Overview of Fertility Treatments

Reviewed By: Dr. Jyothi C Budi - Medical Director at Ferty9 Fertility Clinic, Secunderabad, Hyderabad

One in six couples worldwide faces challenges when trying to conceive naturally. Infertility treatment for male and female patients has evolved significantly, offering multiple options for those struggling to start a family. Modern fertility treatments range from simple medication-based approaches to advanced reproductive technologies, with success rates improving each year. Whether couples need basic fertility medications, intrauterine insemination (IUI), or more complex procedures like in vitro fertilisation (IVF), understanding these treatment options helps them make informed decisions about their reproductive journey.

What is Fertility Treatment?

Fertility treatment encompasses medical procedures and interventions designed to help individuals and couples achieve pregnancy. These treatments address various fertility challenges and are tailored to specific medical conditions or reproductive needs.

Doctors recommend fertility treatments when:

• Couples have been unable to conceive after one year of trying
• Women are 35 or older and have been trying for six months
• Individuals have known medical conditions affecting fertility
• People experience irregular or absent menstrual cycles
• Medical conditions like endometriosis or past miscarriages are present

The treatment choice depends on several factors:

• The underlying cause of infertility
• Age of the individual or couple
• Previous pregnancy history
• Personal preferences and circumstances
• Treatment costs and availability

Diagnosis of Infertility

Doctors begin the diagnosis of infertility with a holistic evaluation of both partners to identify potential fertility barriers. The diagnostic process typically starts after couples have attempted conception for one year without success or six months for women over 35. The following are some common fertility tests for couples:

Tests for Men

Male fertility testing begins with a detailed medical history and physical examination. The primary diagnostic tools include:

• Semen Analysis: Evaluates sperm count, shape, and movement
• Blood Tests: Checks hormone levels, including testosterone
• Scrotal Ultrasound: Examines testicular structure and identifies varicoceles
• Genetic Testing: Identifies chromosomal abnormalities affecting fertility
• Post-ejaculation Urinalysis: Checks for retrograde ejaculation

Tests for Women

Female fertility assessment involves examining the reproductive system and hormonal balance. Doctors conduct several vital tests:

• Imaging Tests: Including transvaginal ultrasound.
• Hormone Evaluation: Checks thyroid function, reproductive hormones
• Ovarian Reserve Testing: Assesses egg quantity or ovarian reserve 
• Tubal patency tests : Saline infusion sonography , Hysterosalpingography 
• Hysteroscopy : Examines the uterine cavity for abnormalities

Non-surgical Fertility Treatments

Treatment options for fertility challenges often begin with less invasive approaches before proceeding to more complex interventions. 

Fertility Medications - Ovulation Induction Drugs & Hormone Therapies

These medications work by prompting the follicles in ovaries to grow  or by adjusting hormone levels to create optimal conditions for conception. Common fertility medications include:

• Clomiphene Citrate: Acts by blocking receptors in hypothalamus leading to stimulation of follicles & ovulation 
• Letrozole: Works by preventing enzyme aromatase from converting androgens to estrogens 
• Gonadotropins: Injectable medications that directly stimulate the ovaries
• Human Chorionic Gonadotropin: Helps in triggering the dominant follicle and  ovulation timing

Intrauterine Insemination

Intrauterine insemination (IUI) offers a straightforward approach to fertility treatment by placing specially prepared sperm directly into the uterus. This procedure increases pregnancy chances by helping sperm bypass the cervix and reach closer to the egg. 

The success rate of IUI varies depending on individual circumstances, with pregnancy rates typically ranging from 10% to 16% per cycle. This treatment proves particularly effective for couples with unexplained infertility or mild male factor infertility.

Also read: The Benefits and Limitations of IUI Treatment

Surgical Fertility Treatments

These procedures address structural issues in the reproductive system and can significantly improve fertility outcomes for both men and women.

Surgical Interventions - Hysteroscopy, Laparoscopy and Varicocele Surgery for Men

Modern surgical techniques offer several benefits for fertility treatment:

• Minimal recovery time
• Precise treatment of specific conditions
• Higher success rates for certain fertility issues
• Immediate resolution of structural problems

Hysteroscopy enables surgeons to examine and treat issues within the uterine cavity using a thin, lighted scope. This procedure effectively addresses problems such as uterine fibroids, polyps, and adhesions that may interfere with implantation or pregnancy.

Laparoscopy includes small incisions in the abdomen to treat conditions affecting fertility. Through these tiny openings, surgeons can remove endometriosis, repair fallopian tubes, and treat other reproductive system abnormalities. This minimally invasive approach typically allows patients to return home the same day.

For male fertility issues, varicocele surgery treats enlarged veins in the scrotum that can affect the development of sperm & quality. This procedure, typically performed as an outpatient treatment, has shown significant success in improving male fertility factors in some cases  and increasing pregnancy rates in couples where the male partner has a varicocele.

Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) represents the most advanced frontier in fertility medicine, offering hope to couples who haven't succeeded with conventional treatments. 

In Vitro Fertilisation (IVF)

IVF stands as the most successful and widely used ART procedure, accounting for 99% of all assisted reproductive treatments. The process involves several carefully coordinated steps:

• Ovarian Stimulation: Medication to stimulate  multiple follicles
• Egg Retrieval: Collection of stimulated follicles and examination of retrieved oocytes 
• Sperm Processing: Preparation of healthy sperm
• Fertilisation: Combining eggs and sperm in laboratory conditions
• Embryo Transfer: Placement of embryo(s) in the uterus

Advanced ART Techniques - Blastocyst Culture & Genetic Testing

Blastocyst culture allows embryos to develop for 5-6 days in specialised laboratory conditions, enabling specialists to select the most viable embryos for transfer. This approach achieves a 65% success rate in laboratory development.

Preimplantation genetic testing (PGT) represents another significant advancement, allowing embryologists to screen embryos for genetic abnormalities before transfer. This process involves:

• Removing 5-7 cells from the embryo
• Analysing DNA for chromosomal issues
• Selecting only healthy embryos for transfer

Risks and Considerations

Doctors carefully evaluate and discuss these considerations with patients before proceeding with any treatment plan.

Multiple Pregnancies

The likelihood of carrying multiple foetuses increases substantially when multiple embryos are transferred during IVF or when certain fertility medications are used.

Key risks associated with multiple pregnancies include:

• Increased chance of pregnancy-related complications such as pre-eclampsia and gestational diabetes
• Higher risk of premature birth & low birth weight
• Greater likelihood of requiring a caesarean section
• Increased maternal health risks, including anaemia and heavy bleeding
• Enhanced possibility of developmental complications in babies

The National Institute for Health & Care Excellence (NICE) has established specific guidelines to minimise these risks. These guidelines recommend double embryo transfers only for women aged 40 to 42, while younger patients should receive single embryo transfers when high-quality embryos are available.

Ovarian Hyperstimulation Syndrome

This condition develops when ovaries overreact to fertility drugs used to stimulate egg production.

Signs and Symptoms:

• Mild abdominal pain and bloating
• Rapid weight gain (more than one kilogram in 24 hours)
• Nausea and vomiting
• Decreased urination
• Shortness of breath

Doctors diagnose OHSS through physical examinations, ultrasound scans & blood tests to monitor hormone levels. 

Prevention strategies include careful medication dosing and regular monitoring during fertility treatments. Doctors often use specific protocols, such as "coasting" (temporarily stopping medications) or freezing embryos, to reduce OHSS risk in susceptible patients—women with polycystic ovary syndrome or those under 35 face higher risks of developing this condition.

Conclusion

The journey through fertility treatment requires careful consideration of various factors, including age, medical conditions, and personal circumstances. While treatments carry certain risks, such as multiple pregnancies or ovarian hyperstimulation syndrome, proper medical supervision and adherence to established guidelines help manage these challenges effectively. Success rates continue to improve as medical technology advances and treatment protocols become more refined.

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