope attached to a camera. This procedure allows the doctor to diagnose abnormalities (e.g., fibroids or polyps) within the uterine cavity.  The abnormalities may actually be corrected or removed via narrow instruments that run through the hysteroscope. This procedure is also performed in an outpatient setting. Hysteroscopy can also be combined with laparoscopy when necessary.

Abdominal myomectomy is a procedure performed through a very low horizontal abdominal incision. The incision allows access to the uterus for fibroid removal. This procedure can also be performed with laparoscopy.

Medications to induce egg development and ovulation. 

Some women are unable to produce an egg in a traditional manner. Help with ovulation may be the key. There are medications available to help stimulate the ovary to develop mature eggs for ovulation. Medications typically come in the form of pills taken by mouth or injections.

The most commonly prescribed pill to stimulate ovulation is clomiphene citrate. Here is how the drug works: Clomiphene (an anti-estrogen) binds in a part of the brain, called the hypothalamus. This act eventually leads to stimulation of the ovary to grow and release an egg.

The most commonly prescribed injections are called gonadotropins, which are taken nightly for 5 – 10 days. The injection directly impacts the cells of the ovary to stimulate egg development and release.

Intrauterine insemination (IUI)

In this process, sperm is placed into the uterine cavity. The premise is that there will be a better chance of conception by bypassing the cervix and bringing a higher concentration of motile sperm closer to the tubes and ovulated egg.

In Vitro Fertilization (IVF)

In vitro by definition means “outside the body.” IVF has a successful history of helping families achieve pregnancy since 1978. IVF begins with the removal of eggs directly from the ovary. The eggs are then fertilized with sperm in a laboratory. The embryos are then directly transferred into the uterus. The IVF process generally follows the following outline:

 

  • Female partner receives gonadotropin injections to stimulate the ovaries to produce many eggs. 

 

  • Once eggs reach maturation, they are retrieved under mild anesthesia in an operating room.
  • An Embryologist fertilizes the eggs using the male partner’s or donor sperm. The sperm can either be mixed with the eggs to allow normal fertilization (conventional insemination) or by injecting one sperm into each mature egg (ICSI).
  • The fertilized eggs become embryos. They grow and develop for 3 to 5 days.
  • One or two embryos, which have demonstrated appropriate development, are carefully transferred into the uterine cavity.
  • A pregnancy test is performed 2 weeks after the egg retrieval.

Third party reproduction

This is a process where another party provides sperm or eggs with the purpose of helping another person or couple have a child. The four types of third-party reproduction are as follows:

  • Sperm donation: Donated sperm is used for insemination in the uterus, or for fertilization of eggs in the IVF process.
  • Egg or ovum donation: An egg donor undergoes an IVF cycle in order to obtain her eggs. The eggs are then donated and fertilized. The resulting embryos are then transferred into the uterus of the future mother.
  • Embryo donation: Fully developed embryo from another person in combination w/donor sperm, or couple who underwent IVF, are donated to the future intended mother.
  • Gestational surrogacy: Another woman will undergo an embryo transfer and carry the pregnancy for another person or couple.

For questions or if you are seeking support during your fertility/reproductive journey, please contact the Amy Wine Counseling Center at (832) 421-8714.