By Dr. Amr Azim August 8, 2014 - 2:42pm

What Are the Fertility and Infertility Treatment Options

Following detailed fertility investigation of the male tubal and ovarian factors, patient and her reproductive endocrinologist decide together on the optimal fertility treatment options.

Factors to consider in selecting the best fertility treatment options include:

Sperm source

1 ) Is there a male partner: if so what is the ejaculate volume, sperm concentration, motility and shape? if >10 million moving sperm then pregnancy through intercourse or IUI is possible. Lower numbers indicates IVF or ICSI. If azospermia (no sperm in the ejaculate) then surgical sperm retrieval may be needed (TESE) or donor sperm can be used.

2 ) If there is no male partner: anonymous or known donor sperm is used.

Tubal Factor

1 ) Open fallopian tubes allow for natural conception or IUI.

2 ) Blocked fallopian tubes require IVF. Sometimes tubes can be fixed using tubal surgery.

3 ) Blocked and dilated fallopian tubes (Hydrosalpinx) require surgical removal of the dilated tubes followed by IVF. Dilated tubes are very difficult to fix and can leak fluid into the uterine cavity and prevent implantation of the embryo.

Ovarian Factor

1 ) Women who do not ovulate due to polycystic ovary syndrome (PCOS): ovulation can be induced using oral medications (clomid or letrozole) or injection medications (gonadotropins). This is usually combined with IUI.

2 ) Women who do not ovulate due to defect in the master gland in the brain (Hypothalamic amenorrhea): ovulation can be induced using injection medications (gonadotropins). This is usually combined with IUI.

3 ) Women diminished ovarian reserve and unexplained (idiopathic) infertility commonly have lower quality eggs and may benefit from inducing multiple ovulation followed by IUI or IVF, to increase the chance that one of the eggs is healthy (chromosomally normal).

Donor Eggs

1 ) Donor eggs are needed in women with low egg reserve that fail multiple IVF cycles after menopause or those who carry some genetic abnormalities.

2 ) Donor eggs can enable same sex male couples parent a child (together with a gestational carrier).
Gestational carriers.

3 ) Gestational carriers enable women to parent a child if the uterus is absent or was removed due to a disease e.g endometrial cancer or if the lining of the uterus is damaged e.g intrauterine scarring due to prior scrapping.
Gestational carrier enable women who cannot get pregnant to parent a child e.g history of breast cancer
Gestational carriers enable same sex male couples to parent a child.

Genetic analysis of the eggs or embryos (PGD)

1 ) Women and men with risk of conceiving a child with a specific genetic disorder e.g cystic fibrosis, sickle cell anemia should consider testing their embryos before transfer into the uterus (PGD).

2 ) PGD can also be used for selecting the sex of the baby for family balancing.

3 ) PGD can be used to test the chromosomes of the embryo to increase the chance for pregnancy in women select women but its efficacy for that purpose is still being investigated.

Fertility Preservation

1 ) Women at risk for diminished fertility due to a medical problem or treatment e.g breast cancer can freeze their eggs or embryos to use later.

2 ) Men at risk for azospermia due to genetic factors, cancer and cancer treatment can freeze sperm for use later
Many other techniques for fertility preservation can also be applied to adults and children to preserve reproductive organs and tissue.

Many fertility treatment choices exist to help women and men conceive a child. One or more of these methods can be tailored to each.

Individual circumstances:
1 . singles women or men,
2 . heterosexual couples or
3 . same sex couples.

reproductive aim:
1. wants to get pregnant now versus later,
2 . wants one child only or accepts twins,
3. wants to conceive a child of certain sex,
4. will use own uterus or a gestational carrier,
5. will use own gametes- sperm or egg or donor gametes.

To learn more about fertility treatment options please visit nycivf.org

By
DR. AMR AZIM

Amr Azim, MD, FACOG is a reproductive endocrinologist and a fertility treatment specialist with special training in treating simple and complex fertility problems. His areas of expertise are assisted reproduction and preservation of fertility.