Successful treatment for infertility presupposes an accurate diagnosis of the cause. Further, appropriate treatment requires that we utilize the least invasive, most cost-effective therapy that is likely to work – given our diagnosis. You wouldn’t go chasing after a mosquito with a shotgun. Nor would you hunt lions with a fly swatter!

There are a number of different regimens used to treat infertility. Some are medical, some are surgical and some are combinations of both. Each has its unique advantages and disadvantages.

OVULATION INDUCTION (O.I.)
This term – strictly applied- refers to the use of a medication, usually Clomiphene Citrate – Clomid – to induce ovulation in a patient who is not normally ovulatory. The most common use of O.I. is in the treatment of polycystic ovarian disease. Clomid may also be used in other conditions where patients are not ovulating regularly.

SUPEROVULATION WITH CLOMID
By far the most common use of Clomid is to enhance ovulation in patients who otherwise appear to be ovulating normally or nearly normally. This is common in unexplained infertility and in subtle conditions of ovarian dysfunction. The hope is that by the use of Clomid, we will increase the total number of eggs released in a given cycle – a process referred to as superovulation.

There is also evidence that in some cases the egg quality may actually improve. Experience has shown that the greater the number of eggs released the better the pregnancy rates.

The use of Clomid or other medications to improve egg quantity and quality is restricted to only those patients with normal tubal function and those whose male partners have borderline or normal sperm counts. It would be useless to increase egg quantity if damaged tubes prohibited the egg and sperm from any chance of meeting. So too would it be futile to increase egg numbers if there were not adequate sperm.

INFERTILITY SURGERY
In the days before IVF, reproductive surgery was often the only hope for patients with severe tubal disease. As results with IVF have gotten better and better, and as the cost has gradually gone down, reproductive surgery has been utilized less and less. Often, the decision is based on insurance coverage. More and more, we are seeing IVF as a covered service and infertility surgery less frequently covered.

Microscopic tubal surgery is still used occasionally in patients with tubal ligations who wish to get pregnant. The results are variable and depend greatly on the current condition of the tubes.

Diagnostic and operative laparoscopy and hysteroscopy still constitute the vast majority of reproductive surgeries. Generally, these surgeries are used for diagnosis rather than treatment. However, on occasions, either of these procedures may be well suited to correct any number of problems that might be contributing to infertility.

IVF (IN-VITRO FERTILIZATION)
Most patients never need IVF. Still, it is by their IVF success rates that all fertility clinics are judged. IVF is generally regarded as the best last hope for many patients. It is the gold standard of infertility care.

In many cases it is the first line of treatment and offers excellent results. It allows us to achieve pregnancy in patients whom, 20 years ago – even five years ago – never could have become pregnant. Originally, IVF was developed to treat hopeless tubal disease.

Soon after the procedure was developed, it was used successfully in couples whose male partners had sperm counts far too low to ever conceive by traditional techniques. With the advent of microscopic techniques, pregnancy is now possible in women whose partner’s sperm counts would have rendered pregnancy hopeless even 5 years ago.

As many as 25% of my patients have unexplained infertility. In other words, all their testing is normal, yet they still do not conceive. IVF has become a very important technique in the treatment of patients when other less aggressive treatment procedures have failed.

IVF has clearly revolutionized the care of the infertile couple. Our success rates have soared in the past decade. Though much of this success can be attributed to improvement in or traditional treatment, it is IVF that has made pregnancies possible in so many couples who previously would have been deemed sterile.