Fertility treatments have come along way over the years. As they continue to develop, the chances of success increase. Yet, many people feel that these options are not for them. The price tag on some of these treatments, like in vitro fertilization, can end up being close to $20,000, which means couples in lower income brackets just cannot afford these solutions. Insurance companies also do not cover the costs for these treatments (with the exception of some surgeries) so couples must shoulder the financial side entirely on their own. Here is an overview of the most common hi-tech treatments for fertility problems.
Depending on what type of surgery you or your partner need, it may be covered by your insurance. There are different types of surgery that may be recommended for you or your partner. If you have been diagnosed with endometriosis, fibroids, tubal factor or some other type of blockage or structure problem, surgery may be a solution for you. If your partner has a blockage problem, then most likely surgery can solve it. Also, if your partner has had a vasectomy, it is possible to get this reversed through surgery. And if you have had a tubal ligation, you can undergo a procedure called tubal ligation reversal. Discuss with you health care provider whether or not surgery is an option for you.
In Vitro Fertilization (IVF)
This is definitely one of the most well known treatments for infertility, although not as many people take advantage of it as you may think. Roughly, less than 2% of couples experiencing fertility problems choose IVF. If you decide to try IVF, you will first receive hormones (like a gonadotropin) to stimulate your ovaries in order to produce enough eggs for retrieval. Next, the eggs are harvested using aspiration (a type of suctioning device), which is guided by a transvaginal ultrasound. It is important to get the timing of the harvesting just right. Doing it too early or too late can result in eggs that are either not mature enough to fertilize or are too mature. Or, your body may have already released them. Alternatively, if your egg quality is very poor, you may want to use a donor egg from a third party.
Once the eggs are retrieved, they will then be mixed in a petri dish with a fresh semen sample from your partner or a donor and put into an incubator. After about two days, eggs that have been fertilized will be transferred back to your uterus. This can be done in the doctor’s office but may require you to stay there for a few hours after the transfer. Because it is common for multiple eggs to be transferred back into the uterus, there is a higher chance of having multiple births. Some doctors recommend transferring only one egg in order to eliminate the chances of multiple births. Others argue against this because IVF has a low success rate with multiple eggs (only about 65% of couples successfully conceive through IVF) and will only have a lower success rate if there is just one egg transferred. Additionally, because IVF is such an expensive procedure, costing up to $20,000, many couples can only afford to try this treatment one time.
Gamete Intrafallopian Transfer (GIFT)
This procedure is done for women who have normal fallopian tube function. Like IVF, you will receive hormones to stimulate you egg production. Your eggs are then removed and mixed with your partner’s or a donor’s sperm before being transferred back to you. Rather than being transferred to your uterus, though, the eggs are transferred to your fallopian tubes. This allows for a more natural fertilization process and also means that the whole procedure can be done in one visit. However, while IVF allows doctors to observe and evaluate the quality of the fertilization process, GIFT does not.
Zygote Intrafallopian Transfer (ZIFT)
If you were to take IVF and GIFT and mix them together, you would get ZIFT. This process starts out like IVF. You will receive hormones to stimulate your egg production, your eggs will then be retrieved and fertilized outside of you. However, when it comes time to transfer the fertilized eggs back to you a few days later, the eggs will be transferred to your fallopian tubes, not your uterus. ZIFT allows doctors to evaluate the fertilization process but not the process where the embryo divides.
Intrauterine Insemination (IUI)
This treatment is for couples who have a male factor infertility problem. Also, healthy, fertile women who do not have a male partner but would like a child may choose to use this method. IUI involves taking a sample of your partner’s or a donor’s sperm and injecting it into your uterus. The injection happens 24 to 36 hours after the increase of hormones that indicate ovulation will occur soon. You will be given blood and urine tests to help determine when your ovulation is approaching.
Intracytoplasmic Sperm Injection (ICSI)
This is a procedure that can be used with IVF and is helpful to men who have poor sperm quality. Whether your partner has a low sperm count in his ejaculation or his little guys just can’t swim, ICSI can help you out. Even if your partner has no sperm in his ejaculation, ICSI can be performed. This is a relatively new procedure that allows for a single sperm (that’s right, just one teeny, tiny sperm) to be injected directly into your egg. To get the sperm, you partner can either provide a sample or, if there is no sperm in his semen, sperm can be removed directly from his testicles. The IVF treatment and procedures are exactly the same for you; the only thing that will be different is that your egg will be injected with one sperm instead of mixed in a petri dish with a full sperm sample.
However, because the eggs are fertilized by sperm that may not be top-notch quality, there is an increased risk of passing on certain genetic conditions to your baby. Additionally, this is quite new technology, so the long-term effects on children conceived through this method have not been properly evaluated. The research that has been done, though, has not indicated any increase in abnormalities.
This can be a very sensitive area, so if you choose this option, proceed with caution. If you cannot carry a child to term due to problems with your uterus, this may be an option for you. However, it is a very expensive option. To put it simply, surrogacy involves taking your egg fertilized by your partner’s sperm, your egg fertilized by a donor’s sperm, or an egg from another woman fertilized with your partner’s sperm and transferring it to the uterus of another woman who will then carry your child to term. The fertilization and transfer is done through IVF.
This option is expensive because you and your partner must pay all the related costs. This includes any fertility treatments, IVF, any costs related to the pregnancy such as doctor’s visits, plus a payment for the surrogate (unless the surrogate is someone close to you who has decided to volunteer themselves as a surrogate). When everything is tallied up, the final costs can be in the range of $50,000 or more. In addition to the financial burden, there can also be a number of emotional issues involved in this arrangement. Be sure to think completely and thoroughly about this option before acting. Also, in addition to seeking medical advice, it is a good idea to seek legal advice regarding this issue. In some places, it may even be illegal to pay for the services of a surrogate, so be sure you’re up to date on the existing laws regarding surrogacy where you live.
Revision date: July 4, 2011
Last revised: by Sebastian Scheller, MD, ScD