Approximately 15% of couples in the United States are infertile. The cause of infertility may be associated with the male, female or both. 40% of infertile cases are due to poor egg or sperm quality. Another 20-30% of cases are due to certain disease states, which include diabetes, thyroid disorders, and obesity. 7% of cases can be contributed to hormonal imbalances that may affect the male or female. Specifically, poly cystic ovarian syndrome or pelvic inflammatory disease affect female fertility and Klinefelter syndrome exclusively affects male fertility.
Another 30% of cases of females have structural defects of the fallopian tubes, or males have testicular problems. In males, about 15% are due to lower sperm count which is seen when there is a blockage in the exiting pathway of the sperm or when high alcohol or tobacco amount is being used. While 30-40% of cases have no identifiable cause, infertility can be treated with medications, in vitro fertilization (IVF), and surgery.
Medication
There are a variety of medication options available. The success rate after medical treatment is 20-60%. In females, for example clomiphene, which is generic for Clomid, and gonadotropins such as Bravelle, and Follistim are used to help regulate reproductive hormones and promote the release of one or more eggs per cycle. The majority of women use these medications for three to six months before being able to conceive or switching to IVF.
Medication regimens for males consist of vitamins or Human chorionic gonadotropin (hCG) injection 3 times weekly. The recommended vitamin regimen is vitamin C 500mg each day, vitamin E 200IU each day, selenium 200mcgs each day, a multivitamin that contains 20mg zinc, folic acid 800mcg, and coenzyme Q10 200mg; this helps promote sperm growth and count.
In Vitro Fertilization
In vitro fertilization (IVF) uses sperm to fertilize eggs harvested from the woman in a laboratory setting. The success rate after IVF is between 28-35%.6 For IVF, sperm is collected from the partner or a donor prior to treatment while the female is typically started on medications after a close examination of her cycle. Gonadotropins are usually taken for 10 to 14 days, by the female, along with either Lupron or Ganirelix for 3 to 5 days, followed by an injection of hCG roughly 35 hours before the procedure – which ensures more than one egg will mature at one time. Eggs are removed from the ovary just before a woman ovulates. Once the eggs are retrieved, they are fertilized in a laboratory and then placed in the woman’s uterus.
Surgery
Surgery is used if the fallopian tubes are blocked or scarred. The success rate after surgery is about 40-60% for those with endometriosis and between 10-90% for women who have their tubes opened.
Endometriosis is a condition where the cells lining the uterus begin to grow in other areas of the body. It can lead to blockage of the tubes, the uterus, and can potentially alter hormone levels in the woman’s body, altering fertility chances.
Surgery is used to:
- – Open or remove build up in fallopian tubes
- – Remove growths such as polyps, fibroids, or cysts
- – Remove scarring from a previous surgery, infection or endometriosisFertility treatments can be challenging and exhausting for many couples. It is important to discuss all available options with your doctor and your partner to understand the benefits and risks of each option available.
