Infertility Treatments and Medications

Infertility is the inability to become pregnant after one year of trying, or 6 months if you’re a female 35 years of age or older. It is a common condition in 9% of men and 11% of women. The causes of infertility have a wide range, from age to hormone deficiency. Although infertility rates appear to be rising, there have been many advancements in assisted reproductive treatments to overcome fertility problems. Let’s take a look at the causes of infertility as well as the medications and procedures available to treat it.

What is infertility?

Infertility is the inability to become pregnant or maintain a pregnancy. Individuals who have been trying to conceive or having unprotected sex for a consecutive year without fertilization may have concerns about being infertile; for women aged 35 or older, that timeframe decreases to 6 months.

Types of infertility

There are two categories of infertility:

• Primary infertility: Individuals or couples who cannot conceive after 12 months of trying to become pregnant, or 6 months in women aged 35 years or older

• Secondary infertility: Individuals or couples who have already had at least one pregnancy but are subsequently unable to become pregnant again.

Causes of infertility

Both women and men can experience infertility. Causes of infertility vary greatly from low egg reserve or sperm count, underlying health conditions, exposure to heat or chemicals, and even excessive alcohol consumption. Although self-diagnosis is common with infertility, a healthcare professional can perform a physical examination and order tests to determine a diagnosis of infertility. Although a clear answer is not always detected, fertility can be evaluated in a variety of ways through blood tests that assess hormone levels, semen analysis, and ultrasounds to determine ovarian reserve.

Causes of infertility in women

While age definitely plays a role in female infertility, there are numerous reasons why a woman may not be able to conceive. The most common causes of female infertility include ovulation problems, damage to fallopian tubes or uterus, or problems with the cervix. Age can also contribute as women’s fertility naturally declines with age.

Ovulation problems may manifest as a result of one or more of the following:

• Hormonal imbalances, including genetic disorders like congenital adrenal hyperplasia and chronic kidney disease

• Thyroid gland disorders

• Premature menopause

• Obesity

• Low body weight (including eating disorders and lack of nutrition)

• Stress

• Exposure to radiation or chemotherapy

• Exposure to pesticides

• Excessive use of alcohol, tobacco, marijuana, cocaine, or other drugs

Damage to the fallopian tubes or uterus can cause fertility due to one or more of the following:

• Pelvic inflammatory disease

• Uterine fibroids

• Endometriosis

• Side effects of medication

Causes of infertility in men

Men can also experience infertility. The most common causes of male infertility are categorized as problems with abnormal sperm production or function, problems with the delivery of sperm, exposure to certain environmental factors, or direct damage related to cancer treatment.

Causes of abnormal sperm production or function include:

• Undescended testicle(s)

• Varicocele (Varicose vein in scrotum)

• Testicular failure

• Accessory gland failure

• Hormonal imbalances, such as is seen in hypogonadism

• Medical conditions, such as diabetes

• Genetic conditions, like Klinefelter syndrome

• Certain bacterial or viral infections

• Stress or anxiety

Problems with the delivery of sperm can occur secondary to the following:

• Premature ejaculation

• Cystic fibrosis

• Structural abnormalities, like testicular blockage or hypospadias

• Injury to reproductive organs

• Retrograde ejaculation (semen is released into the bladder instead of exiting the penis)

Overexposure to environmental factors, including:

• Exposure to pesticides

• Excessive use of alcohol, tobacco, marijuana, cocaine, or other drugs

• Side effects from certain medications, like antibiotics and antidepressants

• Use of anabolic steroids

• Frequent use of hot tub or sauna

• Tight underwear

RELATED: How a dad’s health impacts his baby’s

How is infertility diagnosed?

Before you can get treated for infertility, you must be tested and diagnosed by a healthcare professional. A physical exam and overview of your medical history can help the doctor determine if you need to undergo fertility treatment.

Couples may be referred to a fertility specialist, also known as a reproductive endocrinologist. If needed, some men may also be recommended to see a urologist for further testing. Both men and women will likely need to have some labs done.

Men may undergo:

• Sperm analysis: A microscopic examination of a semen sample is used to analyze sperm concentration, motility, morphology, volume, pH levels, liquefaction time, and fructose levels.

• Testicular biopsy: A small portion of the testicle is removed and analyzed to identify possible blockages, detect testicular cancer, or retrieve sperm for IVF.

• Genetic testing: A blood test to identify genetic diseases that could cause infertility

Women may undergo:

• Hysterosalpingogram: An X-ray of the cervix to examine the health of the uterus and female reproductive organs.

• Pelviscopy: A small video camera is used to view the organs within the pelvic cavity for any abnormalities that may be contributing to infertility.

• Hysteroscopy: A fiber optic telescope inserted through the vagina is used to examine the uterus.

A woman may also be asked to document her menstrual cycle, frequency of intercourse, basal body temperature, and assess her vaginal mucus as part of diagnosing infertility.

Infertility treatment options

A variety of holistic and medical options are available for increasing the chances of conception. Hormone treatments, surgery, and assisted reproductive technology (ART) are among the methods used to treat infertility.

Lifestyle changes

“Smoking, alcohol, or drugs can drastically reduce fertility in men and women,” according to Lina Velikova, MD, a medical writer for Supplements 101. Lifestyle changes for both men and women, such as refraining from drinking alcohol and maintaining a healthy body weight, can also affect one’s fertility. Be sure to inform your doctor of all necessary information that could affect your infertility; identifying the cause of infertility may take months.

Hormone therapy

Hormone injections can be used in men or women. Infertility caused by dwindling testosterone can be boosted with hormone injections. Testosterone replacement therapy (TRT) is used to increase healthy sperm production. Hormone therapy may involve using follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to increase sexual reproduction health.

Reproductive medicine

Medications are available for both men and women to increase fertility. If a man is experiencing erectile dysfunction, medication can help the male reproductive organ function properly. A doctor may also prescribe medication to increase sperm production. Clomiphene citrate is an estrogen-blocking drug that could also help male fertility. Meanwhile, women can be prescribed fertility medication or hormones that can induce or regulate ovulation.

Talk to your healthcare provider about potential medications that could be helpful in increasing fertility. Medications could lead to conception without having to have surgery.

Surgery

A variety of surgeries could help in correcting infertility. Surgery to remove scar tissue from endometriosis, fibroids, polyps, or adhesions may be helpful in restoring a woman’s reproductive system. Blocked fallopian tubes can be reopened through laparoscopic surgery. If the surgeon cannot remove the blockage, the fallopian tube may be severed and reconnected to remove the damaged portion.

A man may need to have surgery as well. For example, an epididymis (a transport system that stores and moves sperm) can be blocked. A surgical procedure can unblock this vital tubal passageway to allow sperm to be ejaculated properly.

Another example is a varicose vein in the scrotum that can increase the temperature of the reproductive organs, causing infertility. This condition is called varicocele. A surgical procedure can be helpful in restoring the affected vein, causing infertility.

In vitro fertilization

In vitro fertilization (IVF) is the process of extracting eggs from the female’s body to be fertilized with sperm (either from the male partner or donor sperm) in a laboratory. Fertilized eggs are reinserted into the woman’s uterus. Success rates of IVF are highly dependent on several factors, but as a generalization, can vary from 40% to 60%. Donor eggs can also be used to enhance success.

Assisted reproductive technology such as IVF and artificial insemination can lead to multiple births. More than one egg can be fertilized during the process leading to twins, triplets, quadruplets, or more.

RELATED: IVF costs

Intrauterine insemenation

Intrauterine insemination (IUI) involves inserting sperm into the uterus using a catheter. This method guarantees that the sperm is reaching the uterus, increasing the opportunity for fertilization.

Fertility drugs

Estrogen modulators

Estrogen modulators, or selective estrogen receptor modulators (SERMs), act as estrogen in the receptors of breast tissue. SERMs can act either as agonists or antagonists, meaning they can activate estrogen’s effect in other cells or block its effect on other cells.

SERMs such as clomiphene citrate and tamoxifen can be used to treat male infertility and have been shown to increase serum luteinizing hormone, follicle-stimulating hormone, and sperm concentration and count.

These SERMs also help to activate ovulation in women by imitating the effect of estrogen on the pituitary gland. Clomiphene citrate, also known as Clomid or Serophene, is used to treat women with polycystic ovarian syndrome (PCOS).

Common side effects of SERMs include but are not limited to:

• Fatigue

• Hot flashes

• Night sweats

• Vaginal discharge

• Mood swings

Anti-diabetic medication

Anti-diabetic medications manage blood glucose levels for those with diabetes but can also aid in infertility.

Metformin—also known as Glucophage, Riomet, or Glumetza—is a medication used to treat Type 2 diabetes. It can also treat infertility in women due to polycystic ovary syndrome (PCOS). PCOS leads to a hormonal imbalance that causes the egg to not be fully developed or released from the ovaries, and Metformin helps to improve the rate of ovulation by regulating reproductive hormones. For those with diabetes, it can also help to sustain a healthy blood sugar level while pregnant.

Side effects of metformin include:

• Heartburn

• Stomach pain

• Nausea or vomiting

• Bloating

• Gas

Hormones

Hormonal medications work by triggering the body’s natural processes to prepare for pregnancy.

• Progesterone: Often prescribed for ART procedures such as IVF. It helps to prepare the uterus for pregnancy by thickening the uterine lining to maintain the implantation of a fertilized egg and create an ideal environment for the fetus. Progesterone, Crinone, Prometrium, Utrogestan, and Cyclogest are also commonly prescribed.

• Estradiol: Estradiol is a form of the estrogen hormone that helps in the maturation and release of an egg and thickens the uterine lining to support implantation. Estradiol medications include Vivelle-Dot, Yuvafem, and Delestrogen.

• Gonadotropins: An injectable hormone that contains follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), which helps to produce and release eggs from the ovaries. Gonadotropin medications include Follistim, Menopur, Bravelle, and Gonal-F.

Sex hormone suppression

Sex hormone suppression medications suppress the body’s production of hormones produced by a sex organ.

Leuprolide acetate: Commonly known as Lupron, this injectable medication is commonly used in IVF cycles to reduce the production of estrogen and progesterone by the ovaries, allowing for a more predictable response to gonadotropins.

Side effects of Lupron include:

• Hot flushes

• Headaches

• Nausea

• Mood changes

• Decrease in breast size

• Vaginal dryness

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