Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse for individuals under 35, or after six months for those over 35. While in vitro fertilization (IVF) is an effective advanced reproductive technology, other treatments can be explored first. A stepped approach offers options tailored to individual circumstances.
Personal Strategies and Lifestyle Optimizations
The fertility journey often begins with personal strategies and lifestyle optimizations. Understanding the menstrual cycle and identifying the fertile window is fundamental. Ovulation predictor kits (OPKs) detect the LH surge preceding ovulation, and basal body temperature (BBT) charting reveals a slight temperature rise after ovulation, indicating the fertile period.
Dietary adjustments support reproductive health. A balanced diet rich in essential nutrients, including folic acid and iron, contributes to reproductive function. Maintaining a healthy body weight through moderate exercise is also beneficial, as both underweight and overweight conditions can affect hormonal balance and fertility.
Stress reduction techniques can manage emotional strain. Practices such as mindfulness, yoga, or meditation can promote a relaxed state.
Avoiding harmful substances is important, including refraining from smoking, limiting alcohol, and avoiding recreational drugs, all of which negatively impact fertility.
Initial Medical Evaluation and Targeted Treatments
If personal strategies are unsuccessful, consulting a fertility specialist is the next step, typically after 12 months of trying for those under 35, or six months for those over 35. A comprehensive evaluation involves diagnostic tests for both partners to identify infertility causes. For women, this includes hormone level checks (FSH, AMH) to assess ovarian reserve and function.
Semen analysis evaluates sperm count, motility, and morphology to identify male factor infertility. For women, further assessments include ovulation assessment, and a hysterosalpingogram (HSG) to check fallopian tube patency and uterine cavity. A pelvic ultrasound provides images of the uterus and ovaries, detecting structural abnormalities.
Once underlying conditions are identified, targeted medical approaches can be implemented. For instance, polycystic ovary syndrome (PCOS), a common cause of ovulatory dysfunction, may be managed with medications like metformin or laparoscopic ovarian drilling. Endometriosis can be treated with medication or surgery, and thyroid disorders are addressed with appropriate hormone regulation.
Oral fertility medications are often the first-line medical intervention to stimulate ovulation. Clomiphene citrate (Clomid) works by blocking estrogen receptors, which prompts the body to produce more Follicle-Stimulating Hormone (FSH), thereby encouraging follicular development and ovulation. Letrozole, an aromatase inhibitor, lowers estrogen levels, leading to an increase in FSH and promoting ovulation, particularly in women with PCOS or unexplained infertility.
If oral medications are insufficient, injectable fertility medications, known as gonadotropins, may be used. These hormones, such as FSH and LH, directly stimulate the ovaries to produce multiple follicles, though their use requires close monitoring due to increased risk of multiple pregnancies and ovarian hyperstimulation syndrome.
Intrauterine Insemination
Intrauterine insemination (IUI) is a common intermediate step for specific fertility challenges or when initial medical treatments are unsuccessful. The procedure involves collecting and “washing” a semen sample to concentrate healthy, motile sperm. The prepared sperm is then placed directly into the woman’s uterus using a thin, flexible catheter around the time of ovulation.
This bypasses the cervix and shortens the distance sperm must travel to reach the egg, increasing the likelihood of fertilization within the fallopian tube.
IUI is often recommended for couples with mild male factor infertility, such as issues with sperm count or motility. It is also suitable for unexplained infertility or cervical factor infertility, where cervical mucus may impede sperm movement.
IUI cycles are frequently combined with ovarian stimulation using oral or injectable medications to increase the number of mature eggs available for fertilization. The process typically involves monitoring follicular growth with ultrasounds and blood tests, followed by a “trigger shot” of human chorionic gonadotropin (hCG) to induce ovulation at a precise time. Insemination is then scheduled about 24 to 36 hours after the trigger shot.
While success rates vary depending on factors such as age and underlying fertility issues, IUI typically has a per-cycle success rate ranging from 10% to 20% for women under 40, and often reaches cumulative success rates of 40-50% over three to six cycles.