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January 20, 2015

Treatments for Infertility

JAMA. 2015;313(3):320-321. doi:10.1001/jama.2014.7051

Infertility is a common problem, but several types of treatment exist.

Evaluation for infertility is done after a woman has tried for 1 year to become pregnant without success. Infertility is a couples’ problem, but treatments for infertility are focused on women.

What Causes Infertility?

In most women, each month, 1 egg is released by one of the ovaries. This is called ovulation. The egg travels through the fallopian tube to the uterus (womb). For pregnancy to happen, healthy sperm needs to be present in the uterus around the time of ovulation. In women, infertility can result when there are problems with the above process. In men, infertility can result when there are problems with the number or quality of the sperm.

Ovulation is controlled by hormones. Conditions that cause hormone imbalances can affect ovulation. These conditions include polycystic ovary syndrome, being overweight or underweight, and older age. Problems with the fallopian tubes and the uterus can also cause infertility. For example, some women may have scarring of these organs (from past infections or surgery). Others may have fibroids (noncancerous growths) in the uterus or endometriosis (overgrowth of tissue that normally lines the inside of the uterus into areas outside the uterus).

How Can Infertility Be Treated?

The best treatment for infertility depends on the cause. In most cases, the cause can be found through blood tests, sperm tests, or imaging studies, which help guide treatment. However, sometimes no clear cause can be found. This is called unexplained infertility. Also, sometimes there is more than one cause contributing to the problem.

Some women can be treated by changes in their lifestyle. Others might require medicine or even invasive treatment. Treatment options (from least to most expensive and invasive) include the following.

  1. Lifestyle changes, such as weight loss in overweight women or weight gain in underweight women, can help promote ovulation. Quitting smoking also improves the chance of pregnancy.

  2. A medication called clomiphene, taken as a pill, can promote ovulation.

  3. If clomiphene does not work, hormone shots can be used to promote ovulation.

  4. Intrauterine insemination (IUI) is another option for treatment. A doctor uses a tube to deliver sperm directly into a woman’s uterus right before ovulation. This is usually done in combination with clomiphene or hormone shots. This treatment can be effective when male infertility plays a role or in cases in which no cause of infertility has been found.

  5. In vitro fertilization (IVF) is the most invasive and costly treatment for infertility. It is usually reserved for when other treatments have not worked. A doctor carefully removes eggs from the ovaries. The eggs are placed in a test tube or dish along with sperm so that fertilization of the egg by the sperm can happen. The fertilized eggs (embryos) are then placed into the uterus.

How Well Do These Treatments Work?

Each woman responds to each treatment differently, and the chance of success is difficult to estimate. Sometimes, successful treatment takes months. But if one treatment has not worked after 6 months, a new approach should be tried. The chance of success decreases with older age.

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Article Information

Sources: American College of Obstetricians and Gynecologists, American Society of Reproductive Medicine, Centers for Disease Control and Prevention

Correction: This article was corrected online on January 28, 2015, for an error in a website address.

Topic: Women’s Health