Treatment of Infertility: General
When looking into infertility, if the doctor finds that a young woman is ovulating, has normal tubes and uterus, and the man’s sperm analysis is normal, he or she may reassure the couple that they may very well go on to get pregnant without treatment. The doctor will go over the best times to have sex. He may want to make sure the couple is not using any lubricant that could interfere with conception. Medication can be given to a man with erectile dysfunction. The doctor will also tell the woman to stop drinking caffeine, which can lower fertility. Both partners should reduce or eliminate the use of alcohol, cigarettes, or any street drugs.
Since any significant medical problems can cause infertility in women, these must be treated. Diabetes must be under excellent control. Any woman who is significantly overweight or underweight will need dietary guidance to try and get closer to a healthy weight. Women diagnosed with polycystic ovary syndrome (PCOS) may be given a specific medication that may stimulate ovulation in women with PCOS.
Hormonal problems can be treated. High or low thyroid levels can be corrected. If either partner has elevated levels of the hormone prolactin, medications can be given that should allow ovulation and normal sperm production.
Any infection, especially sexually transmitted diseases but also urinary tract infections, must be treated in both partners.
Sometimes surgery is indicated. Men may have obstructions to the flow of semen removed. They can also have collections of blood vessels in the scrotum (called a varicocoele) repaired, although the surgery is not proven to improve fertility.
Fallopian tubal damage can be repaired. Women with endometriosis can have endometrial tissue (the tissue normally lining the uterus) outside of the uterus. Removal of this tissue may help some women become pregnant.
When infertility is due to the low sperm counts or less than ideal sperm, intrauterine insemination (IUI) is often performed. The man’s sperm can be concentrated and treated in various ways before being placed into the uterus. Sperm can even be extracted from the testicles directly. If the male partner is completely infertile, donor sperm can be used for IUI.
Sperm treatment along with ovarian stimulation and IUI can be successful in some cases of male infertility. Ovarian stimulation will be done with an oral medication called clomiphene citrate, at low doses.
Sometimes the evaluation for infertility will also be treatment. A hysterosalpingogram is performed by introducing dye into the uterus and Fallopian tubes while x-rays are taken; this test is done to see if there are any obstructions or abnormalities. The actual movement of dye through the reproductive tract can clear blockages in the Fallopian tubes in some cases.
There are also more complicated interventions possible, depending on the reason for infertility. Most of these involve the handling of both eggs and sperm outside the body. These methods are referred to as assisted reproductive technology, or ART (see article on ART).