other ways to get pregnant besides ivf

other ways to get pregnant besides ivf

other ways to get pregnant besides ivf

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Non-IVF Therapies
  1. Medications to induce ovulation. Many medications are used to treat infertility.
  2. Clomiphene citrate (Clomid®)
  3. Aromatase Inhibitors: Letrozole (Femara®)
  4. Metformin.
  5. Gonadotropins.
  6. Intrauterine insemination (IUI)
Assisted conception treatments include:
  • Intrauterine insemination (IUI). Sperm cells are inserted directly into your womb (uterus) at the time of ovulation.
  • In vitro fertilisation (IVF).
  • Intracytoplasmic sperm injection (ICSI).
  • Donated sperm.
  • Donated eggs or embryos.
  • Surrogacy.
other ways to get pregnant besides ivf
other ways to get pregnant besides ivf

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Non-IVF Therapies

Our physicians may recommend one of several medical therapies that can help people who are trying to get pregnant. These often

serve as first line and even second line treatments prior to IVF. These medications are typically used to help induce

ovulation in patients who have ovulatory dysfunction (Am I ovulating, btw?) or to help superovulate patients to increase the chances for pregnancy in a given cycle.

Medications to induce ovulation

Many medications are used to treat infertility. Several are listed below, but talk with your infertility specialist about the purpose

for each one. Never take infertility medications or herbal products that have not been prescribed for you.

Clomiphene citrate (Clomid®)

If a male or sperm-related factor has been ruled out, the first step for many couples is to enrich the egg production. This can be done

with oral drugs, the most common of which is clomiphene citrate.

This agent is used to induce ovulation, to correct irregular ovulation, to help increase egg production and to correct luteal phase deficiency.

This drug acts as “anti-estrogen” and tricks the pituitary gland into producing more follicle stimulating hormone (FSH) and luteinizing

hormone (LH), which, in turn, stimulates the ovaries to produce more eggs and follicles. The widely cited twin rate for patients using

clomiphene citrate is 5-8% and the triplet rate is 1%.

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Over-the-counter ovulation predictor kits can help determine when ovulation will occur. These kits may help time when an increase in

sexual intercourse is approrpiate, or an indication to visit the Center for intrauterine insemination.

Historically, clomiphene citrate has been the first line therapy for inducing ovulation in patients with PCOS and up to 80% of patients with

PCOS will respond and ovulate. Recent data pitting clomiphene citrate against letrozole in patients with PCOS showed that live

birth rates were higher in the patients who took letrozole. The findings of these results suggest that letrozole may be a better first line option.

Clomiphene citrate 100mg with artificial insemination (IUI) remains the first line treatment of choice for unexplained infertility.

other ways to get pregnant besides ivf
other ways to get pregnant besides ivf

Aromatase Inhibitors: Letrozole (Femara®)

In the past, letrozole was used as a second line agent for those patients who expressed resistance to clomiphene citrate, but it has recently

emerged as a first line treatment in certain patient populations.

As noted above, letrozole is a preferred first line ovulation induction agent for patients diagnosed with PCOS. Letrozole is an aromatse inhibitor

and works by temporarily stopping the conversion of androgens to estrogens, therefore the brain responds by increasing secretion of FSH.

It is important to discuss the choice of ovulation induction agent with your MD.

Metformin

Metformin is a diabetic medication used to reduce insulin resistance and may play a role in women who continue to be resistant to oral ovulation

induction medications. Historically, it has been used as a first line agent to induce ovulation but a large and thorough study has shown that

clomiphene citrate alone is superior to metformin in ovulation induction. We consider starting metformin if patients show signs or symptoms of insulin resistance/glucose intolerance.

Gonadotropins

Gonadotropins are fertility medications given by injection that are identical to the natural follicle stimulating hormone (FSH) produced

by the pituitary gland, alone or combined with luteinizing hormone (LH), also produced by the pituitary gland. The result of these

additional hormones circulating in the bodies the stimulation and growth of multiple follicles.

Gonadotropins are helpful for women with various diagnoses:

  1. Those who are resistant to oral medications
  2. diagnosis that precludes the use of oral medications
  3. Empiric therapy (unexplained)
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They are also used to induce development and ovulation of multiple follicles in patients undergoing assisted reproductive technologies such

as in vitro fertilization or intrauterine insemination.

In addition to increasing the number of eggs, timing factors — such as ovulation — are controlled to maximize the chance of becoming pregnant

by intercourse or IUI. The use of injectable medications increases the risk of ovarian hyperstimulation syndrome (OHSS)

as well as the risk of high order multiples (triplets or more).

Usually three cycles (months) are adequate to determine if gonadotropins will result in a pregnancy. If not, it is recommended the

couple move on to other options. Gonatropin/IUI therapy is utilized much less today than in years past for two reasons: 1) A desire

to reduce the number of higher order multilples (triplets or more) and 2) the vast improvement in IVF success rates over the last 20 years.

Intrauterine insemination (IUI)

Intrauterine inseminationis a medical procedure that places the sperm directly into the uterus. The sperm does not have to travel up the

vagina and through the cervix to reach the uterus. The advantage of IUI is that it puts a much larger number of sperm into the uterus

than would occur with intercourse. IUI may be useful if the male partner has a low sperm count, but also has a role in empiric use.

other ways to get pregnant besides ivf
other ways to get pregnant besides ivf

Ways To Help Get Pregnant That Don’t Involve IVF

Most of us spend years trying to avoid getting pregnant. But, when you actually want to conceive, it can be harder than you thought.

But you might not need IVF even if you’re struggling—here are six other ways your doc can help first.

If it’s taking time for you to get pregnant, doctors stress that you shouldn’t freak out and assume you need in vitro fertilization (IVF).

Not that there’s anything wrong with IVF, of course—it can just be costly, doesn’t have a guaranteed success rate, and can be tough on you and your partner.

Luckily, there are many other things doctors can try first. “IVF is not necessary in most cases,” says Lauren Streicher, M.D.,

an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine and author

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of Sex Rx: Hormones, Health, and Your Best Sex Ever. “There’s a protocol we go through. Nobody goes straight to IVF.”

Board-certified ob-gyn Pari Ghodsi, M.D., also points out that a third of fertility problems can be attributed to the guy, and another

third are due to unknown factors, so it takes some trial-and-error. “There are many tests to diagnose the problem and each has individualized treatments,” she says.

Most doctors won’t want to have the fertility talk unless you’ve been having regular, unprotected sex for a year without getting

pregnant, Dr. Ghodsi says. (But, if you’re 35 or older, they’ll want to talk after six months.) At that point, there are a variety of options they can look into:

Track your ovulation: “Just because you’re having regular periods doesn’t mean you’re ovulating,” Dr. Streicher says, which is

why she recommends that women use an ovulation predictor kit to see if they’re ovulating. Your doctor may also monitor your

cycle with blood work (to make sure your hormone levels are correct) and an ultrasound to see if there’s a follicle forming and

the lining of your uterus is thick enough. Then, you may have your blood progesterone level checked to see if you actually ovulated.

“From that first basic set of tests, we’re really looking at ovulation—if they’re doing it and when,” Dr. Streicher says. “You can’t assume.”

Test his sperm: It takes two people to make a baby, and that can mean your difficulty getting pregnant may not be due to

something on your end. “I don’t do anything that’s painful or invasive until we do a semen analysis,” Streicher says. “If there’s a

man in the picture, too often we find the guy has no sperm or it’s moving in the wrong direction. For me, that’s part of the

initial fertility evaluation.” If everything on his end looks good, doctors will then move on to the next step.

 

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