The number of people seeking treatment for infertility—and talking about it—is on the rise: According to a 2023 poll, 42 percent of adults said they had pursued a fertility treatment or personally knew someone who had, compared to 33 percent of adults who said the same in 2018.
Of course, infertility being common doesn’t make it easier to experience. But if you’re considering fertility treatments, know that doctors have several options to try to help you have a baby.
The first step is a fertility evaluation to try to determine a cause.
“The treatment will depend on the diagnosis, and the journey will be different for each patient,” says UNC Fertility doctor Jaime Roura, MD. “So much goes into what might be better for a patient—age, what they value, evidence from medical studies. It’s really individualized.”
Dr. Roura explains some of the common treatments you might hear about on this journey.
Medications for Infertility
During a fertility evaluation, your provider will work to ensure you are regularly ovulating—without the regular release of an egg, pregnancy can’t occur.
“For patients with irregular or absent menstrual cycles, oral medications can help to induce ovulation,” Dr. Roura says.
For some women, medication alone may be all that’s needed for pregnancy. Other times, medication is used in combination with other treatments.
Surgery to Treat Infertility
If screening reveals a mass or scar tissue affecting a woman’s reproductive organs, your doctor may recommend surgery to remove the blockage.
“Fibroids and polyps are common growths in the uterus and the most common causes of surgical management for infertility,” Dr. Roura says. “We can also remove scar tissue. Most of these procedures can be done vaginally and some can even be done in the office.”
Men may need surgery if it’s determined they have varicoceles, or swollen veins in the scrotum, as these can affect semen quality. Most men can have a minor outpatient surgery to remove the veins.
Intrauterine Insemination
Some people may benefit from intrauterine insemination, or IUI—a procedure that shortens the journey that sperm has to make to the fallopian tube and is timed to ovulation, maximizing the odds that sperm and egg meet.
Before an IUI, a woman may take ovulation-inducing medication, and a man provides a semen sample. The semen will be “washed” in a lab, ensuring that a high concentration of the healthiest sperm is used.
For women, the procedure will feel similar to a pelvic exam, because a speculum is inserted to accommodate a thin, flexible catheter that places the sperm close to the uterus. The procedure typically takes less than 10 minutes and does not require anesthesia.
In Vitro Fertilization
In vitro fertilization, or IVF, is increasingly common. In 2022—the most recent year for which national data is available—more than 98,000 infants were born as a result of in vitro fertilization (IVF), accounting for roughly 2.5 percent of total births in the country.
Your doctor will help you determine if IVF is right for you based on your diagnosis and medical history; it does directly assist with all of the most common causes of infertility, including ovulation issues, sperm’s ability to travel to the fallopian tube and fallopian tube blockages.
The process starts with medications to stimulate the ovaries and then an egg retrieval.
“We use injectable medications to stimulate the ovaries, so they will build the follicles that house the eggs,” Dr. Roura says. “We can see the follicles develop via ultrasound, which is how we’ll know when a patient is ready for retrieval.”
The number of days that a patient will need to be on medication will vary; while Dr. Roura says that nine to 12 days of medication is an average, your doctor will use images on the ultrasound to determine when eggs have matured and are ready.
Egg retrievals are short, 10-to-15-minute procedures done under local anesthesia. Using an ultrasound for guidance, a doctor inserts a needle via the vagina to the ovaries to remove the eggs. Retrieved eggs might be frozen for future use or mixed with sperm to create an embryo; embryos can either be used immediately or frozen for future use. If creating embryos, then sperm is needed at this point.
It’s important to note that not every egg retrieved can be frozen or fertilized. Fertilized eggs grow in the lab for five days, and some of these embryos stop developing. Your doctor will tell you the number of eggs retrieved and then, after work in the lab, how many were frozen, fertilized or became embryos.
After five days of growth in the laboratory, an embryo can be transferred directly to the uterus, or the embryo can be frozen for transfer at a later time. During a transfer, you are awake, and the procedure is similar to an IUI or a pelvic exam: a speculum is placed, and a thin, flexible catheter places one or more embryos, with most transfers taking just a few minutes. About nine days later, you will take a blood test to determine if you are pregnant.
Donors and Surrogacy
For some couples, a fertility evaluation may reveal that their own sperm or eggs aren’t healthy enough to create a pregnancy, or they may not produce sperm or eggs due to a previous illness or treatment. They may decide to use sperm or eggs from a donor or enlist the help of a surrogate or gestational carrier to carry the pregnancy.
Using donor egg or sperm are also options for single people pursing pregnancy and same-sex couples. Donor egg and sperm can be used as part of the IUI or IVF process. A fertility clinic can help with the process of choosing and obtaining egg and sperm.
Things to Know about IVF and Other Fertility Treatments
IVF and other fertility treatments do come with risks. Medications, taken on their own or as part of IVF, can have side effects. If medications are administered through an injection, there can be pain or discomfort at the injection shot. When ovaries are being stimulated before a retrieval, the medications can make a woman feel bloated, heavy, uncomfortable and tired. Other medications taken during the process can cause side effects similar to those women experience during their menstrual cycle, such as breast tenderness, changes in mood or headaches. During egg retrieval, there is a very low risk of the needle causing bleeding or damage to organs.
Dr. Roura says the timeline to prepare for and undergo fertility treatments can look very different than what patients are used to, particularly IVF, and that they should anticipate some uncertainty during the process.
“Our unit of time is the menstrual cycle, which is a different unit of time than other experiences people have within the healthcare system,” he says, noting that steps within IVF, such as ovulation induction, are tied to the female partner’s cycle and that it might take several menstrual cycles for treatment. “We’re also used to planning something and knowing when it will happen, but for IVF, we can only plan about six days into the cycle. After that, we’re basing decisions on ultrasounds and lab work findings. We can estimate when an egg retrieval or transfer might be, but some people go faster or slower through a cycle.”
It’s difficult to put in so much time, effort and money and not know if the treatment will result in a healthy pregnancy. Your doctor will be able to share success rates for a given treatment, for patients who might be of a similar age or diagnosis as you, but they cannot guarantee a pregnancy or baby on the first try. Some people need multiple treatment cycles to successfully conceive. Some fertility treatments may not be covered by insurance, so multiple cycles can be cost-prohibitive.
“It’s a long, complex, stressful process, and there are not a lot of markers for success along the way,” Dr. Roura says. “When people ask their chances of taking a baby home, it really depends on a lot of factors. It’s not possible for everyone to walk away with a baby on the first try, and there may be financial barriers or life stressors that limit another try.”
Still, Dr. Roura encourages people struggling with infertility to be evaluated before dismissing the idea of fertility treatment. Couples are advised to try to conceive naturally for a year if the female partner is younger than 35 and for six months if the female partner is older than 35. If you have a known issue that could prevent pregnancy, seek care earlier.
“Infertility is hard and isolating, so look for a healthcare system where you feel supported,” Dr. Roura says. “If you’re trying, we’re going to get you through and root you on. We want to help you meet that goal of building your family, however that looks for you.”
If you have questions about fertility, talk to your doctor. If you need a doctor, find one near you.