Part 1 of the “What do my treatment options mean?” series ….
When one begins the journey of looking at fertility treatments, it can be very overwhelming, so we are going to do a series of posts on what that information means for you.
In general, if you are not getting pregnant, there are a myriad of choices available to you. Let’s break them down and look at their overall SUCCESS RATES.
First, let’s look at what “Success Rate” can mean. “Success” can refer to actually getting pregnant (urine/blood hCG test), or a successful LIVE birth. Depending on your age, miscarriage risks can significantly change pregnancy rates versus live birth rates. There is considerable data on miscarriage risks (after a documented pregnancy) based on age:
In general, live birth rates are much better tracked by the CDC for IVF treatments than for non-surgical fertility treatments. Keep in mind that, because of this, there are not consistent comparisons between treatment success rates.
These are the treatment options available:
- Timed Intercourse (TI) is exactly what it sounds like: Having intercourse timed to a woman’s ovulation. This is the “natural” method, and what most of our patients have been doing (sometimes for YEARS) before they come to us. TI can be done with our without medications like Clomid or Letrozole. A woman’s age makes a significant difference in these chances each month: At age 30, the chance of conceiving each month is about 20%, but at age 40, the chance is about 5%. Additionally, a man’s age has an impact on conception: It can take 5 times as long to conceive a pregnancy if a man is over 45 years of age, than if he is 25.
- Intrauterine Insemination (IUI) is the form of treatment where a man’s sperm is “washed” (aka prepared) and then placed inside a woman’s uterus. This procedure is done at a specific time in a woman’s cycle and gets the sperm and egg closer to each other. It bypasses the vagina, the cervical mucus, the cervix, and some of the uterus. The sperm then need to swim up into the fallopian tubes, find the egg, and fertilize it. The fertilized egg (“embryo”) then travels back to the uterus for implantation. An IVF center in Chicago studied couples under 35 who had normal fertility testing and no pregnancies in 2 years. They found that IUIs resulted in a pregnancy 7% of the time. If Clomid was given with IUI, the pregnancy rate per month was 9%.
Source: Advanced Fertility Center of Chicago
- In Vitro Fertilization (IVF) is the process where a woman takes injectable fertility medications for about 10 days and then her eggs are surgically removed under a light anesthesia. Those eggs are fertilized in an embryology lab and grown until they are either transferred into the woman’s uterus, or frozen for testing or later use. IVF has become the gold standard of care in many instances because it can both diagnose and treat fertility issues. By examining the sperm and egg directly in the lab, overall health of both can be assessed. By visualizing fertilization and the growth of the resulting embryo, additional information is gained. Additionally, when the embryo is returned to the woman’s uterus, it is in the place where it will implant.
This process is longer and more complicated, but it alleviates many of the places for failure along the process of conception. Pregnancy rates and live birth rates vary by center. Conceptions, however, has the highest live birth rates (not just pregnancy rates) for Frozen Embryo Transfer centers: https://www.conceptionsrepro.com/fertility-success-rates.html .
This chart also includes national CDC live birth rates by age for fresh and frozen transfers:
- Donor Sperm. If a man’s sperm is absent or inadequate (or there is no male partner), donor sperm can be used. Donor sperm can be used in conjunction with IUI or IVF. Donor sperm is usually procured from donor sperm banks, where the donor has been extensively screened for STDs. Success rates vary significantly depending on the treatment used along with the donor sperm.
- Donor Egg. If a woman’s eggs are determined to be inadequate or absent, or there are hereditary concerns, donor eggs can be used. Donor eggs can be from a “fresh” cycle at a fertility clinic, or secured through a frozen egg bank. The eggs are fertilized with the intended father’s sperm (or donor sperm) and transferred to the intended mother’s uterus to carry the pregnancy. This process requires IVF as the eggs must be surgically removed and fertilized in the lab. Success rates vary by clinic.
- Gestational Carrier is the process where a woman carries the pregnancy for a couple. The intended mother’s egg is fertilized with the intended father’s sperm, and the fertilized embryo is transferred to the carrier’s uterus. This process requires counseling and legal agreements.
- Last but not least, Adoption is an option if the above routes are not successful or if a couple is not interested in them.
Stay tuned for the next blog post in our series.