Trying to conceive a baby is often touted as an exhilarating time that brings couples closer together. But for many hopeful parents who struggle with infertility or are same-sex couples, it can turn out be an emotional rollercoaster.
If you haven’t become pregnant after having regular sexual intercourse without birth control for one year (or six months if you’re over 35), you should talk to your doctor about having a fertility evaluation. Both you and your partner will be asked about your medical history and undergo a physical exam. Women will also undergo blood work, an ultrasound and a series of other tests, while men will have a semen analysis.
Finding out that you have fertility issues can be distressing, but you’re not alone: according to the Centers for Disease Control and Prevention (CDC), 1 in 8 American couples have trouble getting pregnant or sustaining a pregnancy. Fortunately, there are plenty of fertility treatments available today.
Here’s a breakdown of your options:
1. Lifestyle changes
Before you start any fertility treatments, your doctor may suggest some lifestyle changes that could improve your fertility. These may include cutting out cigarettes, alcohol and illegal drugs, as well as eating a healthy diet and maintaining a healthy weight. Studies show that women who have weight-related infertility could kick-start their ovulation by losing just 10 percent of their weight.
Your doctor may also want to investigate whether an underlying illness – such as diabetes, celiac disease or a thyroid disorder – could be affecting your fertility.
2. Fertility drugs
Fertility drugs are mainly used to stimulate ovulation in women with ovulation disorders, but they can also stimulate sperm production in some men. They’re also frequently used in combination with intrauterine insemination (IUI) and in vitro fertilization (IVF).
The two main types of fertility drugs are Clomid (clomiphene citrate) and gonadotropins, including LH and FSH.
Success rates: Approximately 40 to 45 percent of couples get pregnant within six cycles of using Clomid. Couples using gonadotropins have a 15 percent chance of conceiving at each cycle.
Risks and side effects: Fertility drugs increase your chances of having a high-risk multiple pregnancy (twins or triplets) and they can cause a range of side effects such as mood swings, breast tenderness, headaches, nausea, mild depression and ovarian cysts.
Costs: Clomid pills cost between $10 and $100 per month. Gonadotropin injections are $1000 to $5000 a month. These costs don’t include doctor visits, blood tests, IUI or additional procedures.
Surgical procedures such as laparoscopy (small incisions in the abdomen through which a camera and small instruments are inserted) and laparotomy (a larger abdominal incision) can be used to treat a range of fertility problems. These surgeries can open blocked fallopian tubes, remove endometrial tissue and uterine fibroids, and treat polycystic ovary syndrome (PCOS). Some male fertility problems can also be fixed through surgery.
Success rates: Pregnancy rates are approximately 20 to 60 percent after unblocking fallopian tubes, 40 percent for women who received surgery for mild endometriosis, and about 50 percent for women treated for PCOS. Depending on the condition, it can take up to a year for women to fall pregnant after surgery.
Risks and side effects: Your incisions may feel sore for a few days. If you had a laparoscopy, you may also experience shoulder and back pain caused by the carbon dioxide used to inflate your abdomen. After a general anesthesia, you may experience side effects such as sleepiness, nausea, vomiting and sore throat. In rare cases, general anesthesia can cause dangerous reactions such as spikes in blood pressure.
Costs: Between $2000 and $10,000 or more depending on the type of procedure and your health insurance coverage.
4. Intrauterine insemination (IUI)
Intrauterine insemination involves depositing your partner or a donor’s sperm in your uterus when you’re ovulating. IUI can be used in combination with fertility drugs to stimulate ovulation.
Success rates: With only a 4 percent chance of conceiving per IUI cycle that doesn’t include fertility drugs and an 8 to 17 percent chance when fertility drugs are used, the success rate of IUI is low. But many couples try it before IVF because it costs so much less.
Risks and side effects: Side effects can include breast tenderness and mood swings, and IUI increases your chances of conceiving multiples, infection, ectopic pregnancy and ovarian hypersensitivity syndrome (OHSS, which involves producing too many eggs).
Cost: Approximately $900 per cycle.
5. Assisted reproductive technologies (ART)
ART refers to any fertility treatment where both the egg and sperm are handled. The most common is in vitro fertilization (IVF), which involves stimulating ovulation with fertility drugs, collecting eggs from your ovaries and combining them with your partner’s or a donor’s sperm in a lab, waiting for fertilization to occur, and then transferring one to three embryos to your uterus. There are several other procedures, such as intracytoplasmic sperm injection (or ICSI, which involves injecting one sperm directly into one egg) that can be added to an IVF treatment for a higher chance of success.
Gamete intrafallopian transfer (GIFT) involves mixing the eggs and sperm in a lab and then injecting them into your fallopian tubes so that fertilization can occur naturally. With zygote intrafallopian transfer (ZIFT), fertilization occurs in the lab and zygotes (one-celled embryos) are placed into your fallopian tubes.
Success rates: Approximately 40 percent of IVF cycles in women under the age of 34 lead to a successful pregnancy. The numbers drop steadily as maternal age increases, to approximately 30 percent for women aged 35 to 37 and 5 percent for women 43 and over. About 26 percent of GIFT cycles and 22 percent of ZIFT cycles produce a baby.
Risks and side effects: ART carries a higher risk of multiples, OHSS and infection. Side effects include mood swings, sore breasts, headaches, cramping and spotting. GIFT and ZIFT have a longer recovery time than IVF because they involve laparoscopic surgery.
Costs: Between $12,000 and $15,000 per cycle for basic IVF using your own egg and sperm. Additional technologies such as ICSI and donor eggs cost extra. GIFT and ZIFT can cost anywhere from $15,000 to $25,000 per cycle.
6. Third-party reproduction
Donor eggs, sperm or embryos may be used when your own eggs or your partner’s sperm aren’t viable. They may also be used after repeated failed IVF cycles or by same-sex couples.
Success rates: The chances of a successful pregnancy are around 50 percent with fresh donor eggs and they hover around the 40 percent mark for frozen donor embryos and embryos created from frozen donor eggs.
Risks and side effects: It can be a long and expensive process, and it may be difficult to accept that your child isn’t biologically yours. There’s also a higher chance of conceiving multiples.
Costs: Approximately $4000 to $9000 per frozen embryo donor cycle, $12,000 to $16,000 per frozen egg donor cycle and $20,000 to $30,000 per fresh egg donor cycle.
Surrogacy is when a woman carries a baby for a couple either because the woman can’t carry it herself or the couple comprises two gay men. In traditional surrogacy, the surrogate mother is also the egg donor, whereas in gestational surrogacy she simply carries the embryo created using the parents’ or donors’ eggs and sperm (or a combination of the two). Altruistic surrogacy is when a surrogate doesn’t receive any financial compensation and commercial surrogacy is when the surrogate is paid.
Success rates: For women aged 34 and under who use their own eggs and a surrogate, approximately 50 percent of IVF cycles produce a baby. Success rates decrease as the age of the mother increases.
Risks and side effects: Surrogacy can be expensive and emotionally taxing for the intended parents.
Costs: Commercial surrogacy costs between $90,000 and $130,000. You can cut costs significantly if you use an altruistic surrogate or your own eggs.
8. Natural fertility treatments
If you’d like to try a more natural approach, a natural fertility specialist can recommend herbs, natural medicines, dietary changes and alternative therapies such as acupuncture that may help boost your fertility. These can be used on their own or in combination with traditional fertility treatments to increase your chances of success.
Success rates: Because these treatments are often used in combination with traditional fertility treatments, success rates are hard to determine. Studies on the effectiveness of acupuncture have shown mixed results.
Risks and side effects: While herbs are generally safe to use, some can be risky during pregnancy. Consult your healthcare provider before taking any herbal medicines or supplements. Acupuncture is generally deemed safe while pregnant.
Costs: The initial consultation with a natural fertility specialist ranges between $100 and $300. Acupuncture sessions cost $75 to $150 each and they’re generally performed once a week to once every two weeks. Herbs and supplements can cost $100 to $150 a month.