Many people 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 patients 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, 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 physician Dr. Grace W. Graham.
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 irregular ovulatory cycles to complete lack of ovulation. The treatment for this common disorder involves medication, taken orally for 5 to 7 days, or injected. We typically use oral Clomiphene Citrate (Clomid) or Letrozole for ovulation induction, or injectable gonadotropins when indicated. The goal of these medications is to stimulate the growth and maturation of eggs which culminates in the ovulatory event.
A fertility specialist will advise the couple on the optimal time for sexual intercourse, 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 more precise timing.
Many 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 or the morphology (the shape of the sperm) could be abnormal.
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 simple procedure introduces the sperm inside of the uterus at the time of ovulation. The process is quick and painless. It is done in the office and patients may resume their normal activities immediately after.
Unexplained infertility
About 30 percent of infertility diagnoses are unexplained, meaning the underlying cause cannot be precisely determined with the tests 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 Clomiphene Citrate (or an injectable medication) to help eggs grow, along with IUI. By increasing the number of eggs available for fertilization, and increasing the concentration of sperm that encounter eggs, the chances of pregnancy can be increased.
When to schedule an appointment with a fertility specialist
“Rarely are two cases of infertility exactly the same,” shares Dr. Graham. “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.”
For women younger than 35 with regular periods, we recommend scheduling an appointment when you’ve had 12 months of unprotected intercourse without conception. For women ages 35 to 39, we recommend seeing a fertility specialist after 6 months of unprotected intercourse without conception. For women 40 and older, we recommend seeing a specialist right away if pregnancy is desired.
Medical contribution by Grace W. Graham, M.D.
Grace W. Graham, M.D., is board certified in obstetrics and gynecology (OB/GYN). Dr. Graham completed her residency in OB/GYN at Vanderbilt University Medical Center in Nashville, Tennessee. From there, she trained in Reproductive Endocrinology (REI) at the National Institutes of Health in Bethesda, Maryland.
Editor’s Note: This article was originally published in May 2012, and has been updated for content accuracy and comprehensiveness as of February 2024.
