American Medical Association Family Medical Guide - American Medical Association [268]
Ask whether the doctors who will be caring for you are board-certified in reproductive endocrinology, how many live births have occurred in their program, and what the costs will be. Insurance coverage for infertility treatment varies by state and type of health insurance. Check with your employer to find out exactly what kind of coverage you have.
The US Centers for Disease Control and Prevention (CDC) collects and reports the success rates of all assisted reproductive technology programs in the country that belong to the Society for Assisted Reproductive Technologies. You can access this information on the Internet at http://www.cdc.gov/nccdphp/drh/art.htm. To obtain a printed copy, call the CDC′s division of reproductive health at 770-488-5372.
Unexplained Infertility
About 10 to 30 percent of all infertile couples are told that their infertility cannot be explained. Doctors reach a diagnosis of unexplained infertility after ruling out other possible causes through a standard battery of tests. The diagnosis does not mean that no cause for the infertility exists, but rather that the cause cannot be identified using the initial screening tests.
After 1 to 3 years of unexplained infertility, many couples conceive on their own. The age of the woman is usually the key in this process. Spontaneous conception is much more likely in a woman under age 35 than in a woman who is over 40. But treatment for unexplained infertility has been shown to improve pregnancy success rates over unprotected intercourse alone.
Many infertility centers recommend the following course of treatment: three to six cycles of ovulation-inducing drugs combined with intrauterine insemination (see page 500), followed by in vitro fertilization. Using this treatment regimen, pregnancy rates for couples with unexplained infertility are equal to or higher than those of couples with a diagnosed cause of infertility.
Treating Infertility
Once the doctor has determined the cause of your infertility, he or she will recommend the most effective treatment. Many doctors try one therapy, such as ovulation-inducing drugs, for several months before changing to another. Infertility treatment can be stressful, so be sure to ask your doctor how realistic your chances are of conceiving using a given method before trying it. Remember that you have control over whether to continue treatment, stop treatment temporarily or permanently, or explore other options, such as adoption.
Treating Infertility in Women
Infertility treatment for women depends on the cause. Doctors usually try to treat infertility using conventional methods, such as drugs and surgery, before trying more advanced assisted reproductive techniques, such as in vitro fertilization (see page 500). However, some infertility problems, such as blockage of the fallopian tubes, have a better outcome using treatments such as in vitro fertilization, and doctors often recommend using them right away.
Drugs that induce ovulation
If failure to ovulate is the reason for your infertility, the first step is to look for easily treatable causes such as thyroid disease, which can often alter a woman’s hormonal balance enough to affect ovulation. Otherwise, your doctor may recommend starting you on an ovulation-inducing drug such as clomiphene citrate (in pill form), which can stimulate the ovaries to release mature eggs. Women usually take one to four pills a day from the third to the seventh day of their menstrual cycle. Your doctor may take several blood samples to measure estrogen levels while you are taking the drug, and ultrasound scans to monitor your eggs. If this drug regimen is not effective in stimulating ovulation, the doctor may start you on a series of human menopausal gonadotropin hormones, taken by injection. This treatment may continue for several months and may be repeated.
While taking drugs to induce ovulation, you will be examined with vaginal ultrasound scans to check the growth of the developing ovarian follicles.