What Are Your Fertility Options?

When it comes to infertility, knowing how to take the first step can feel overwhelming. You may be struggling with feelings of inadequacy or fear, and juggling the variety of options for conceiving can be daunting. In order to help you understand the various options you have for conception assistance, we’ve broken them down for you.

Not every solution will be right for everybody, so it’s important to have a discussion with your healthcare provider about which solution is right for you. This information can help you in that conversation.

Fertility Medications

What are fertility medications? They are medications taken by a female who is wanting to get pregnant and needs support. They are sometimes used alone (without assisted conception procedures such as intrauterine insemination (IUI) or in vitro fertilization (IVF)) or in conjunction with assisted conception procedures. These medications are often prescribed by OB/GYN physicians, Certified Nurse Midwives, or Reproductive Endocrinology and Infertility (REI) specialists. Some medications you may come across are described below. 

Ovary Stimulation Medications:

• Clomiphene citrate (clomid): inexpensive medication that stimulates the ovaries to produce multiple eggs. It is often used in women with PCOS or who have irregular or infrequent ovulation. Prolonged use of clomiphene citrate (over a year) may increase the risk of ovarian cancer and it is not usually used beyond this time frame.  
• Letrozole (femara): ovary stimulating medication that is frequently used with patients who have PCOS. It is used “off label” for infertility as it is typically used for women with breast cancer. It lowers the levels of estrogen and the body responds by increasing another hormone that helps with ovulation. 
• Folitropin alpha and beta (follistim): medication that contains multiple hormones that encourage the development of multiple eggs. It requires a small injection just under the skin. Although most people tolerate it well, some women experience abdominal discomfort with it.
• Menotropins (repronex): medication that has one type of hormone, FSH, that stimulates the ovaries to make multiple eggs. It is injected just under the skin or into the muscle. Rarely it can cause ovarian hyperstimulation, which is just one reason why it is important to work closely with your healthcare provider when using these medications. 

Medications that Prevent Premature Ovulation: 

• GnRH agonists or antagonists (e.g. lupron or cetrotide) may be used so that ovulation (release of an egg from the ovary) does not happen prematurely, for women who are going through assisted reproductive procedures. 

Hormonal Medications: 

• Hormones such as progesterone (e.g. prometrium and crinone) or estrogen are sometimes used to support the natural hormones that a woman is already producing, or to help the uterine lining with implantation of the embryo. 

Assisted Conception

Assisted conception involves either intrauterine insemination (IUI) or in vitro fertilization (IVF). In both cases, procedures are used that are different from using only medications or only surgery in order to conceive. Read below to learn more about these two important and commonly used procedures to support conception in some women with infertility. 

Intrauterine Insemination (IUI): 

• What is it? 
  • Intrauterine insemination is when a thin catheter (tube/straw) is placed through the cervix (opening of the uterus) to deliver sperm directly into the uterus. 
• Why is it used? 
  • It allows a greater number or concentration of healthy sperm to be placed directly into the uterus, than would usually reach the uterus through vaginal intercourse. This allows more healthy sperm to be placed closer to the egg, than would happen without the procedure. 
• Who may use this procedure? 
  • IUI may be used with a sperm donor, when there is a problem with a male partner’s semen and a greater concentration or number of healthy sperm are needed to be delivered directly to the uterus, if a woman’s cervical mucus is making it difficult for sperm to get into the uterus, or for unexplained infertility. 
• What preparation is needed for this procedure? 
  • Sometimes medications are used to support ovulation so that IUI can be timed appropriately. In other circumstances, ovulation monitoring may be done through ultrasonography, ovulation predictor kits, blood draws, or basal body temperature monitoring, so that IUI can be timed appropriately. 
• Where and how is this procedure usually done? 
  • IUI can typically be done in a gynecologist or reproductive endocrinology and infertility (REI) specialist’s office during a short office procedure. The start of an IUI procedure may feel similar to getting a pap smear done, as a speculum is placed inside of the vagina so that the doctor can see the uterus and place the catheter through the cervix to deliver the sperm. 
• How is IUI different from In-vitro fertilization? 
  • As the names indicate, intrauterine insemination is when the insemination (inserting of semen) happens in the uterus. Fertilization (when the egg and sperm meet) happens without direct intervention. WIth in-vitro fertilization, the meeting of the egg and sperm happens outside of the body. 
• What is the success of IUI? 
  • The success of IUI depends on the underlying reason for why the procedure is being done. Although the chances of success are typically lower than they would be with IVF, IUI is less invasive and costs less than IVF. 

In Vitro Fertilization (IVF):

• What is it? 
  • In vitro (which means “in glass” and therefore outside of the body) fertilization is when fertilization (meeting of the egg and sperm) happens outside of the body.
• Why is it used? 
  • IVF is a more complex treatment so it is usually reserved for when other interventions have failed or if there is a reason that IUI or other less invasive treatments are not appropriate.  
• Who may use this procedure? 
  • IVF may be used when pre-fertilization, embryo genetic testing is desired as this can be accomplished prior to IVF. It is also used when fertilization within the uterus or fallopian tube is unlikely without direct intervention (for example, if the fallopian tubes are blocked). It may also be used for male infertility, when a women is using a sperm donor, if other less invasive procedures have not worked, or for other reasons. 
• What preparation is needed for this procedure? 
  • Egg retrieval: Medications are typically used to stimulate the growth of multiple eggs. Serial ultrasounds and blood tests are done to time the procedure correctly so that a woman can undergo egg retrieval.
  • Embryo transfer: Dependent upon your hormone levels as well as your specific situation, you may be given progesterone supplementation prior to embryo transfer or have an unmedicated cycle.   
• Where and how is this procedure usually done? 
  • IVF requires a minor surgical procedure that can be done at a hospital or an infertility center. 
  • Egg Retrieval: The egg retrieval involves a needle going through the vaginal wall and into the ovaries under ultrasound guidance, to collect the eggs. After this procedure, the eggs are combined with sperm (from a male partner or sperm donor), in a laboratory dish. This is fertilization. These embryos are kept in an incubator so that they can grow over the next few days. 
  • Embryo Transfer: Once the embryos are at the appropriate stage, one or more embryos is chosen to be transferred into the uterus. This is called an embryo transfer. It is usually done in a clinic, a hospital, or an infertility center, with a very small catheter being used to go through the cervix (opening of the uterus) and into the uterus to deposit the embryo(s). 
• What is the success of IVF? 
  • The success of IVF depends upon the underlying reason for the procedure as well as the number of embryos that are placed into the uterus.

Hopefully this blog helped you to better understand some of the options available for supporting women with infertility. The only way to really know what is best for you, is to partner with a health professional to better understand the underlying reasons for infertility. At Diana Health, we are committed to working with you and your partner, as you explore potential options for addressing infertility. We know that your health and fertility journey is unique, and through shared decision making, we can support you in making the best decisions for your family, one step at a time. For more information on things to consider if you are having trouble conceiving, read our Fertility Considerations blog. If you’re interested in talking about your particular preconception needs, please book a visit with us – visits are available in-person and virtually!