Many couples assume that infertility treatment always leads to in vitro fertilization (IVF). In reality, the most advanced fertility interventions are reserved for only a relatively small number of infertile couples and are rarely the first course of treatment. With fertility care, most patients will begin with low-tech treatment and a plan that is individualized according to the underlying cause of their disorder.  

“At Shady Grove Fertility (SGF), we believe in a stepped-care approach to treatment, starting with the simplest, most affordable low-tech fertility treatment options first and moving up to more advanced treatments only if needed,” shares SGF New York physician Robert Setton, M.D., who sees patients at SGF’s Brooklyn office.  

For the following common infertility diagnoses, it is often best to start with low-tech fertility treatment.  

Ovulatory Disorder 

One common cause of infertility is ovulatory dysfunction. It affects as many as 40% of infertile women and the disorder has a spectrum ranging from erratic ovulatory cycles to complete lack of ovulation. The treatment for this common disorder is based on medication taken orally for some 5 to 7 days. We use Clomiphene Citrate or Letrozole for ovulation induction. The drugs stimulate the growth and maturation of eggs which culminates in the ovulatory event.  

In some instances, the medication used is injectable. It serves the same purpose. The specialist will advise the couple on the optimal time for sexual intercourse in order to increase the chances of pregnancy. For this, a variety of means are used, ranging from intercourse on alternate days around the expected day of ovulation, to monitoring the progression of the cycle with vaginal ultrasounds and blood tests for a more precise timing.  

The vast majority of women with ovulatory dysfunction will respond to treatment and the chances of pregnancy will approach those of the standard population.

Male Factor

Another relatively common cause of infertility is that due to male factor infertility, meaning that the sperm count or motility (the number of actively moving sperm) may be decreased.  

Male factor is a cause of infertility in 40 to 50 percent of couples. The Center for Male Fertility at Shady Grove Fertility offers a range of services including basic evaluation and testing to help determine the best treatment options. 

Many times it is quite possible to use low-tech treatment to address male factor infertility, such as intrauterine insemination (IUI). This relatively simple procedure consists of introducing the sperm inside of the uterus at the time of ovulation. The process is quick and painless. It is done in the office and the woman may resume their normal activities immediately after.

Unexplained infertility 

Approximately 10 percent of infertility diagnoses are unexplained, meaning the underlying cause cannot be precisely determined with the tests that are currently available. These patients are said to have unexplained infertility. In these cases, the initial stages of treatment are also relatively simple and are a combination of the two techniques explained above: Clomiphene Citrate (or an injectable medication) to help eggs grow, along with IUI. The chances of pregnancy may be slightly lower than those of the normal population, but are still quite acceptable. 

When to schedule an appointment with a fertility specialist 

Rarely are two cases of infertility exactly the same. That’s why it’s important to undergo a consultation with a fertility specialist and complete a comprehensive infertility evaluation before making any assumptions on the type of treatment necessary. 

Medical contribution by Robert Setton, M.D.

Robert Setton, M.D., is board certified in obstetrics and gynecology and in reproductive endocrinology and infertility. Dr. Setton is passionate about working with patients to overcome infertility, particularly with his extensive knowledge on diminished ovarian reserve, male infertility, and endometriosis. He sees patients at SGF New York’s Brooklyn and Manhattan offices.

Editor’s Note: This article was originally published in May 2012, and has been updated for content accuracy and comprehensiveness as of July 2022.