Treatment Overview

• Fertility medication which stimulates the ovaries to “ripen” and release eggs (e.g. clomifene citrate, which stimulates ovulation)
• Surgery to restore patency of obstructed fallopian tubes (tuboplasty)
• Donor insemination which involves the woman being artificially inseminated with donor sperm.
• In vitro fertilization (IVF) in which eggs are removed from the woman, fertilized and then placed in the womans uterus, bypassing the fallopian tubes. Differences of IVF include:
– Use of donor eggs and/or sperm in IVF. It happens when a couples eggs and/or sperm are unusable, or to avoid passing on a genetic disease.
– Intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into an egg; the fertilized egg is then placed in the womans uterus as in IVF.
– Zygote intrafallopian transfer (ZIFT) in which eggs are removed from the woman, fertilized and then placed in the womans fallopian tubes rather than the uterus.
– Gamete intrafallopian transfer (GIFT) in which eggs are removed from the woman, and placed in one of the fallopian tubes, along with the mans sperm. It allows fertilization to take place inside the womans body.
• Other assisted reproductive technology (ART):
– Assisted hatching
– Fertility preservation
– Freezing (cryopreservation) of sperm, eggs, & reproductive tissue
– Frozen embryo transfer (FET)
• Alternative and complimentary treatments
– Acupuncture Recent controlled trials published in Fertility and Sterility has shown acupuncture to increase the success rate of IVF by as much as 60%. Acupuncture was also proven to be effective in the treatment of female an ovular infertility, World Health Organization, Acupuncture: Review and Analysis of Reports on Controlled Trials (2002).
– Diet and supplements
– Healthy lifestyle

Clomiphene citrate (CC)
CC is a drug that induces ovulation and is used as a frontline fertility treatment for both anovulatory and ovulatory women. It can be harmful to the cervical mucus, however, and should be combined with intrauterine insemination (IUI) so as to maximize the chances for conception.
The usual initial dose is 50 mg per day from days 3-5 through days 7-9 of the womans menstrual cycle. All patients should use an LH kit and time their intercourse to make best use of the chances of conception. This kit augurs when ovulation will occur based on the level of LH in the womans urine.
If ovulation occurs as a result of CC treatment, the 50 mg/day regimen should be maintained for 3 to 4 cycles.
If ovulation doesnt occur, the dose can be increased by 50 mg increments.
If even as much as 150 mg per day doesnt induce ovulation, then a transvaginal ultrasound should be performed to allow the physician to get a close-up view of the development of the follicle (the follicle is a cluster of cells in the ovary that change in color and shape during the different phases of the menstrual cycle).

Transvaginal ultrasound (US)
A transvaginal ultrasound engages inserting an ultrasound probe into the womans vagina.
US treats in such a way:
– Ultrasound waves emitted from the probe pass through the vaginal wall and bounce off the ovaries, producing an image or photograph of the ovaries.
– If follicular development appears normal, the next step usually involves an injection of the hormone HCG (human chorionic gonadotropin) to trigger ovulation, followed by intrauterine insemination.

Intrauterine insemination (IUI)
For the period of ovulation, a womans cervical mucus should be abundant, clear, and slippery to make easy the sperms passage up through the cervical canal. But if its not, which may be the case for women on CC infertility therapy, IUI is an effective medical alternative. IUI includes separating the sperm from the seminal fluid and resuspending it in a small amount of fluid thats then placed directly inside the uterus.

Human chorionic gonadotropin (HCG)
Human chorionic gonadotropin (HCG) is a hormone that stimulates the ovaries and triggers ovulation. Its frequently used in women for whom CC medication doesnt work but in whom follicular development appears normal. HCG is a very effective fertility drug that should only be used under the guidance of a fertility specialist.

Assisted reproductive technology (ART)
Even if the success of assisted reproduction has augmented substantially over the past 10 years, it makes up less than 5% of all infertility treatments. Assisted reproductive technology is a high-quality treatment option for couples who are infertile as a result of male infertility factors, unexplained infertility (which accounts for about 20% of all infertility cases), tubal factors (blockage or abnormalities in the fallopian tubes), or endometriosis. This is significant that patients who might benefit from these high-tech treatments consult fertility specialists who are knowledgeable about all of the options.

In Vitro Fertilization (IVF)
The most popular ART technique is in vitro fertilization. Latin term in vitro fertilization meaning “in glass.” In IVF, the womans eggs are surgically removed and mixed with sperm in a glass dish. A couple of days later, when the eggs have been fertilized, they are placed in the womans uterus where they continue to develop.
IVF is a pricey, delicate procedure that requires sophisticated equipment and expertise. The normal pregnancy rate for IVF patients is about the same as that for fertile couples who conceive and carry the infant to term.

Bear in mind:
– Smoking cigarettes has been shown to decrease the number of eggs available for fertilization and increase the risk for a womans eggs to have genetic abnormalities.
– Cessation of smoking for at least 2 months before attempting IVF considerably improves the chances for conception.