Treatment and Prevention
While couples shouldn't rush to the nearest infertility clinic after failing
to conceive for a month or two, there's no reason to be shy about asking a doctor
for advice even before trying to get pregnant. A doctor may know things
from a medical history that are relevant to the chances of having a healthy
baby.
It's not unknown for "infertile" couples to have their problems resolved
after a five-minute consultation. Some people, for example, use commercial lubricants,
and are unaware that they may kill sperm or reduce their motility (the
ability to swim around). If you are using a lubricant, check with your doctor
to see whether you should continue.
The most important way to prevent infertility is to practice safe sex. Because
sexually transmitted diseases such as chlamydia and gonorrhea can lead to infertility,
it is important to protect yourself against them, and to have them quickly diagnosed
and treated if they occur. Excessive amounts of exercise reduce fertility in
both men and women. Also, if weight fluctuates a lot, hormones may be thrown
out of balance. You should talk to your doctor if you think these factors might
be playing a role.
Many causes of infertility can also be treated in the operating room.
A laparoscopy can identify endometriosis and treat it at the same operation..
Fibroids or scarring in the uterus can also be treated with a hysteroscope.
Surgery can often repair mechanical problems of ejaculation in men, and varicose
veins in the testes.
Infertile women, and especially women who have suffered repeated miscarriages,
may have an immune reaction to the pregnancy itself. There are many new tests
and treatments for these problems. Women who have tried in-vitro fertilization
(IVF), but find that apparently healthy embryos fail to implant in the uterine
wall, should also consider this possibility.
There are several hormone treatments that are used to treat women who don't
have a surgically treatable problem. These may come as pills or injections.
Hormonal treatments are typically less expensive than other fertility drugs.
These drugs, and the cost of procedures to enhance fertility such as sperm
wash and IVF are also expensive. Like IVF, these drugs enormously increase
the chance of a multiple pregnancy (twins, triplets, etc.) There are several
techniques to increase the chance of a woman becoming pregnant. In IVF, hormones
are used to stimulate the production of many eggs which are then removed from
the body and placed in a dish containing sperm. Technicians determine which
eggs have become fertilized (in vitro fertilization) and multiple eggs are inserted
into the uterus. In intracytoplasmic sperm injection (ICSI), the eggs
are removed from a women's body and one sperm is injected into one egg. This
is done for several eggs in cases of very low sperm counts, or when there has
been failure of the sperm to fertilize the egg in IVF.
The chance
of a successful pregnancy depends on the age of the woman and whether male causes
of infertility are involved. Only the fertility specialist can estimate each
individual's chances of success.
A quarter of IVF pregnancies produce twins, compared to only about 1% of unassisted
pregnancies. Triplets, quadruplets and quintuplets are a real possibility with
IVF. Multiple pregnancies tend to result in premature delivery, more miscarriages,
and higher risk of birth defects. A doctor may suggest reducing one or more
fetuses if there are more than three. This carries a small (about 4%) chance
of total miscarriage, but it's usually safer that trying to deliver them all.