Treating endometriosis and PCOS may or may not fix a fertility problem. Around 10% of infertility issues are due to unknown causes and another 30% are due to problems in both the female and male partner. In addition to surgery and medication, one class of infertility treatment for women is assisted reproductive technology (ART).
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) involves combining the woman’s eggs with the man’s sperm in a laboratory and then transferring the resulting embryos to the woman’s uterus. First performed in 1977 in England, IVF now helps thousands of couples worldwide achieve pregnancy. The steps of IVF are:
Step 1: Stimulation of the ovaries to produce several oocytes (eggs).
Step 2: Egg retrieval from the ovaries.
Step 3: Fertilization of the eggs and culture of embryos in the IVF lab.
Step 4: Embryo transfer to the uterus for implantation.
Causes of Female Infertility treated with IVF
Some causes of infertility can be treated using IVF. These include:
Tubal disease or absence of fallopian tubes
Genetic diseases that do not cause miscarriage or abnormal births
Allergy to sperm antibodies
Endometriosis that does not respond to treatment
Many women are unable to get pregnant because the embryo’s outer shell (zona pellucida) is too thick. Assisted hatching is a procedure used to thin the outer shell, so the fertilized egg can easy break through. The procedure involves making a measurement of the shell’s thickness, and creating a hole in the surface, using either a chemical, laser, or microsurgical technique. Candidates for this procedure are women age 38 years old and older, or women who have failed on previous IVF cycles.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is the process of preparing concentrated sperm that is highly motile and placing the sperm directly into the uterus. Also called artificial insemination, the IUI pregnancy rate is around 15%. IUI is often performed using fertility medications, but it can be used without them. This is a cost-effective, low-tech procedure.
Injectable hormones are used to increase the number of eggs that reach maturing, as well as increase the chances for conception. These drugs are quite expensive and increase the chances of multiple pregnancies. Ovulation induction is often combined with IUI and IVF. These drugs often treat women who have subtle unidentified defects in ovulation and improve the quantity and quality of ovulation. The following are used for ovulation induction:
Human menopausal gonadotropin (hMG) – Pergonal, Repronex, and Humegon
Clomiphene citrate – Clomid and Seraphene
Follicle-stimulating hormone (FSH) – Follistem
Human chorionic gonadotropin (hCG) – Pregnyl and Profasi
Leuprolide – Lupron
Synthetic gonadotrophin inhibitor (FSH/LH)
When a woman has serious infertility issues, use of donor eggs is an option. Eggs are obtained from the donor’s ovaries and fertilized with the male partner’s sperm. The resulting embryos are then transferred to the female recipient’s uterus. This form of ART has a 55% success rate, and it allows older women to become mothers.
When a woman cannot produce eggs, does not have a uterus, or has severe infertility issues, the use of a surrogate is an option. After laboratory insemination of the female partner’s eggs, or the surrogate’s eggs, the resulting embryos are transferred to the surrogate who carries the baby to term. This procedure has a live birth rate of 20-30% per cycle.
When both the male partner and the female partner have fertility issues, use of donor embryos is an option. Another couple’s embryo can be used for pregnancy. Either a surrogate or the female partner carries the baby to term. Donor embryo live birth rate is 30-50%, according to most studies.