Infertility feels like stepping out onto a barren wasteland, cold and empty as far as the eye can see. Once the shock has settled, and you've started to adjust to the cold, you notice the diverging pathways packed into the snow. There are paths to take, and though none can guarantee success, 1 in 8 couples navigate the world of infertility treatments. For those who are unfamiliar with this world, here is a brief overview of some of the many forms of family building with science.
Medicated cycles
There are two kinds of medicated cycles - oral medications and injectables. In both cases, the woman takes medication (either orally or by giving herself a shot daily) to encourage her body to ovulate one or more eggs. In the case of oral medication, the medication is taken once a day for 5 days. Injectables are taken once or twice a day for 7-12 days. The growing follicles (which release mature eggs at ovulation) are monitored via ultrasound. When one or more follicles are mature, a trigger shot may be taken, giving the body a high dose of a hormone to help trigger ovulation. The couple will either have timed intercourse on the days prescribed by the RE (super romantic, right?), or proceed with an IUI.
Intrauterine insemination (IUI)
A semen sample will be prepared by a lab and inserted into the uterus with a catheter. The goal is to get the sperm as close to the fallopian tubes as possible, increasing the possible chance of conception.
In vitro fertilization (IVF)
IVF is a highly specialized science that aims to place a growing embryo into a woman's uterus with the hopes that it will stick to the uterine lining and continue developing. The medication protocol varies widely person to person, but typically the woman will start by taking birth control to suppress her natural hormonal cycle to prepare her for the medication. Next, a series of shots will be self-administered over several days to trick the body into producing many eggs at once. After 10-14 days, the eggs will be surgically retrieved for fertilization. Sperm from a semen sample will either be exposed to the eggs in a petri dish, or injected directly into the eggs. If the eggs are fertilized and begin to grow, one or more may be transferred back into the uterus in 3-5 days. Typically the final embryo count will be half or less than the initial number of mature eggs harvested. After transfer, any remaining embryos may be frozen and stored for future use.
Donor eggs, sperm donors, donor embryos, gestational carrier (surrogacy)
If needed or desired, a donor may be used for eggs, sperm or both. A donor embryo is an embryo that was already fertilized and frozen after beginning to grow, often an extra embryo from a previous IVF cycle that the biological parents are not able to use themselves. If the woman desires and is able to carry a pregnancy, the embryo may be inserted into her uterus after she has taken medications to prepare her body. If a gestational carrier is used, the carrier (or surrogate) will carry the pregnancy for the parents. In this case, the embryo might be the couple's embryo that the woman is unable to carry herself, a donor embryo, or could involve an egg donor or sperm donor. The gestational carrier may herself be the egg donor, or another donor may be used.
Acupuncture and Traditional Chinese Medicine (TCM)
Research is growing that shows the positive impact TCM can have on fertility. Acupuncturists may work with a couple to increase their chance of success with trying to conceive naturally or with any of the above treatments. Acupuncture points specifically targeting the reproductive system may improve hormonal production, thicken uterine lining, help support strong ovulation, and improve the odds of embryo implantation. Chinese herbs can also be taken, though should always be under the direction of a qualified acupuncturist. While the eastern approach is not as common as western interventions, this is a treatment path that has helped many couples find success.
What you might not have known about infertility treatments
There are side effects and risks to all treatments. Medications are known to give women the "clomid crazies" - wild hormonal shifts that make mood swings and hot flashes the norm. Injected medications may cause bloating so severe you look like you are already in your second trimester of pregnancy. Women going through IVF may have trouble sitting comfortably due to severe bruising from shots. The emotional challenges that come with carrying a child that is not biologically yours can be so extreme, most REs require therapy prior to allowing a couple to proceed with donor eggs or a gestational carrier. Many doctors recommend a lifetime maximum use of the oral medication clomid because of the damage it can do to the uterine lining. Risk of multiples (twins or more) can be higher with medicated cycles and IVF, increasing the risks of complications in pregnancy and of premature birth. Every treatment comes with its own risks, side effects and potential complications.
It's not that simple. None of these treatments are quick and easy. They involve a lot of trial and error and are trying physically and emotionally. REs are working off of their experience and their knowledge of medical research, but they don't know how you as an individual will respond to treatment. The human body is intricate, complex, unique - it often takes several cycles to figure out what works for an individual.
Success is not guaranteed. IUI has an incredibly low success rate, from 7-20%. For comparison sake, a fertile couple trying to conceive has a 20% chance of success every cycle. IVF results in a live birth approximately 57% of the time for women under 35, with the success rate quickly falling as the mother's age increases. As my diagnosis puts me into the <42 club with regards to how my body behaves, my odds of success with IVF is 6%. For more IVF statistics, see SART National Summary Report
Insurance often doesn't cover treatment. Insurance companies often consider infertility treatments elective, and cover no services. In some cases, insurance will cover portions of treatment and not others. Couples may continue trying medicated cycles or IUI if their insurance covers it, but have no coverage for IVF.
It's expensive. If insurance doesn't cover some or all of these treatments, the costs are staggering. A single cycle of IVF can cost anywhere between $12,000 and $20,000, with at least a thousand dollars worth of medications on top of that.
Choosing a path
When facing an infertility diagnosis, growing your family is no longer a simple choice. Yet there are still choices you can make. Treatment options are available, though none are guaranteed to be successful. You may choose between paying off debt and going into more debt for treatment. Perhaps the choice is whether to scale back at work to accommodate daily visits to the RE, or to quit your job entirely to focus on fertility treatments. Many people can choose only what they can afford, continuing with treatments that have little chance of success, forever meeting the brick wall of financial constraints. Others stop treatments and remain child free not by choice. Regardless of the decisions made, they are yours to make. And by making these choices, we have a small semblance of control over our infertility.
To learn more...
This has been a very high level overview of infertility treatments. For more information, visit Resolve.org