Fertility
Treatments

Decisions, Decisions, Decisions

Choosing the Fertility Treatment That's Right for You

People often want to know “what is the best fertility treatment. While there is no best fertility treatment, there may be a fertility treatment that is best for you at this moment. When deciding on your treatments during your consultation (or before or after) it’s important to consider many different things. There is a surprising number of reasons people come to seek fertility treatment – some of which lead down fairly straight forward treatment paths or options while others will require testing and will even factor in things like personality when choosing their treatment.

Our provider will listen to your story and help you through these things, but it’s always good to be thinking ahead!  Let’s start by discussing two general philosophical approaches to fertility treatments.

• The Path of Least Resistance

  Most people choose a treatment path that follows a path of least resistance. That means you do all of your testings, then you start with basic treatments and slowly move on to slightly more invasive procedures if unsuccessful with the previous.  In addition to having less invasive procedures, many insurances cover these less more basic solutions while not covering the more advanced treatments.

• The Fast Track

  Some people with testing supportive of starting with a less invasive treatment prefer to jump straight to a treatment like IVF which offers much higher odds of success per cycle than simpler solutions like ovulation induction or IUI. Others choose to skip basic treatments out of medical necessity (ie those pursuing fertility treatments for genetic reasons), sex selection, after a sterilization surgery, or those in the LGBTQ community looking to both be involved in their child’s creation (reciprocal IVF).

The Path of Least Resistance Continued

General Progression of Fertility Treatments

Given the (slight) majority of people continue down the path of least resistance, that’s a good place to start for a more in-depth conversation and exploration of the generic progression of fertility treatments from the more simple to the progressively more complex.

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  Ovulation Induction

  For women with ovulation disorders, PCOS, or irregular menstrual cycles many start with simple oral medications (aka ovulation induction) and timed intercourse.

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  IUI

  Helps put sperm in the right place at the right time. Many will go straight to IUI. Most often uses medications to stimulate the ovaries and help time the “procedure.”

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  IVF

  The gold standard of fertility medicine. Highest level of control for high-level results.

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  Enhancement Protocols & Surgery

  Comprehensive immunological protocols. Primarily for those with failed implantation/IVF cycles or recurrent pregnancy loss. Most often paired with IVF, but can be paired with IUI. Also, a great time to consider Laparoscopy & Hysteroscopies to explore things like endometriosis and other inflammatory pathologies (inflammation is the #1 cause of “unexplained infertility”).

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  Donor Gametes or Embryos

  Used in combination with IUI/IVF for LGBTQ, advanced age, specific diagnosis, or unexplained repetitive IVF failures.

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  Surrogacy/Gestational Carriers

  If unable to carry – often, but not always combined with donor gametes.  Also the starting place for homosexual male couples.

One should always be following our recommendations for improving male and female fertility – ideally for 90 days prior to the start of any treatment.

The Path of Least Resistance Continued

How Testing Effects Treatment Options

The above outline of fertility treatment progression is most directly and appropriately followed after all testing has been done with all results coming back negative . . . meaning unexplained infertility. Through testing, we can gain a better understanding of appropriate treatments and potentially eliminate dead-end paths.

• How's the sperm?

  Sperm is half the battle and the most often overlooked component – not the case here at CNY Fertility. Knowing the quantity and quality of your sperm is vital. It can either keep your options wide open (pending female evaluation) or make many treatment options completely futile. Remember, sperm have a long way to swim so if they don’t look like they’re entering the Olympics you may want to steer clear of some basic treatment options that require the sperm to do some heavy lifting.

  If sperm and female are good – ovulation induction and IUI could be great places to start.

  A sperm count of under 10 million motile sperm is counter indicative for these treatments. It may be recommended to jump to IVF (with ICSI). With very little (oligospermia) or no sperm (azoospermia), it may be required to have a testicular sperm extraction or even use donor sperm.

• Ovulating?

  Not ovulating or having regular cycles? It doesn’t sound good, but it may actually be one of the “best,” diagnoses you could receive as treatment can be incredibly straight forward.  Many with ovulation disorders conceive with simple oral medications and regular intercourse in an ovulation induction cycle.  If that were unsuccessful, treatment would typically progress in line with the map above.

• How are the fallopian tubes?

  If the fallopian tubes are damaged the real question becomes how much or how bad? With mild damage or damage that is localized to one side then one could potentially proceed with basic treatment options or have surgery to correct the damage. 

  If the damage is severe enough that there becomes no hope of the egg ever passing through to meet the sperm than IVF is a great option as it completely bypasses the tubes.

  If the woman has had a tubal ligation (tubes tied) they will either need a reversal or go straight to IVF.

• How is the uterus?

  There are two main questions here . . . are there any gross anatomical issues and how does the lining develop.

  Many anatomical abnormalities or pathologies can be surgically corrected and open up most treatment options.

  Lining issues can be challenging but can be helped with medications and PRP while still keeping most treatment options open.

• Hormone levels . . .

  Everything looking good? Great!

  Things like a Low AMH, High FSH, High Estradiol, and thyroid disorders may indicate a rapid progression through basic treatments (or skipping straight to IVF).  Donor eggs could also be discussed (although never pushed on you or required).

  Other lab values like low vitamin D can have a drastic effect on fertility, but for that, let’s just start by taking some vitamins.

• Age . . .

  All things being equal, the quality of eggs and sperm decline as we age – and rapidly after the age of 35. Those on the friendly side of 35 can generally take their time progressing through treatments where those nearing 40 should get moving with IVF sooner than later.

Fast Track Continued

Other Common Reasons People Jump to "Advanced" Treatments

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  Trouble Carrying

  From genetics to the immune system, inflammation, and lining issues there’s lots to consider but most paths lead to reproductive immunology with IUI or IVF before moving on to gestational carriers.

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  Genetics

  Sometimes chromosomal abnormalities can lead to incompatibilities with life and cause miscarriage while others simply do not want to pass along a genetically related disease. IVF with genetic testing or donor eggs/sperm can help often help.

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  Sex Selection

  Some people choose to do IVF to choose the sex of their child. Some call this family balancing, others gender selection.  To do this, you will need to do IVF with genetic testing.

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  Previous Sterilizations

  People with elective sterilizations often undergo a Tubal Reversals & Vasectomy Reversals or IVF (with a sperm retrieval if the man has a vasectomy). Others with work or battlefield injuries or other medical procedures that left them sterilized may need donor sperm, eggs, or gestational carriers.

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  LGBTQ

  Most people in the LGBTQ community will need donor sperm or eggs and potentially a gestational carrier coupled with either IUI or IVF to start their family. Check out our LGBTQ Guide!

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  Fertility Preservation

  There are numerous reasons why people may want to preserve their fertility – depending on what we are dealing with, people either undergo: egg freezing, sperm freezing, or embryo freezing. Gametes and embryos can be frozen for decades and maintain their integrity.