Pros and Cons of Different Fertility Treatments

Deciding to have a child can be an exciting time, but it can be particularly complex for those facing fertility challenges. Modern treatments include various techniques, from fertility medicine to surgical therapies. When considering your fertility options, medical recommendations, treatment efficiency, average costs, and individual preferences should all be evaluated.

In this article we will explore the pros and cons of different fertility treatments.

Types of fertility treatments

Infertility is defined as the failure to conceive after one or more years of trying. About 17.5% of the adult population worldwide, or 1 in every 6 persons, is affected by infertility. A few types of treatments are available for individuals who can afford fertility treatment. Treatment options include:

• Medicinal therapy
• Surgical corrections
• Assisted conception

Each type has pros and cons. Keep in mind that success rates are ranges and will vary based on your individual situation.

Fertility medicine

Fertility medicine is used to restore the menstrual cycle, stimulate the ovaries to produce mature eggs (ovarian stimulation), or prevent premature ovulation. Other medications may be used to enhance fertility, such as doxycycline, which reduces the risk of infection after egg retrieval, and progesterone, to prepare and maintain the uterus for pregnancy. Common types of fertility medication are listed below:

• Clomiphene citrate (Clomid). An ovarian stimulant that works similarly to estrogen.
• Human menopausal gonadotropin or hMG (Repronex, Pergonal). An ovarian stimulant containing follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
• Follicle-stimulating hormone or FSH (Gonal-F, Follistim). A hormone that stimulates the growth of eggs in the ovary.
• Gonadotropin-releasing hormone (Gn-RH) analog. This suppresses FSH and LH to pause menstruation to help improve the ovarian reserve (e.g., the number and quality of eggs).
• Metformin (Glucophage). This is used to reinstate the menstrual cycle in individuals with PCOS-related insulin resistance.
• Bromocriptine (Parlodel). This helps normalize prolactin hormone levels to restore menstrual cycles and fertility.

Fertility medications can cost around $7,000 per cycle.

Surgical infertility treatment

Surgery may be recommended in some cases to help increase the chances of a successful pregnancy. Some surgeries are required to correct abnormalities or other conditions affecting their reproductive system, such as fallopian tube blockage, or to treat enlarged veins disrupting flow to male reproductive organs.

Female infertility

For women and individuals assigned female at birth (AFABs), common surgeries to treat conditions contributing to infertility are listed below.

• Endometriosis. Surgery to treat endometriosis helps remove tissue similar to that of the uterus but growing in the wrong parts of the body. The endometriosis tissue can bleed and break down during the menstrual cycle, leading to inflammation and scar tissue that interferes with the movement of the sperm and egg between the fallopian tubes and uterus. Approximately 40% of women and AFABs with infertility have endometriosis.
• Fallopian tube surgery. Damaged or blocked fallopian tubes may be caused by various factors, including endometriosis, inflammatory diseases, or past surgeries. Surgery is used to correct or reverse the damage.
• Polycystic ovarian syndrome (PCOS). In PCOS, ovaries produce more male sex hormones, which disrupts the menstrual cycle. Laparoscopic ovarian drilling may treat PCOS-related fertility problems by lowering testosterone levels, helping to correct hormone imbalances.

Male infertility

For men and individuals assigned male at birth (AMABs) common surgeries to correct infertility include the following:

• Variocelectomy. This surgery is used to correct varicocele, a condition in which the enlarged veins negatively impact the blood flow to reproductive organs. The condition has been shown to occur in 40% of men experiencing infertility.
• Vas deferens correction. Corrective or reversal surgery may be used to repair the vas deferens, the tube that carries the sperm out of the testes. The vas deferens can be damaged due to trauma, infections, or cut and sealed for a vasectomy.

In individuals with low sperm count or with a blockage that cannot be corrected, sperm aspiration or extraction may be used to retrieve the sperm for use in other assisted reproductive techniques (ART).

The average cost can range from $3,000 to $8,000 for one surgery.

Assisted reproductive technologies (ART)

With assisted reproductive technology (ART), the eggs, sperm, and embryos are handled outside the body. Two percent of infants in the US born each year are conceived using ART. ART treatment costs typically range from $5,000 to over $30,000 for a single treatment, depending on the facility, type of therapy, insurance coverage, and more.

In vitro fertilization (IVF), the most common ART technique involves fertilizing an egg outside the body and in a lab setting before transferring it back into the uterus through a catheter inserted into the vagina (transvaginally). Ovarian stimulation is also performed before the procedure to help mature eggs develop before the procedure. Other types of ART techniques are listed and briefly described below.

• Gamete intrafallopian transfer (GIFT). Combining the eggs and sperm outside of the body before placing them back into the fallopian tube through a surgical incision, where fertilization will occur.
• Tubal embryo transfer (TET). Eggs and sperm combined outside of the body and allowed time for fertilization before being inserted into the fallopian tubes via a surgical incision.
• Frozen embryo transfer (FET). Involves thawing frozen fertilized eggs and inserting them into the uterus transvaginally via a catheter.
• Zygote intrafallopian transfer (ZIFT). Eggs and sperm are combined and left for 24 hours to fertilize and then inserted into the fallopian tubes via a surgical incision.
• Intracytoplasmic sperm injection (ICSI). Used during IVF for couples with severe male factor infertility or previous failed IVF attempt, where a single sperm is injected directly into the egg.

According to the Centers for Disease Control, more than 300,000 ART cycles were performed in the US, which resulted in more than 70,000 successful births.

Artificial or intrauterine insemination (IUI)

Artificial insemination, also called intrauterine insemination (IUI), is another type of fertility treatment that involves extracting, washing, and then inserting the sperm inside the uterus using a speculum. While this handles the sperm, it is not considered an ART, as neither the egg nor an embryo is being manipulated.

In many cases, IUI may be a first step and can be helpful in cases of sexual dysfunction or other troubles. Women and AFABs in this process are also provided with hormones to stimulate ovulation or improve ovarian reserve. Those initially recommended for IUI but who experienced failures with the procedure may be recommended for IVF.

IUI costs range from a few hundred to $1,000 per procedure.

Alternative fertility treatments

Complementary and alternative medicine (CAM) has emerged as a holistic approach to infertility treatment. CAM therapies include acupuncture, yoga, pelvic physical therapy, and herbal medicine.

Other alternative interventions include homeopathy, electric support, and hyperbaric oxygen therapy. Current studies continue to show mixed results regarding the effectiveness of alternative fertility treatments, and more high-quality studies would be needed before alternative therapies may be recommended in place of established fertility treatments.

However, combining therapies proven to reduce stress and improve overall health may be beneficial for certain individuals. Always discuss therapies and alternative options with a healthcare provider.

Choosing a fertility treatment

When considering fertility treatment options, several important factors should be considered.

First, it is vital to have open and honest communication with a qualified healthcare provider specializing in fertility. Always speak with a medical professional who can assess your specific medical history and provide personalized guidance. They can evaluate factors such as age, underlying health conditions, and previous treatments to determine the most suitable options for you.

It is also necessary to consider the potential costs, as fertility treatments can be expensive. If you plan to use insurance, reach out to the appropriate provider or representative to understand coverage (e.g. check if, for example, IVF, is covered by your insurance provider). Discuss payment plan options with the medical office or other financing opportunities, and consider the potential long-term financial commitment for different treatments. Also, less complex and less-invasive options could be more suitable and less costly for those just exploring fertility treatment.

From fertility medicine to surgery, each therapy has merits and considerations. By considering your personal medical history, and professional recommendations, and evaluating the feasibility of different treatments, you can make informed decisions that align with your needs and will help increase your chances of success.