Pathways to Parenthood: Understanding Your Fertility Treatment Options

Couple consulting with a fertility providor

Did you know that—based on estimates provided by the American Society for Reproductive Medicine—the likelihood of natural conception in each cycle is approximately 25% for women under 30, 20% for those over 30, and about 5% by the age of 40?

While the data may seem daunting, we always congratulate patients for taking the first courageous step on their fertility journey. We are committed to considering their entire situation and exploring all available treatment options.

Our Approach to Choosing Treatments

While some may be ready for In Vitro Fertilization (IVF), it’s our responsibility to inform them about the spectrum of assisted reproductive technologies. Treatments go from lesser to different with options including:

  • Timed intercourse with Clomid or Letrozole
  • Intrauterine Insemination with Clomid or Letrozole
  • Intrauterine Insemination with injectable medications (FSH)
  • In Vitro Fertilization with fresh transfer or Frozen Embryo Transfer

For all treatments mentioned above, apart from timed intercourse, donor sperm is an available option for same-sex couples or male factor infertility with participating sperm banks. Egg donor treatments are also coordinated with participating egg donor banks or known donors.

Timed Intercourse with Medications

Timed intercourse is ideal for couples without male factor infertility. Oral medications such as Letrozole or Clomid increase chance of conception with each cycle up to 10%. The mechanism for each is different: Clomid tricks the body of having lower estrogen while Letrozole actually blocks the protein in charge of making estrogen. In both cases these mechanisms trigger the body to make more FSH (Follicular Stimulating Hormone) therefore, more eggs for one cycle. The medications induce ovulation and for some, the dosing may need to be increased if ovulation has not been achieved.

We may also use HCG (human chorionic gonadotropin) to trigger ovulation with appropriate monitoring of the growth of follicles by ultrasound and elevation of estrogen and LH by blood work. If there is no success after 6 months, then considering other methods of ovulation induction would be valuable.

Intrauterine Inseminations

In cases where the sperm may be of concern then Intrauterine Inseminations (IUI) may become a great tool. With any use of ovulation induction medications, we generally monitor with ultrasound and blood work. The insemination is timed based on ovulation. This entails the male partner producing a sample the morning of the insemination and we prepare the specimen in our lab. The specimen is identified by patient and the procedure is similar to a GYN exam. We load the specimen to a small catheter, and this is advanced through the vagina and into the cervix, so the sample is injected into the uterus. We recommend having intercourse that day and for the next few days and to plan for a home pregnancy test two weeks after.

For inseminations with use of injectable medications such as FSH, the monitoring is more frequent as we must monitor closely to prevent hyperstimulation. Chances of conception increase to about 25%. When more than 4 follicles are growing in one cycle we must cancel as the risk of multiple pregnancy is substantially increased to 8% per cycle. The insemination process is the same and we make sure ovulation occurs with the use of a trigger injection, Human Chorionic Gonadotropin (HCG). With these types of cycles, we recommend the use of progesterone in the luteal phase to help support the implantation process for pregnancy.

In Vitro Fertilization (IVF)

For couples who have undergone unsuccessful IUI cycles, In Vitro Fertilization (IVF) becomes a consideration. The process involves careful preparation, medication administration, and close monitoring, with options for fresh or frozen embryo transfers. Other factors like male factor, egg donation or blocked fallopian tubes may lead to more immediate IVF. While IVF is more intricate, it offers a comprehensive solution for various fertility challenges.

We plan for a visit a few weeks before the stimulation starts to do a baseline ultrasound, measurement of the uterus to map out for the placement on the embryo as well as consent signing as needed. Couples may also plan for medication teach as most medications for the IVF stimulation are injectables.

Once treatment is initiated patients are closely monitored with bloodwork and ultrasound and on average the total amount of days on medication may range from 9-12 days. Once the follicles are ready for ovulation the patient is triggered and the retrieval of the eggs is timed 36 hours after the HCG injection. The procedure is completed under IV sedation and lasts for about 10-15 minutes. Between admission, retrieval and recovery, patients are at our center for about 90 mins. At our center we do offer fresh transfers as well as frozen embryo transfers with pre-implantation genetic testing to check for aneuploidy (abnormal number of chromosomes).

Without genetic testing from beginning to end it may range from 4-6 weeks. If opting for genetic testing of the embryo the treatment is prolonged as it becomes 2 parts and from beginning to end is about 10-12 weeks all dependent on dates available.

When patients come in for an initial consult and a workup is recommended it is all meant to diagnose and treat for infertility as well as other possible underlying issues such as dealing with polyps, fibroids and even endometriosis. In these cases, treatment start for conception may be delayed since surgery becomes part of the equation.

Every couple is unique, and our approach is tailored to meet both emotional and physical needs, ensuring informed and empowered decision-making throughout their fertility journey.

Call us at 732-758-6511 or email and make an appointment to get evaluated by one of our experienced providers.