Every year, thousands of couples struggle with what seems like it should be easy -- getting pregnant. Thankfully, there are a number of treatments available to help infertile couples have a child. The first step is to consult with a qualified infertility specialist or reproductive endocrinologist. This physician will order tests to determine exactly what is causing the infertility and design a treatment plan to help you.
Natural Cycle Monitoring
The least invasive treatment is for the doctor to monitor your cycle through blood testing and ultrasounds to determine exactly when you should begin having intercourse. This can maximize your effort, especially if the diagnosis is unexplained infertility.
Your doctor will give you instructions as to when you should come in for your monitoring appointment, usually around the beginning of your cycle, which will consist of blood testing and/or an ultrasound. Based on those results, you will be instructed when to come back. The doctor will continue to periodically monitor your cycle, including your hormonal levels and the follicular growth. Once an egg follicle reaches maturity, he will instruct you to either have intercourse or an intrauterine insemination (IUI).
This can be diagnostic as well, helping your doctor detect hormonal issues or problems with ovulation that may not have been detected otherwise.
Medications
Sometimes the doctor may recommend medications to increase the number of egg follicles that you produce during a cycle. These hormones are synthetic versions of the ones that your body produces naturally each month, but are given in precise dosages to control the number and growth of the follicles.
Clomiphene citrate, or Clomid, is often a first choice. It is an oral medication that you will take for five days, starting in the beginning of your cycle. Clomid is dispensed as a 50 mg pill, and you will take 50 mg, 100 mg or 150 mg (one, two or three pills) each day, at the same time as directed by your doctor. Periodic monitoring will be required to check your response, and you will also be instructed when to have intercourse or return for an IUI.
Follicle stimulating hormone (FSH), lutenizing hormone (LH) or combinations of these two hormones are also given as injectable medications. Your doctor will instruct you when to begin taking them, but starting around day three or day four is common. More frequent monitoring is also required, especially once you get close to ovulation. You dose will be determined based on the results from your monitoring. A "trigger" injection of human chorionic gonadotropin, or HCG, is sometimes required to bring on your ovulation. Again, you will be instructed when to have intercourse or an IUI.
Intrauterine Insemination
Intrauterine insemination is an option for couples in which a male factor or an issue with cervical mucus is present. The male partner gives the laboratory a semen sample, which is cleaned and prepared for the insemination process. This can take a few hours, depending on the lab.
Once the specimen is ready, a specially trained nurse or doctor will verify that the specimen is correct with the woman receiving the IUI. A speculum is inserted into the vagina so the cervix can be visualized and cleaned. A small catheter is then passed through the cervix and into the uterus, where the sperm will be injected. The woman may be asked to remain lying down for a period of time before returning home.
In Vitro Fertilization
The most invasive form of treatment, in vitro fertilization (IVF) requires a lot of time, injections and monitoring. A woman is given high doses of FSH and LH to stimulate her ovaries to produce many egg follicles. An additional injectable medication is required to prevent the woman from ovulating. The follicles are allowed to mature, and once ready, she will take a one-time trigger injection of HCG. The eggs are retrieved surgically and allowed to fertilize in the lab.
At this point, the woman will begin taking estrogen and progesterone supplements to help her uterus prepare for a pregnancy. A designated number of embryos, usually two or three, will be transferred three to five days after the egg retrieval. Any extra embryos can either be disposed of or frozen for a later cycle. Your doctor will instruct you when to return for your pregnancy test.
Egg or Sperm Donation
If there is something abnormal about either the eggs or sperm, using donated cells may be an option. Your clinic will assist you in selecting the right egg or sperm donor for you. While using a known donor is an option, using an anonymous donor is often a viable option for couples as well.
If using a sperm donor, the cycle for either IVF or IUI will proceed in exactly the same manner, except that the laboratory will substitute the donated sperm cells for the male partner's sperm.
If you will be using an egg donor, the process is a bit more complicated. The egg donor will move through the initial stages of the IVF process, taking the medications to stimulate her ovaries. At the same time, the recipient will begin taking estrogen and progesterone supplements to build up her uterine lining. Once the donor's eggs are retrieved, they will be fertilized in the lab with the male partner's sperm and then transferred back into the recipient.
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