So which infertility treatment is right for me if I’ve had a hard time conceiving?
So many factors come into play when trying to figure out the best path to parenthood. Step one, though, if possible, is to find out why you haven’t conceived yet.
The American Society of Reproductive Medicine recommends you see a fertility doctor (Reproductive Endocrinologist) if the female partner is under the age of 35 and has been trying to conceive for at least one year; or if the female partner is over 35 and has been trying to conceive for at least six months without success.
Some fertility roadblocks for women could be irregular periods, any history of sexually transmitted diseases, early menopause or menopause in general (depending on your age), polycystic ovarian syndrome (which can cause irregular periods), or endometriosis, just to name a few possible issues. For men, there may be a concern with the sperm, such as low sperm count or perhaps poor morphology.
Getting a diagnosis will help provide insight into the best course of action and whether or not fertility treatment is needed just yet. You may have a condition or issue that could be helped through medication, surgery, lifestyle changes (such as losing weight, quitting smoking, etc.), or some other underlying health issue that needs to be addressed.
If there’s no clear reason for why you haven’t conceived yet, you may be given the infamous and frustrating diagnosis of “unexplained infertility.”
If treatment is recommended in any of the above cases (including unexplained), you have several options to explore such as:
Intrauterine Insemination (IUI): This is when a catheter is used to “bypass” the cervix and insert sperm (partner’s or donor’s) into a woman’s uterus when she is ovulating.
In Vitro Fertilization (IVF): When IVF is performed, a woman’s eggs are retrieved and combined with your partner’s or a donor’s sperm. After fertilization, ideally, embryos will be created. You can discuss with your doctor how many to transfer and/or freeze to be transferred later. Of the ones you plan to transfer, similar to IUI, the embryo is put into a catheter where it is transferred to the woman’s uterus in the hopes that it will implant into the uterine lining.
Intracytoplasmic sperm injection (ICSI): This is when a single sperm is injected directly into your egg, rather than placing many sperm next to the egg, as in IVF above. This is sometimes a recommended option when there are male factor fertility concerns.
“Freeze All” IVF Cycle: IVF cycles described above typically involve the transfer of “fresh” embryos to the uterus within three to five days after the egg retrieval. With a “Freeze All” cycle, any embryos created are immediately frozen using a process called “vitrification,” which is a fast freeze, and the embryos are transferred at a later time. Some doctors recommend this to give the woman’s body time to return to its “normal” state (after being hormonally stimulated to produce more eggs) and can also provide the option of doing genetic testing on the embryos, such as Pre-implantation Genetic Diagnosis (PGD) or Pre-implantation Genetic Screening (PGS).
Donor Egg or Donor Embryo: If you’re unable to conceive with your own eggs or if you’re a same-sex male couple, you can have IVF treatment using donated eggs. The eggs are combined with a partner or donor sperm, and just like the IVF, the resulting embryo(s) is/are transferred to the intended mother or gestational surrogate’s uterus (see below).
Donor Sperm: This is an option either for LGBTQ couples or single women as a means of conceiving, if a male partner has no sperm or a poor semen analysis (azoospermia, low count, poor motility), or when there is a genetic concern that could be inherited from the male.
Surrogacy (gestational carrier): Another woman carries your embryo or donor embryo to term and gives birth to your baby. Note that gestational carriers do not have a biological tie to the child. If they did, it would be called, “Traditional Surrogacy,” which isn’t typically recommended.
It’s best to discuss with your doctor which of the above they recommend as well as discuss with your partner what you’re comfortable with. The path to parenthood can take many different routes for everyone and you need to decide what’s best for specifically you.