Fertility Treatments 101

For many couples, having a baby is the ultimate act of emotional fulfillment. Their little bundle of joy is an affirmation of life, and their new role as parents is the beginning of a uniquely rewarding journey. Even the physical pain associated with childbirth is usually viewed as a labor of love. But for an estimated 10 percent of U.S. couples, who struggle with infertility, the road to reproduction is often paved with high hopes, repeated setbacks—and for an increasing number of prospective parents, eventual success. 

Thanks to innovative medications, surgeries, and assisted reproductive technologies, two-thirds of couples treated for infertility go on to have babies, reports the National Women's Health Information Center. At the same time, the process of trying to become pregnant can be stressful, costly, and time-consuming. For this reason, experts urge prospective patients talk to their doctors to determine the best course of action and to do their research so they can better understand the condition.

Understanding Infertility

According to the American Society for Reproductive Medicine (ASRM), infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the ability to conceive children. Infertility affects an estimated 6.1 million Americans, or roughly 10 percent of the reproductive-age population, and is generally diagnosed when a couple is unable to become pregnant after a year of trying or after repeated miscarriages.

As the ASRM points out, conception is a complicated process. For it to occur, a couple must produce healthy sperm and eggs; the woman's fallopian tubes must allow the sperm to reach the egg; the sperm must be able to fertilize the egg; and the fertilized egg, or embryo, must be able to implant itself in the uterus. After that point, the embryo must be healthy, and the woman's hormonal environment must be able to adequately provide for its development. If any of these factors is impaired, infertility can occur.

What Causes Infertility?

If a couple is infertile, it's important to remember that no one is to blame. Infertility is a disease, and just as you wouldn't blame anyone for having cancer, no one can be faulted for being infertile. Along these lines, there are numerous reasons why a couple may be unable to conceive.

About one-third of cases can be attributed to male factors, another third can be attributed to female factors, and the remaining third are the result of a combination of those factors or may be unexplained.

Infertility in men may be caused by azoospermia, when no sperm cells are produced, or oligospermia, where too few sperm are produced. In some cases, sperm may be malformed or die before reaching the egg, or a genetic disease, such as cystic fibrosis, could be the cause.

In women, infertility may be the result of ovulation disorders, blocked fallopian tubes, or uterine abnormalities. In addition, infertility rates in women increase significantly with age. According to the ASRM, while infertility impacts only 7 percent of women between the ages of 20 and 24, it affects 22 and 29 percent of women from ages 35 to 39 and 40 to 44, respectively.

Diagnosing Infertility

If you think you or your partner may be infertile—and you've already tried at-home remedies, such as charting basal body temperature and administrating ovulation tests—experts recommend that you see your physician. He or she can conduct a physical examination, analyze your medical history, and advise on lifestyle factors, such as dietary changes or quitting smoking. In addition, your doctor can conduct tests to look for hormone imbalances and to determine sperm quality.

According to the American Pregnancy Association, a fertility specialist can administer more sophisticated exams, such as cervical mucus tests, ultrasounds, hysterosalpingograms, and endometrial biopsies.

Treating Infertility

If you are infertile, there may be ways to give nature a helping hand, and experts recommend that couples start with the least invasive options first. When hormones are the culprit or the cause is unknown, medications may be helpful. If the sperm is simply having difficulty meeting the egg, artificial insemination may do the trick. And in cases of blocked fallopian tubes, endometriosis, fibroids, or ovarian cysts, surgery may be appropriate.

For some couples, though, getting pregnant requires more state-of-the-art techniques, collectively known as assisted reproductive technology (ART). According to the American Pregnancy Association, such techniques include:

In vitro fertilization (IVF)

The most common of all ART techniques, IVF manually combines an egg and sperm in a laboratory dish. When successful, the procedure is combined with embryo transfer, which physically implants the embryo in the uterus.

Intracytoplasmic sperm injection (ICSL)

This procedure involves the direct injection of sperm into eggs obtained from in vitro fertilization. Again, when successful, it is combined with embryo transfer. ICSL may be indicated when male fertility is a factor.

Gamete intrafallopian transfer (GIFT)

GIFT involves removing a woman's eggs, mixing them with sperm, and immediately placing them into the fallopian tube. Unlike with IVF and ICSL, fertilization takes place inside the fallopian tubes, and as such, a woman must have healthy tubes for GIFT to work.

Zygote intrafallopian transfer (ZIFT)

This technique, also known as tubal embryo transfer (TET), is similar to GIFT, but in this case, the sperm and egg are given time to fertilize in the lab before being placed in the fallopian tubes.

In addition, some couples may find success with intrauterine insemination (IUI), a procedure that places sperm inside a woman's uterus to facilitate fertilization but does not manipulate the actual eggs. In other cases, an egg donor or gestational carrier (better known as a surrogate mother) may be suitable.

Risks vs. Rewards

In all of these cases, experts urge prospective parents to talk with their doctors about not only the potential rewards of treatment, but also the possible risks. Be sure to find an experienced doctor who is willing to answer all your questions, and ask for extensive information about the procedure, including:

  • the pregnancy rate;
  • the success, or live birth, rate;
  • the miscarriage rate;
  • the rate of ectopic pregnancy (when the egg attaches itself to a place other than inside the uterus);
  • the number of attempts couples usually have to make;
  • your chances of multiple pregnancy (twins or triplets); and
  • other medical risk factors and side effects.

Your Financial Options

Although fertility treatments may assist couples in their quest to have a baby, these therapies can be quite expensive. According to the ASRM, one cycle of in vitro fertilization costs an average of $12,440, and it generally takes two to three cycles for conception to occur. What's more, this amount may or may not include all of the costs associated with blood monitoring, ultrasound, anesthesia, and other related fees.

Since most health insurance companies don't cover fertility treatments, or cover only limited procedures or techniques, it's important to check your policy. If your insurance company does not cover the costs, take a realistic look at your finances to determine what you can afford. Also keep in mind that there may be other options available. Financial institutions, such as Capital One, offer health-care loans specifically designed for couples seeking fertility treatments.

Once you've found a doctor to perform the procedure, be sure to ask about the cancellation policy so you don't have to pay for services that aren't performed. And finally, be wary of any clinic or doctor offering a money-back guarantee. While thousands of couples have had success with these techniques, there are no guarantees, and if it sounds too good to be true, it probably is.