Fortunately, there are many fertility treatments for women based upon the cause(s) of infertility. Unfortunately, there are no fertility drug treatments for the male that have been shown to increase pregnancy rates. This is true except for the rare male with severe deficiencies of FSH and LH.  IVF with ICSI is very effective in treating moderate to severe male infertility.

IVF, In Vitro Fertilization

The general public usually equates in vitro fertilization (IVF) with infertility treatments.  This is largely because the media focuses on “high tech” treatments like ART procedures without discussing common therapies, such as intrauterine insemination (IUI) or medications.

Dependent upon the clinic, fewer than 25% of patients will require IVF to become pregnant. Most will become pregnant using medications with/without intrauterine insemination (IUI). First line indications for IVF include:

• Women with moderate to severe fallopian tube damage. The eggs are manually retrieved in an IVF cycle thus “bypassing” the tubes.
• Women who wish to have a tubal sterilization procedure reversed. Some of these women will be candidates for surgical reversal but IVF provides higher success rates.
• Women in their mid thirties to early forties will sometimes have an elevated day 3 FSH level.  FSH levels increase as egg quality declines and women with severe FSH elevations may be candidates for the donor egg program.
• IVF with intracytoplasmic sperm injection (ICSI) is used to treat moderate to severe male factor infertility.  Using ICSI, a single sperm is injected directly into the egg thus increasing fertilization rates.
• Women who fail 3-6 cycles of IUI may be candidates for IVF.  One major advantage of IVF is that it allows the embryologist to view and document fertilization.
• Other couples will be candidates for IVF based upon the judgment of their fertility specialist.

Donor Egg IVF

Women are born with a lifetime’s supply of eggs and 1-2 are ovulated each month. FSH is a measure of the eggs ability to fertilize and develop and elevated FSH levels may signal the need for donor egg IVF.

Donor egg IVF is used in women with reduced ovarian reserve or ovarian failure.  This includes women who may be perimenopausal or menopausal. Egg donors are young fertile females and success rates using their eggs are generally high. See our Long Island, NY Donor Egg Program Web site for more information.

Intrauterine Insemination (IUI)

IUI is often a “first line” fertility treatment and is often conducted with FSH drug stimulation. FSH recruits and supports the development of numerous follicles.  Once the eggs mature, an injection of hCG is given and the IUI’s are scheduled.

Sperm are collected, washed, and concentrated before use in an IUI cycle.  The sperm are injected directly into the uterus which bypasses any cervical mucus problems.

IUI cycles should be administered by a trained reproductive endocrinologist to help avoid high order multiple births and reduce side effects.

Fertility Drugs

By the time some women reach the infertility specialist, they have already tried Clomid under the supervision of their OB/GYN.  Clomid is most likely to be effective during the first 3 cycles and therapy beyond this point should be monitored/administered by a reproductive endocrinologist/infertility specialist. Long term use of Clomid is rarely effective and can lead to side effects. Clomid is also expensive.

In the best case scenario, once a woman suspects she is sub fertile, she will make an appointment with an infertility specialist for a complete evaluation.  This usually results in lower overall treatment costs and increased chances for pregnancy.

Metformin belongs to a class of drugs known as “insulin sensitizing” agents. PCOS patients have chronically elevated insulin levels which ultimately leads or the overproduction of androgens (male hormones) and infertility. Metformin lowers circulating insulin levels, which lowers androgen levels, and usually restores normal ovulation.

Surgery

The fertility specialists at North Shore-LIJ, Center for Human Reproduction have extensive skill and training in delicate microsurgical treatments.  Laparoscopic surgery is used extensively to treat conditions such as endometriosis and many others. Laparoscopy results in less pain, quicker recovery time, less expense, and less scarring.