Should I have infertility treatment?
Content provided by Healthwise
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
After having testing for a cause of infertility, your next step is considering your doctor's recommendations about what to do next. Perhaps your tests have identified a problem, and a potentially effective treatment is available. Or, your test results are normal, finding no obvious reason why you shouldn't be able to conceive. In this case, you may be deciding whether to have more testing, try a treatment for "unexplained infertility," or continue trying to conceive naturally. In any case, you may also be considering adoption as a family planning alternative.
This decision module can help you consider the various medical and personal questions that are related to infertility. It offers you information about infertility, treatment options according to condition, risks of those options, and general outcome information. After reviewing this information, you and your partner can use the worksheet to guide your thinking as you decide what to do next.
Consider the following when making your decision:
- A man's fertility is not known to be severely affected by age. A woman's fertility gradually drops from her mid-30s into her 40s, due in great part to the natural aging of the egg supply.
- In 10% of couples, no cause of infertility is found (unexplained infertility).1 Of all couples with unexplained infertility who do not seek treatment, about 35% will naturally become pregnant within 3 years, and 45% do so within 7 years.2
- The crisis of infertility can be intensified by its treatment, which can be difficult, expensive, and sometimes traumatic. Make a point of:
- Defining your limits for infertility treatment in advance. During infertility treatment, regularly evaluate your emotional, financial, and physical well-being.
- Considering professional counseling. Prolonged infertility testing and treatment can intensify the stress of infertility itself. If you are becoming depressed or overly stressed, or your relationship is suffering, seek professional counseling to help you get through this crisis together.
- Fertility clinic success rates vary. When considering treatment success rates, be aware that many are given in terms of pregnancies conceived. Pregnancy rates do not reflect the fact that some pregnancies miscarry. In any group of women, live birth rates are lower than early pregnancy rates.
For information about any clinic you are considering, see the Centers for Disease Control and Prevention CDC) Web site at www.cdc.gov/reproductivehealth/art.htm.
Medical Information
What is infertility?
Infertility is defined as a couple's inability to become pregnant after 1 year of sex without using birth control. However, "normal fertility" is defined as the ability to naturally conceive within 2 years' time.
A woman's fertility gradually declines from her mid-30s into her 40s, due in great part to the natural aging of the egg supply. A man's fertility is not known to be severely affected by age.
- As egg quality declines with age, miscarriage risk increases
. - Using women's own eggs for assisted reproductive technology (ART) treatment, the annual live birth rate steadily declines from 35% under age 35, to 20% in women aged 38 to 40, to 5% or less in women over age 43.3
- Using donor eggs for ART treatment, a woman's chances of having a live birth do not decline. At age 30 and at age 45, the average donor egg birth rate using fresh embryos is over 45%.3 (Clinics may not accept donor eggs from women over 30 years old.)
What causes infertility?
In about 35% of couples, testing reveals a male fertility problem, as with sperm production or ejaculation. In about 50% of couples, the primary cause is a female fertility problem with ovulation, fallopian tube function, or other pelvic problems, such as endometriosis. Some couples find that both partners have a fertility problem. In 10% of couples, no cause of infertility is found.1
What types of infertility treatment are available?
Infertility treatment ranges from using simple fertility awareness measures to pinpoint your "fertile window" to specialized surgical, hormonal, and assisted reproductive technology (ART) treatments. Some of these can have high financial, physical, and emotional costs.
The following table lists some general causes of infertility and the types of treatment options you may have. Also see the U.S. Centers for Disease Control and Prevention's Web site for the most recent information about assisted reproductive technology success rates at http://www.cdc.gov/reproductivehealth/art.htm.
| Cause of infertility | Possible treatment options | Risks |
|---|---|---|
Sperm problems (low sperm count, lack of sperm) | Use concentrated sperm or donor sperm for artificial or intrauterine insemination. |
|
Use intracytoplasmic sperm injection (ICSI) combined with in vitro fertilization (IVF). |
| |
Increase sperm production with medication or gonadotropins. |
| |
Blocked fallopian tubes or endometriosis | Surgery to open the fallopian tubes (successful procedure can lead to more than one pregnancy). |
|
Have in vitro fertilization (IVF) (which first requires ovulation stimulation with clomiphene, gonadotropin-releasing hormone [GnRH], or gonadotropins, then harvesting of eggs)—successful procedure produces only one pregnancy. |
| |
Ovulation problems | Have sex during 6-day fertile window (fertility awareness). |
|
Stimulate ovulation with clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins. |
| |
Stimulate ovulation with clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins, then harvest eggs for in vitro fertilization (IVF). |
| |
No known cause (unexplained infertility) | Have sex during 6-day fertile window (fertility awareness). |
|
Use artificial or intrauterine insemination, a type of insemination, with or without ovulation stimulation |
|
If you need more information, see the topic Fertility Problems.
Your Information
Your choices are:
- Try an infertility treatment.
- Do not try infertility treatment. This opens up further decisions about putting pregnancy plans aside for awhile, looking into adoption, and/or continuing to try to conceive using fertility awareness measures.
The decision about whether to have infertility treatment takes into account your personal feelings and the medical facts.
| Reasons to have infertility treatment | Reasons not to have infertility treatment |
|---|---|
Are there other reasons you might want to have infertility treatment? |
Are there other reasons you might not want to infertility treatment? |
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about infertility treatment. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
| Infertility treatment feels right for me. | Yes | No | Unsure |
| I am inclined to let nature take its course without using treatment. | Yes | No | Unsure |
| I want to continue trying to conceive naturally before trying treatment. | Yes | No | Unsure |
| I know what kinds of treatment options am I willing to try. | Yes | No | Unsure |
| I know how long I'd be willing to try infertility treatment. | Yes | No | Unsure |
| It is important to me that I/we have a biological child. | Yes | No | Unsure |
| I/we would consider adoption now or in the future. | Yes | No | Unsure |
| I would consider using donor eggs or sperm to conceive. | Yes | No | Unsure |
| I/we have enough money and/or health coverage to fund infertility treatment. | Yes | No | Unsure |
| I/we have figured out the best way to periodically evaluate my/our testing and treatment plan. | Yes | No | Unsure |
Use the following space to list any other important concerns you have about this decision.
|
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have infertility treatment.
Check the box below that represents your overall impression about your decision.
Leaning toward having infertility treatment | Leaning toward NOT having infertility treatment |
Return to the topic Fertility Problems.
References
Citations
Speroff L, Fritz MA (2005). Female infertility. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1013–1067. Philadelphia: Lippincott Williams and Wilkins.
Lobo RA (2007). Infertility: Etiology, diagnostic evaluation, management, prognosis. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 1001–1037. Philadelphia: Mosby.
Centers for Disease Control and Prevention (2006). Assisted Reproductive Technology (ART) Report: 2005 Preliminary Clinic Data by State and National Summary. Available online: http://apps.nccd.cdc.gov/ART2005/clinics05.asp.
Credits
| Author | Bets Davis, MFA |
| Author | Sandy Jocoy, RN |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
| Last Updated | March 21, 2008 |
| Last updated: | March 21, 2008 |
|---|---|
| Author: | Sandy Jocoy, RN |
| Reviewed By: | Sarah Marshall, MD - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology |
| Editors: | Kathleen M. Ariss, MS, Pat Truman, MATC |
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