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The journey to getting pregnant is different for every person. If you’re in the 17.5% of the adult population — roughly 1 in 6 worldwide — that has had problems conceiving after a year of trying, then your next step is to turn to a fertility specialist for assisted reproductive technology (ART).
Embarking on a journey towards ART can be a daunting experience, especially for couples who have faced unique challenges such as cancer, partial hysterectomy, or who are LGBTQ+. It's important to remember that you are not alone in this journey and that each person's path toward parenthood is unique.
Looking for fertility care is totally normal, and there's no need to feel embarrassed. Everyone has the right to make their own decisions when it comes to their reproductive health. That's why we put together a beginner's guide to the most common fertility treatments available — from medication to surgery, to IVF — to help you better understand your options.
Before we dive in, a note on language: we use the terms "woman" and “man" in this article, with "woman" defined as any person with a uterus and ovaries and "man" as any person with a penis and testes.
What does a fertility specialist do?
It's common to start your fertility journey with your OB-GYN, but sometimes you might need to see a specialist called an REI (reproductive endocrinologist and infertility) doctor.
REI is a subspecialty of obstetrics and gynecology that focuses specifically on hormones and fertility. These doctors are trained to be knowledgeable about hormones and everything related to fertility for both men and women. They'll help you figure out what tests and treatments will work best for you.
It's also worth noting that consulting a fertility specialist doesn't always result in undergoing in vitro fertilization (IVF). Several treatment alternatives vary depending on your specific condition. Your specialist will guide you on the most suitable approach for you.
Your REI doctor will help get you and your partner tested to identify any potential problems that might be interfering with your fertility.
During your medical evaluation, they'll take a close look at your previous medical history, including menstrual cycles, any past pregnancies or miscarriages, and family history. They’ll also do semen, hormone, and genetic testing to gain a thorough understanding of your situation.
As part of your check-up, your doctor will also examine your reproductive system. This is important because getting pregnant involves many different parts working together, like the ovaries, uterus, and fallopian tubes. They'll check to make sure everything is functioning properly and that there are no issues with ovulation or the lining of your uterus. It's all part of ensuring you're healthy and ready for whatever pregnancy has in store.
Treating infertility
Dealing with infertility can be a difficult and emotional journey, especially because treatment isn’t always straightforward so if you feel overwhelmed, you’re not alone!
There are many potential causes of infertility, including ovulation issues for women and problems with sperm cells and their function for men. Age, lifestyle, and health conditions, such as reproductive organs or hormonal problems, can also play a role.
If you're having trouble conceiving, there are three main fertility treatments available:
- Medication to help with ovulation
- Surgical procedures to address any reproductive system issues (including endometriosis or blockages in the fallopian tubes)
- Assisted conception techniques that help sperm fertilize the egg and the egg implant within the uterus, which may involve the use of donor eggs or sperm.
Treatment will likely depend on the reason for your infertility, so your treatment plan will be tailored to your specific needs. Your doctor might offer a variety of options to help address the cause of your difficulty conceiving and support you on your path to conception (and parenthood).
Lifestyle changes
Leading a healthy lifestyle can go a long way to improving rates of conception. Your doctor might recommend any of the following lifestyle changes:
- Stopping smoking
- Reducing and/or stopping alcohol consumption
- Staying at a healthy weight
- Eating a healthy diet
- Reducing stress as much as possible
Hormonal treatment
Various hormone therapies can be used in fertility treatment, depending on the issue. Hormonal imbalances can lead to problems with ovulation, but treatment can correct it and increase the likelihood of pregnancy.
Oral medications such as clomiphene citrate and aromatase inhibitors can be used to stimulate ovulation, and monitoring will be done during this time. If these medications aren’t effective enough, gonadotropins (administered via shots) can also be used to stimulate ovulation.
Surgical treatments
If your doctors spot any issues with the reproductive organs with diagnostic tests, they might recommend surgery. Some common surgical procedures include:
- Repairing blocked or damaged fallopian tubes
- Treating endometriosis by removing lesions and scar tissue
- Removing polyps or fibroids from the uterus
- Treating swollen veins in the scrotum.
Intrauterine insemination
If you're trying to conceive, intrauterine insemination (IUI) may be an option for you. During this medical procedure, healthy sperm — whether from your partner or a donor — is placed directly into the uterus around the time of ovulation. Sometimes, ovulation-stimulating hormones are used to increase the chances of success.
People opt for IUI for different reasons, like when a sperm donor is involved, when there's male factor infertility to consider, or even as a first step before trying IVF.
The success rates for IUI range from 5-15% per try, but it's important to keep in mind that the success rates for IUI can vary greatly depending on several factors. Your doctor will help you understand those factors and support you through the process.
It’s generally more affordable than other fertility treatments (such as IVF) but you might have to pay anywhere from $300 to $1,000 without insurance.
Assisted reproductive technology
Assisted reproductive technology (ART) refers to all fertility treatments in which both eggs and sperm are handled, including in vitro fertilization (IVF).
In vitro fertilization
In vitro fertilization (IVF) is probably the most well-known treatment for infertility. IVF is used for various reasons, such as when surgery isn’t an option, or when a donor sperm or egg is needed. It's also useful when the root cause of infertility cannot be identified.
The procedure involves combining sperm with the egg in a lab (that’s the “in vitro” part), followed by transferring the fertilized egg (also known as an embryo) to the uterus.
Each of these steps involves a complex series of procedures, including collecting the egg, fertilizing it with the sperm, and transferring the embryo. It's essential to have frequent doctor visits throughout the process, and it may take more than one cycle of IVF to succeed. Success rates for IVF can range anywhere between 12% and 70% and generally decrease as you get older.
Unfortunately, IVF can also be pretty costly — anywhere between $12,000 to $25,000 per cycle — and most insurance plans don’t cover fertility treatments like IVF.
Egg freezing
Egg freezing, also known as "oocyte cryopreservation", is becoming a more and more popular solution. Although it’s not technically infertility treatment, many people turn to it to preserve their fertility so they can try to start a family in the future.
Egg freezing involves removing eggs from the ovaries, freezing them, and using them later for IVF. Medications are administered to stimulate egg production and once the eggs are mature, they are retrieved. If you choose to freeze your eggs before the age of 35, there is a high chance of having a successful pregnancy (around 80-85%) using IVF.
Fertility naturally declines with age — regardless of your gender — so your chances of conceiving decline as the number and quality of eggs decrease. Egg freezing could be an option if you:
- Have a medical condition or need treatment that will affect your fertility, such as cancer, PCOS, or endometriosis.
- You’re worried about your fertility declining but you’re not ready to have children yet (known as "elective egg freezing").
- You're transitioning from female to male and you want to preserve your fertility before you start hormone therapy or have reconstructive surgery.
The Vaginal Microbiome and ART
As you can see, there are a lot of variables that go into fertility overall and ART specifically. But you might be wondering, does the vaginal microbiome play a role in all of this?
Yes, it might. But research is still being done.
A recent meta analysis of 17 studies, which included 3,543 patients, found that vaginal dysbiosis in in-vitro fertilization (IVF) couples was associated both with early pregnancy loss as well as a reduction in clinical pregnancy rate.
Additionally, the protective microbe Lactobacillus seems to be beneficial for ART success.
One study found that a Lactobacillus dominant VMB was associated with successful ART overall, while another study went even further to say that Lactobacillus dominant VMBs were associated with successful first rounds of IVF!
However, it is unclear what specific role the vaginal microbiome is playing in fertility, vs other microbiomes in the upper reproductive tract (like the cervical or endometrial/uterine microbiome).
One reason this is a bit complicated is that the endometrium has fewer bacteria present (it is a lower biomass niche) and is harder to sample - most of the time a biopsy is needed. So research is limited about the normal composition of the endometrium, let alone how it relates to the VMB. As usual, more research is needed!
