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Houston Fertility Journal

    Is IVF the Only Solution for Infertility?

    June 19, 2018 / by Center of Reproductive Medicine   

    Center of Reproductive Medicine


    A generation or two ago, a visit to a fertility specialist meant a long wait, plenty of uncertainty, and no guarantees. Today’s infertility solutions are better than ever. While in vitro fertilization (IVF) revolutionized fertility medicine, it’s far from the only option. In fact, many couples and individuals are surprised to learn that, even with serious or unexplained fertility issues, IVF is far from the only option. In a consultation with a fertility expert who understands your needs and values, you can choose from many options. IVF is not the only infertility solution, and you may be surprised to learn how affordable infertility treatment is.

    What is IVF?

    In vitro means outside of the body. With in vitro fertilization, the sperm fertilizes the egg outside of the body. This makes it easier to ensure that the sperm actually makes its way to the egg. It can also enable a doctor to see how the embryo develops. Once an embryo begins developing, it is then implanted back into the uterus.

    In many cases, IVF produces multiple embryos. Depending on your needs and fertility issues, we may implant several into the uterus to maximize the chances of a successful pregnancy. To further amplify your chances of success, IVF usually requires fertility drugs to increase the number of eggs a woman produces. This way you get more chances at pregnancy from your IVF treatment.

    IVF is one of the most effective ways to get pregnant. Each IVF treatment offers about a 1 in 4 chance of pregnancy. In the hands of a skilled clinician, the chances are even greater. So it’s important for you to ask your fertility specialize questions about their experience and request statistics on their success rate.

    The appeal of IVF is that it can circumvent many fertility issues, including:

    • Low sperm count
    • Implantation problems
    • Low sperm motility

    IVF also works well for couples with unexplained infertility because it can get around many commonly undiagnosed fertility issues. In women with ovulatory disorders, such as PCOS, IVF drugs can help the woman ovulate and encourage the production of healthy eggs.

    Why Do Some People Want to Avoid IVF?


    Though IVF has a high success rate, many people want to avoid it -- or at least don’t want to use it as a first treatment option. Some of the most common concerns we hear about IVF include:

    • Value conflicts: Some religions view sperm, eggs, or developing embryos as sacred. They believe these embryos should not be grown outside of the body, or that IVF is otherwise harmful.
    • Price concerns: IVF is expensive because it requires significant skill, several different procedures, and has a very high success rate. Not everyone can afford the price, particularly since it is rarely covered by insurance. People with diagnosable fertility issues may prefer to treat the underlying problem, which may be covered by insurance.
    • Fears about the procedure itself: Some people simply don’t want to go through hormone treatments or egg retrievals.
    • A desire for a more “natural” approach: Some people prefer to be more conservative with treatment, supporting the body to get pregnant without such significant interventions.

    Every patient is different. We respect the values of all people from all walks of life, so you don’t need to tell us why you prefer not to use IVF. Simply wanting to try something else is reason enough.

    IVF: Not as Scary as it Seems

    Though there are almost always alternatives to IVF, IVF is the best and most effective treatment for many fertility issues. When IVF seems like the best option for you, we may talk to you about your concerns and work to ally them.

    Many patients find that their concerns about IVF are unfounded. Consider the following:

    • Although IVF can be pricey, it may ultimately prove more affordable than other treatments. A single IVF treatment that works is far less costly than years of treatments that fail.
    • Understanding the science of IVF may help ease concerns about religion and values. We urge you to ask questions so we can ensure we offer you treatments that comport with your values. IVF does not have to mean discarding embryos, or even implanting numerous embryos. People of many religions and from many value systems have tried IVF.
    • IVF is safe for most people, and may be safer than endless hormone or other treatments that don’t work. We can work with you to manage hormone levels and alter dosages to ensure you feel comfortable with IVF treatment.

    So while IVF is not something you have to try, we encourage you to maintain an open mind. Tell us your concerns. Let us address them. You may be surprised when you decide that IVF actually is the best option for you.

    Alternatives to IVF


    Don’t want to use IVF? That’s not a problem. There are many excellent alternatives. Those include:

    • Lifestyle changes to improve fertility. Even when lifestyle changes do not treat the underlying issue, they can increase your chances of a successful pregnancy, particularly when used in conjunction with appropriate medical treatments.
    • Medications to address health issues. Thyroid problems, insulin resistance, infections, and a host of other maladies can make it more different to get pregnant. These are serious medical issues that warrant treatment. In many cases, treatment may be covered by insurance as medically necessary.
    • Hormones to encourage ovulation. In many women, delayed or nonexistent ovulation is the culprit. Helping the woman ovulate can get the process going.
    • Hormones to support early pregnancy. Women with unusually short luteal phases (the period immediately following ovulation) may need more progesterone. Progesterone can also support early pregnancy, and prevent a miscarriage.
    • Monitoring of a woman’s cycle. Sometimes monitoring a woman’s cycle for a month or two uncovers a treatable problem.
    • Sperm donation when there is a serious issue with a man’s sperm.
    • Unblocking a woman’s fallopian tubes that have been closed due to inflammation or infection.
    • Fertility surgery, such as surgery to repair a varicocele.

    One popular alternative to IVF is a procedure called intrauterine insemination (IUI). With this procedure, a doctor can pinpoint the moment at which a woman ovulates. If there are ovulation issues, the woman may also take ovulation drugs to get things going. Then, at the exact right moment, a doctor implants sperm -- either from a donor or form a woman’s partner -- directly into the woman’s uterus.

    This is not surgery, is less invasive than IVF, and can help get around many fertility issues. It’s also far less expensive than IVF, costing most couples just a few hundred dollars. For couples with unexplained infertility, the IUI success rate is 5-10% per cycle, but when fertility drugs are used, the success rate increases to 10-20%. Because IUI is safe and affordable, it can easily be repeated the next cycle if the first cycle fails. For many couples, pregnancy is just a few treatments away.

    A Proper Diagnosis: The Key to Excellent Fertility Treatment

    Infertility is not a diagnosis. It is a symptom. Knowing that you have been unable to get pregnant reveals little about your underlying condition. So don’t assume that infertility means IVF. A proper diagnosis is key to treating infertility.

    Infertility is, first and foremost, a medical concern. All too often, however, people seek treatment from non-experts who recommend hormones or IVF without ever uncovering the problem. Without the skilled diagnosis of a fertility expert, you could spend years -- and thousands of dollars -- on treatment that does not work.

    Infertility issues fall into several categories:

    Ovulation issues

    Ovulation issues -- failure to ovulate, infrequent ovulation -- are among the most common causes of miscarriage. They are often treatable with hormones, lifestyle changes, or medication to address the underlying cause. Though polycystic ovary syndrome (PCOS) is a leading cause of ovulation issues, other factors -- being under or overweight, autoimmune diseases, chronic severe stress, malnutrition, to name a few -- can make ovulation difficult or impossible. Assessing whether a woman is ovulating, how frequently she ovulates, and what might contribute to any ovulatory issues she faces are all critical components of fertility treatment.

    Sperm issues

    Issues with sperm quality -- including not ejaculating, erectile dysfunction, low sperm count, low motility (low sperm), and sperm formation irregularities -- can make it difficult or impossible to fertilize an egg. Sometimes the way the sperm interacts with the egg is also a problem. A simple sperm test can diagnose most sperm issues.

    Implantation issues

    Pregnancy does not begin with the fertilization of the egg. It begins with implantation, when the egg embeds itself in the lining of the uterus. It the egg can’t do this, there will be no pregnancy. Damage to the fallopian tubes, endometriosis, chronic inflammation, and a short luteal phase can make this difficult or impossible. A skilled doctor can determine whether there is an implantation issue and what’s causing it.

    Miscarriages and genetic defects

    Recurrent miscarriage is one of the most painful forms of infertility. Sometimes the problem is due to a rare genetic issue. It may also be due to underlying illnesses, such as an autoimmune disorder. Recurrent miscarriage is often treatable, but it requires a diagnosis.

    Unexplained infertility

    Unexplained infertility is not a diagnosis. It simply means that doctors have not been able to determine the cause of infertility. Sometimes that’s because a couple doesn’t want to keep testing. In other cases, it’s because of an unusual or hard to detect disorder. Unexplained infertility can be deeply frustrating, and switching to another provider may help you get a clearer diagnosis. Unexplained infertility does not always have to remain unexplained.

    When to Seek Help for Fertility Issues


    Many people see seeking help for fertility issues as “giving up.” The truth is that the sooner you seek help, the sooner you can get pregnant. Fertility has a short timeline, so every month you spend trying to get pregnant in spite of a fertility issue is a month wasted.

    We encourage people to seek help for fertility issues when:

    • The woman is under the age of 35 and the couple has tried for longer than a year.
    • The woman is over the age of 35 and the couple has tried for longer than a year.
    • There is a previous history of infertility and the couple has tried longer than three months.
    • Either partner has a serious health condition, such as cancer or an autoimmune disease.
    • Either partner has a disease known to impact fertility, such as PCOS, endometriosis, or ejaculatory dysfunction.
    • Trying to get pregnant is causing problems in your relationship or personal life.

    Putting your family formation efforts in the hands of a skilled fertility expert can be a major stress relief. You don’t have to do IVF. There are many other safe and affordable options. But these options can only work if you’re willing to work with a doctor who takes a comprehensive approach and leaves no stone unturned. So don’t delay. Seeking help now is the best thing you can do for your relationship, your peace of mind, and your chances of ultimately becoming a parent.

    The Center of Reproductive Medicine Difference: A Personalized Approach

    The Texas Center of Reproductive Medicine knows that fertility is about far more than your physical well-being. Fertility issues can affect your relationship, your psychological health, even your sense of self. We work with every couple or individual who comes through our doors to craft a custom fertility treatment plan that works for your needs.

    We’ll ask you questions about:

    • Your values, including how your religious or spiritual beliefs affect your fertility decisions.
    • Your health history.
    • Your fertility history, including how long you have been trying.
    • How you’re doing. Is your infertility affecting your job or relationship?
    • Your budget constraints. We wish it weren’t the case, but we know that finances can limit your options. We work with you to keep your options as open as possible, without harming your bank account.
    • How quickly you want to get pregnant. Do you want to take a conservative approach? Or are you eager to become a parent as quickly as possible?

    We give you all the information you need to make a decision that works with your values and lifestyle. We respect you every step of the way, and offer support to manage the challenges of infertility. We know it’s a hard road to walk. We think it’s easier when you don’t have to walk it alone. If you’re ready to stop fighting, stop feeling sad, stop grieving the pregnancy that never happens, we’re here to help.

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