Treatment Options for Infertility

Association of Reproductive Health

Professionals
www.arhp.org
Learning Objectives
• State at least three infertility treatment
options available for females.
• State at least three infertility treatment
options available for males.
• List two available ovulation-inducing drugs.
Basic Services for Infertile Couples

1. Educate on infertility causes and prevention

2. Conduct
2. Conduct appropriate
appropriate diagnostic
diagnostic workup
workup

3. Offer information on treatment options

4. Provide resources for counseling and

emotional support

Stewart GK. 1998

Fertility Treatments Can Work

“…With thorough evaluation and

application of current treatments
short of IVF, embryo transfer, or
GIFT, 50–60% of infertility couples
will conceive.”
Meldrum DR
1998

Meldrum DR. 1998.

Causes & Treatments for Male
Infertility

Azospermia Inject FSH and LH

Surgical sterilization Reverse vasectomy

Impaired sperm motility Repair varicocele

Nelson AL, Marshall JR. 2004.

Main Causes of Female Infertility

Nelson AL, Marshall JR. 2004.

Treatments for Female Infertility
• Maintain normal body weight
• Clomiphene
• Metformin
• Gonadotropin therapies
• Laparoscopic ovarian drilling

more…
Nelson AL, Marshall JR. 2004.
Treatments for Female Infertility
(continued)

• In vitro fertilization
• With or without salpingectomy
• Tuboplasty (tubal ligation
reversal)

more…
Nelson AL, Marshall JR. 2004.
Treatments for Female Infertility
(continued)

• Laparoscopic ablation
• Intrauterine insemination with
controlled hyperstimulation
• In vitro fertilization

Nelson AL, Marshall JR. 2004.

Ovulation-Inducing Drugs:
Clomiphene
• Chemically stimulates pituitary gland to
produce hormones that trigger ovulation
process
• Usual dosage: 50 mg/day for 5 days
• Numerous side effects
• May not be appropriate for patients with:
▪ Large fibroid tumors
▪ Ovarian cysts
▪ Liver problems more…
Harkness C. The Infertility Book. 1992.
Ovulation-Inducing Drugs:
Bromocriptine
• Reduces production of prolactin hormone
• Dosage: 2.5 mg 1–3 times/day
• Some side effects
• May not be appropriate for patients with
pituitary tumors >1 cm

Harkness C. The Infertility Book. 1992.

Ovulation-Inducing Drugs
• Human Menopausal Gonadotropins (hMG)
• Follicle-Stimulating Hormone (FSH)
▪ Stimulate ovary to develop follicles
▪ 75–150 IU/day (with hCG)
▪ 20–40% possibility of multiple births
▪ May not be appropriate in cases of pituitary
tumor, ovarian cysts

more…
Harkness C. The Infertility Book. 1992.
Ovulation-Inducing Drugs (continued)
Gonadotropin-Releasing Hormone (GnRH)
• Triggers normal pituitary hormonal activity so
ovulation can occur
• Effective in women with hypothalamic
amenorrhea
• No known physical side effects
• Ovulation pump administers injections every
90 minutes
• User must carry pump with attached IV tubing
for 1–2 weeks or until ovulation occurs
Harkness C. The Infertility Book. 1992.
Endometriosis:
Treatment with Surgery
Pregnancy rates after surgery

After Stage 1 or 2 Stage 3 Stage 4

Jennings VH, et al. 1998.
Endometriosis: Drug Therapies
• GnRH agonists
• Birth control pills

Jennings VH, et al. 1998.

Polycystic Ovarian Disease:
Treatment
Ovulation induction
• Clomiphene
• HMG, FSH, GnRH
• Insulin sensitizers (e.g. metformin,
rosiglitazone)

Jennings VH, et al. 1998.

ART Treatments for Infertility

IVF with embryo transfer

Gamete intrafallopian transfer (GIFT)

Zygote intrafallopian transfer (ZIFT)

Cryopreservation

Intracytoplasmic sperm injection (ICSI)

American Society for Reproductive Medicine. 2003.

American Society for Reproductive Medicine. 2001.
IVF with Embryo Transfer
Egg and sperm are retrieved from couple,
donor(s), or both

Combined in a petri dish, incubated for

2–5 days

If fertilization and cleavage occurs,

embryo is transferred through a catheter
to uterus
Clapp DN. 2002.
Gamete Intrafallopian Transfer
(GIFT)

Oocytes retrieved via laparoscopy

Oocytes and sperm placed in same catheter

Injected directly into the fallopian tube via

laparoscopy

Embryo travels through the fallopian tube

to the uterus for implantation
Clapp DN. 2002.
Zygote Intrafallopian Transfer (ZIFT)
Combines techniques used in IVF and GIFT

Ova are placed in a petri dish with sperm

If fertilization occurs, the zygote:

• Is injected into fallopian tube
• Travels through tube to uterus
• Implants in uterus

Clapp DN. 2002.

Cryopreservation
Sperm or embryos are preserved by freezing
for replacement in subsequent cycles

Clapp DN. 2002.

Photo source: http://www.dcmsonline.org
Intracytoplasmic Sperm Injection
(ICSI)
• A single sperm is
injected directly into the
cytoplasm of the oocyte
• Increases probability of
fertilization

American Society for Reproductive Medicine. 2004.

Photo source: www.fertilitycentre.ca
ART Options for Same-Sex Couples
• Combination of their own
and donor sperm and
eggs through IVF
• Surrogacy
• Can parent biological
children

Bateman S. 2004.