Infertility: It's a topic that is definitely difficult to talk about, but extremely important to discuss as you think about planning for a family. In fact, with about one in eight couples having trouble getting or staying pregnant, it's likely that you or someone you know is going through this tough battle. To make it even harder, there is an overwhelming amount of information out there (what the heck do some of these acronyms even stand for?). We're breaking down some important guidelines on when it's time to head to the doctor and the key fertility treatment terms you need to know.
"We usually define infertility as a woman attempting to conceive by having regular unprotected intercourse [for a certain period of time], depending on the woman's age," says Dr. Mazen Abdallah, a reproductive endocrinology and infertility specialist with McGovern Medical School at UTHealth and Children's Memorial Hermann Hospital. "If she's younger than 35, we say a year of attempt without success. If she's above the age of 35, we basically say six months of attempt without success. [At that point], we start a workup and then the treatment."
Abdallah, also medical director of the Houston Fertility Institute, says more than half the time the cause of infertility can be determined by a doctor asking questions and reviewing a patient's history. Here are some of the courses of treatment that can be taken:
If a woman is not ovulating, Abdallah says, certain medication will be used (in either pill or shot form) to help her do so. The next step will be continuing to try to conceive through intercourse or via insemination.
IUI (intrauterine insemination)
This procedure is used when there is a mild decrease in the sperm count or motility, or in combination with ovulation induction to up the chance of conception, or also in rare cases when the cervical mucus is abnormal, Abdallah says. To get more specific, in this process the sperm is separated from the semen by "sperm washing" (yup—you read that correctly!) and is placed in the uterus right around the time of ovulation, he notes. According to fertility expert Cristina Torres, CEO and cofounder of Seed, a non-stimulated IUI cycle is one of the least invasive and least expensive fertility treatment options.
IVF (in vitro fertilization)
This is often the course of action when there are concerns about a woman's fallopian tubes being blocked, or if there is some sort of pelvic disease such as adhesions. It is also used when the sperm count or motility is profoundly abnormal, or when the cause of infertility is unexplained and other treatments did not work, Abdallah says. He explains that initially, medication is administered to help a woman produce 10 to 12 eggs. "Then we fertilize the eggs in the lab and the fertilized egg becomes an embryo," he says. "You grow the embryo for five to six days in an incubator and then you do an embryo transfer and put that embryo in the uterus."
ICSI (intracytoplasmic sperm injection)
Like IVF, ICSI also involves fertilizing an egg outside the body, in a laboratory, and then implanting it into a woman's uterus. To break it down further, it differs from IVF in that ICSI is a laboratory procedure in which a single sperm is injected into an egg, typically due to low sperm motility. In IVF, the egg and sperm are mixed together in a dish without further intervention. IVF and ICSI are the "most common and effective types of assisted reproductive technology," Torres says, though they are some of the most invasive "as they involve a medicated cycle and an egg retrieval procedure."
Mini-IVF (minimal stimulation IVF)
This differs from conventional IVF in that less medication is administered, so that only two to three eggs are produced at a time, compared to 10 or more with conventional IVF. "This is actually tailored to women who do not do well with IVF," Abdallah says, such as women who are a bit older or have tried IVF in the past and did not have an optimal result.
This procedure is one of the newest fertility treatments available, according to Abdallah. A woman will undergo an IVF cycle, with medication being administered that will allow the eggs to mature. The eggs are then collected, frozen and stored until it's a better time for conception. This was originally used for women who were contending with health problems or set to go through intense medical treatments such as chemotherapy. Now, it is available to any woman who wants to preserve her chances of conceiving but isn't quite ready.
IVF/ICSI with donor eggs
According to Torres, it is one of the more common, yet priciest, fertility treatments couples can opt for. In this treatment, donated eggs are fertilized with the sperm of the patient's partner (or donor's sperm) via IVF or ICSI. The developing embryos are then transferred into the patient's uterus, she says.
FSH (follicle-stimulating hormone)
FSH controls follicular growth and typically allows the best egg cells to be released, Abdallah says. To increase the FSH, medication is given in pill form which will block the production of estrogen and nudge the body to produce FSH, or in shot form to provide the FSH itself. "Both work eventually the same way, by increasing the FSH level and allowing more time to grow and release the eggs." he says. It the case of IVF, where the eggs will be collected for use in the lab, other medications are used (along with FSH) to prevent the eggs from being released prematurely."