Should I have infertility treatment?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
After having testing for a cause of infertility, your next step is considering your doctor's recommendations about what to do next. Perhaps your tests have identified a problem, and a potentially effective treatment is available. Or, your test results are normal, finding no obvious reason why you shouldn't be able to conceive. In this case, you may be deciding whether to have more testing, try a treatment for "unexplained infertility," or continue trying to conceive naturally. In any case, you may also be considering adoption as a family planning alternative.
This decision module can help you consider the various medical and personal questions that are related to infertility. It offers you information about infertility, treatment options according to condition, risks of those options, and general outcome information. After reviewing this information, you and your partner can use the worksheet to guide your thinking as you decide what to do next.
Consider the following when making your decision:
- A man's fertility is not known to be severely affected by age. A woman's fertility gradually drops from her mid-30s into her 40s, due in great part to the natural aging of the egg supply.
- In 10% of couples, no cause of infertility is found (unexplained infertility).1 Of all couples with unexplained infertility who do not seek treatment, about 35% will naturally become pregnant within 3 years, and 45% do so within 7 years.2
- The crisis of infertility can be intensified by its treatment, which can be difficult, expensive, and sometimes traumatic. Make a point of:
- Defining your limits for infertility treatment in advance. During infertility treatment, regularly evaluate your emotional, financial, and physical well-being.
- Considering professional counselling. Prolonged infertility testing and treatment can intensify the stress of infertility itself. If you are becoming depressed or overly stressed, or your relationship is suffering, seek professional counselling to help you get through this crisis together.
- Fertility clinic success rates vary. When considering treatment success rates, be aware that many are given in terms of pregnancies conceived. Pregnancy rates do not reflect the fact that some pregnancies miscarry. In any group of women, live birth rates are lower than early pregnancy rates.
For information about clinics you are considering, see the Canadian Online IVF Resource Network Web site at http://www.ivf.ca.
Medical Information
What is infertility?
Infertility is defined as a couple's inability to become pregnant after 1 year of sex without using birth control. However, "normal fertility" is defined as the ability to naturally conceive within 2 years' time.
A woman's fertility gradually declines from her mid-30s into her 40s, due in great part to the natural aging of the egg supply. A man's fertility is not known to be severely affected by age.
- As egg quality declines with age, miscarriage risk increases
.
- Using women's own eggs for assisted reproductive technology (ART) treatment, the annual live birth rate steadily declines from 35% under age 35, to 20% in women aged 38 to 40, to 5% or less in women over age 43.3
- Using donor eggs for ART treatment, a woman's chances of having a live birth do not decline. At age 30 and at age 45, the average donor egg birth rate using fresh embryos is over 45%.3 (Clinics may not accept donor eggs from women over 30 years old.)
What causes infertility?
In about 35% of couples, testing reveals a male fertility problem, as with sperm production or ejaculation. In about 50% of couples, the primary cause is a female fertility problem with ovulation, fallopian tube function, or other pelvic problems, such as endometriosis. Some couples find that both partners have a fertility problem. In 10% of couples, no cause of infertility is found.1
What types of infertility treatment are available?
Infertility treatment ranges from using simple fertility awareness measures to pinpoint your "fertile window" to specialized surgical, hormonal, and assisted reproductive technology (ART) treatments. Some of these can have high financial, physical, and emotional costs.
The following table lists some general causes of infertility and the types of treatment options you may have. Also see the Canadian Online IVF Resource Network Web site that lists fertility treatment centres at http://www.ivf.ca. Individual clinics may list recent information about assisted reproductive technology success rates on their Web sites.
Infertility: General causes, treatment options, and risks Cause of infertility Possible treatment options Risks Sperm problems (low sperm count, lack of sperm)
Use concentrated sperm or donor sperm for artificial or intrauterine insemination.
- Side effects of clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins, if used to stimulate ovulation
- Side effects of a gonadotropin-releasing hormone analogue (GnRH-a), if used to shut down ovaries before stimulating ovulation
- Risks of insemination procedure
- Multiple pregnancy risks to fetuses and mother, if ovulation is stimulated
Use intracytoplasmic sperm injection (ICSI) combined with in vitro fertilization (IVF).
- Side effects of gonadotropin-releasing hormone analogue (GnRH-a), if used to shut down ovaries before stimulating ovulation
- Side effects of clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins that are used to stimulate ovulation
- Risks of procedures used to collect eggs and place embryo
- Multiple pregnancy risks to fetuses and mother
- With ICSI, risk that male child may inherit the father's sperm problems or other genetic problems
- With ICSI, slightly increased risk of certain birth defects
Increase sperm production with medication or gonadotropins.
- Side effects of medication or gonadotropins
Blocked fallopian tubes or endometriosis
Surgery to open the fallopian tubes (successful procedure can lead to more than one pregnancy).
- Risks of tubal surgery
- Greater risk of ectopic pregnancy if tubes are damaged and have scar tissue
Have in vitro fertilization (IVF) (which first requires ovulation stimulation with clomiphene, gonadotropin-releasing hormone [GnRH], or gonadotropins, then harvesting of eggs)—successful procedure produces only one pregnancy.
- Side effects of gonadotropin-releasing hormone analogue (GnRH-a), if used to shut down ovaries before stimulating ovulation
- Side effects of clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins that are used to stimulate ovulation
- Risks of procedures used to collect eggs and place embryo
- Multiple pregnancy risks to fetuses and mother
Ovulation problems
Have sex during 6-day fertile window (fertility awareness).
- Less likely to lead to pregnancy than ovulation-inducing treatments
Stimulate ovulation with clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins.
- Side effects of clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins that are used to stimulate ovulation
- Multiple pregnancy risks to fetuses and mother
Stimulate ovulation with clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins, then harvest eggs for in vitro fertilization (IVF).
- Side effects of gonadotropin-releasing hormone agonist (GnRH-a), if used to shut down ovaries before stimulating ovulation
- Side effects of clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins that are used to stimulate ovulation
- Risks of procedures used to collect eggs and place embryo
- Multiple pregnancy risks to fetuses and mother
No known cause (unexplained infertility)
Have sex during 6-day fertile window (fertility awareness).
- In the presence of a physical problem, is less likely to lead to pregnancy than other possible treatments
Use artificial or intrauterine insemination, a type of insemination, with or without ovulation stimulation
- Side effects of gonadotropin-releasing hormone agonist (GnRH-a), if used to shut down ovaries before stimulating ovulation
- Side effects of clomiphene, gonadotropin-releasing hormone (GnRH), or gonadotropins, if used to stimulate ovulation
- Risks of insemination procedure
If you need more information, see the topic Fertility Problems.
Your Information
Your choices are:
- Try an infertility treatment.
- Do not try infertility treatment. This opens up further decisions about putting pregnancy plans aside for awhile, looking into adoption, and/or continuing to try to conceive using fertility awareness measures.
The decision whether to have infertility treatment takes into account your personal feelings and the medical facts.
Making a decision about infertility treatment Reasons to have infertility treatment Reasons to not have infertility treatment
- You have a known condition that can be corrected for with infertility treatment.
- You have unexplained infertility, and your doctor has proposed a treatment that can increase your chances of carrying a healthy pregnancy.
- You are a woman age 35 or older and are concerned that your chances of pregnancy are decreasing with age.
- You have the financial resources to pay for treatment, as well as pregnancy care.
- The possible risks and side effects outweigh the possible benefits of treatment you're considering.
Are there other reasons you might want to have infertility treatment?
- Testing has not shown a specific cause of infertility, and you want to continue trying to naturally conceive.
- Testing has shown a cause or causes of infertility, and you are not comfortable with the risks or chances of pregnancy related to the treatment.
- You do not have the financial resources to cover infertility treatment and pregnancy care.
- You and your partner have decided on adoption.
- Your religious beliefs do not allow for the type of treatment that could improve your chances of a healthy pregnancy.
Are there other reasons you might not want to infertility treatment?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about infertility treatment. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
Infertility treatment feels right for me. Yes No Unsure I am inclined to let nature take its course without using treatment. Yes No Unsure I want to continue trying to conceive naturally before trying treatment. Yes No Unsure I know what kinds of treatment options am I willing to try. Yes No Unsure I know how long I'd be willing to try infertility treatment. Yes No Unsure It is important to me that I/we have a biological child. Yes No Unsure I/we would consider adoption now or in the future. Yes No Unsure I would consider using donor eggs or sperm to conceive. Yes No Unsure I/we have enough money and/or health coverage to fund infertility treatment. Yes No Unsure I/we have figured out the best way to periodically evaluate my/our testing and treatment plan. Yes No Unsure Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have infertility treatment.
Check the box below that represents your overall impression about your decision.
Leaning toward having infertility treatment
Leaning toward NOT having infertility treatment
Return to the topic Fertility Problems.
| Author: | Shannon Erstad, MBA/MPH Carrie Henley | Last Updated: August 16, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Femi Olatunbosun, MB, FRCSC - Obstetrics, Gynecology and Reproductive Medicine | |
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