Fertility Series: Exploring Fertility Treatment Options 

Estimated reading time: 10 minutes

Medically reviewed and verified by Kate Burke, MD, MHA

After a diagnosis, your reproductive endocrinologist will present you with various personalized treatment options. It is important to acknowledge that these options come with feelings of hope and uncertainty because of their differences in complexity, cost, and success. Here are some of the most common assisted reproductive technology (ART) options and medications used in infertility diagnosis.  

New to the series? Check out these other blogs:

• Introduction to Infertility
• Infertility Isn't Just a Physical Journey… It's an Emotional One
• The Fertility Doctor Visits

Medications and Hormonal Treatments 

Fertility medications are often the first step in treatments, especially if you have been diagnosed with an ovulation disorder or unexplained fertility. Common medications are:  

Clomiphene 

Clomiphene is an ovulation stimulator used in the treatment of ovulatory failure in patients desiring pregnancy. It works like estrogen in a way that encourages eggs to develop and be released.  

Side effects can include: 

• Flushing 

• Vomiting 

• Breast discomfort 

• Headaches 

PLM members using clomiphene have also reported abdominal cramps, irritability, and bloating. 

Metformin 

Metformin is usually used to treat type 2 diabetes, however it has also been prescribed to help with infertility as well. It reduces insulin levels in the bloodstream which promotes ovulation. Some healthcare providers may recommend metformin along with clomiphene if you are living with polycystic ovary syndrome (PCOS).  

Side effects may include:  

• Nausea 

• Vomiting 

• Stomach pain 

• Loss of appetite 

PLM members using metformin have also reported loose bowel movements, low blood sugar (hypoglycemia), and diarrhea.  

Gonadotrophins 

Human chorionic gonadotropin (HCG) induces ovulation and pregnancy in anovulatory, infertile females; uses for HCG in men include hypogonadism and fertility treatment. These hormones are given as shots and have a higher risk of multiple pregnancies like twins or triplets. Studies have shown that gonadotrophins are integral in ovarian stimulation in infertility cases.  

Side effects may include: 

• Multiple gestation, meaning multiple births (twins or more!) 

• Ectopic pregnancies, which can be life-threatening and require surgery. 

PLM members using gonadotrophins have also reported early morning hunger and emotional sensitivity. 

Letrozole 

Letrozole slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH). In a NICHD study, they found letrozole was more effective than clomiphene in causing ovulation and improving live birth rates for people with PCOS.  

Side effects may include: 

• High cholesterol 

• Hot flashes and night sweats 

• Fatigue 

• Nausea 

• Weight changes 

• Muscle and joint pain 

• Bone loss and fractures. 

PLM members using letrozole have also reported hair loss and deep leg pain.  

Antioxidants and vitamins 

There is evidence showing that oxidative stress (OS) plays a role in infertility for both men and women. OS is when there is an imbalance in the body’s ability to neutralize toxic products. This can lead to damage to the reproductive cells and tissues.  

Like the chart above indicates, the antioxidants and vitamins include: 

• Vitamin A – Found in sweet potatoes, carrots, tune, pumpkin, and kale 

• Vitamin C – Found in guavas, bell peppers, kiwifruit, broccoli, papaya, and strawberries 

• Vitamin E – Found in sunflower seeds, olive oil, almonds, avocado, spinach, butternut squash, and kiwifruit 

• Vitamin B9 – Found in liver, yeast, legumes, pulses, fermented foods, and leafy vegetables 

• Selenium – Found in meat, fish, milk, eggs, cruciferous vegetables, liliaceous vegetables, legumes, garlic, and onions 

• Zinc – Found in oysters, beef, chicken, firm tofu, squash and pumpkin seeds, low-fat yogurt, and lentils 

• L-carnitine – Found in sheep meat, beef, pork, fish, chicken, and cow’s milk 

• Melatonin – Found in cherries, walnuts, mustard seeds, poppy seeds, corn, and rice 

• Quercetin – Found in fruits, vegetables, seeds, and nuts 

• Resveratrol – Found in skins of grapes, red and white wines, apples, blueberries, and peanuts 

Exploring Alternative Therapies 

In the next section we are going to explore Assisted Reproductive Technology (ART) options, but I wanted to quickly touch on an alternative therapy, acupuncture.  

Acupuncture is part of the ancient practice of Chinese medicine where mall metallic needles are placed at different places along the body. The idea revolves around the body’s ability to heal itself and to encourage health and wellness. Is it an effective therapy for infertility?  Maybe. The studies are a mixed bag.  

• In a 2011 study, they were able to show improvement in fertility. 

• In 2011 a review found that if you believed it would work then there was a higher likelihood of success. 

• In this 2018 study,   they concluded that there was no change in fertility rates with the use of acupuncture.  

With acupuncture's benefits of rebalancing your body’s energy to help with stress and anxiety and its ability to release endorphins to help with pain management, I can see how this can be an attractive complementary therapy. Be sure to discuss it with your healthcare team before you try it out.  

Assisted Reproductive Technology (ART) 

ART refers to various medical procedures used to address infertility and help individuals conceive. These procedures involve manipulating eggs, sperms, or embryos to increase the changes of pregnancy. Some of the most used ART procedures include in vitro fertilization (IVF), intrauterine insemination (IUI), and fertility preservation methods like egg freezing and sperm banking. ART is also a key part of an LGBTQIA+2S couples' journey through sperm donations, surrogacy, and reciprocal IVF. Some important things to consider when deciding on your next step are the medical complications, emotional needs, and financial needs when it comes to building your family.  

In Vitro Fertilization (IVF) 

IVF is a widely known fertility treatment. In the absolutely simplest terms, IVF takes eggs and sperm and combines them in a culture dish in a lab. Embryos form and then are inserted into the uterus. If it grows and develops, then congrats you get to take your baby home in nine months. How do we get there? 

1. Ovarian stimulation: IVF doctors aim to stimulate the ovaries and produce multiple eggs to increase the chances of successful fertilization. You’ll be prescribed some FSH and LH hormone medications to encourage your ovaries to produce multiple eggs. They will be monitoring you for about two weeks to make sure your ovaries aren’t overstimulated, causing ovarian hyperstimulation syndrome (OHSS). This leads to swollen ovaries, stomach pain, and fluid retention. 

2. Egg retrieval: Once the eggs are ready for retrieval, 36 hours before the procedure you are injected with hCG to help the egg(s) reach maturity. Egg retrieval  

3. Fertilization: After the eggs are retrieved, they are fertilized with sperm in a lab. Typically mixed in a petri dish and left to fertilize naturally but in some cases, they may inject the eggs with the sperm.  

4. Embryo transfer: Once the embryos are ready, the best one is selected and transferred into the uterus with a catheter. Don’t worry, this is painless! Two weeks later you can take a pregnancy test to see if it worked! If you had multiple embryos, they are frozen for future IVF cycles. 

Reciprocal IVF 

Reciprocal IVF allows lesbian partners to participate biologically in the pregnancy. One partner provides the eggs, which are fertilized through IVF with donor sperm. Then the embryo is transferred to the woman who is carrying the pregnancy. This is an incredible option for those who want to be both physically and emotionally invested in the birth process.  

Donor eggs and sperm 

Donor eggs are recommended for those who with poor ovarian function, due to either age or chemotherapy treatments. Donors are typically women under 35 with healthy ovaries and no significant genetic conditions. Donor sperm is common for male infertility, single women, and same sex couples. Sperm donors are typically 18-40 and are also screened for genetic conditions. In both cases, donors can be known or anonymous. Whether it’s a friend or an anonymous donor, be sure you understand the legal parental rights when determining which option is best for your family. 

IVF has shown high success rates for those struggling with fertility, particularly young women.  However, it is important to understand the emotional stress of rigorous medical procedures and the uncertainty of success for your circumstance, the financial costs because one cycle could be thousands of dollars and in most cases more than one cycle is needed before success, and lastly the physical side effects from the hormone medications. 

Intrauterine Insemination (IUI) 

IUI involves placing sperm directly into a woman’s uterus during ovulation. This is a little less invasive and typically a more affordable procedure. This is the medical office version of the “turkey baster” method, which refers to at-home insemination kits. How does IUI work? 

1. Ovulation monitoring: Doctors will monitor your ovulation cycle to determine the best time for ovulation. Typically this is about two weeks before your next period starts. You can use an app like PatientsLikeMe to track your cycle too.  

2. Sperm preparation: The best swimmers, aka sperm that that are the healthiest are prepared in a lab. This is from sperm sample from your donor or male partner.  

3. Insemination: Similar to IVF, a catheter is used to transfer the sperm into the uterus so they can fertilize the eggs.  

4. Test: After two weeks you can take a pregnancy test to see if it worked! 

Uterus Transplant 

A uterus transplant is not a common procedure. It is an innovative procedure typically performed on women with absolute uterine factor infertility (AUFI), a condition where the uterus is absent, non-functional, or caused by Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). 

Navigating Treatment Choices 

Each of these fertility treatments come with their own set of emotional, physical, and financial needs. It is important to find a community or support circle for you to lean on to weigh these options. Connect with others who share similar experiences and gain access to valuable insights and support tailored to your health needs with PatientsLikeMe.

PatientsLikeMe provides the tools and community support you need to manage your fertility journey. Join others who share their experiences with infertility and insights, offering advice and encouragement. Track your symptoms, treatments, and outcomes, to see the full picture of your health. You can also evaluate the effectiveness of treatments based on comprehensive patients' data. Join for free today.

Resources 

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