Guide | Advances in Infertility Treatment: More Options and Higher Success Rates
In the United States, about one in eight couples experiences infertility. For these couples, pregnancy may seem like a distant and frustrating goal. However, advances in infertility treatment, a wider range of options, and improved clinical expertise have made the outlook increasingly encouraging. Experts note that seeking medical care earlier may improve outcomes, and timely treatment is especially important for older women.
Substantial Improvement in Treatment Success
Dr. Mousa Shamonki, a reproductive endocrinologist at the David Geffen School of Medicine at UCLA, said, "Success rates have improved significantly over the past decade." According to Dr. Shamonki, average success rates at fertility clinics roughly doubled during that period.
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 48,000 babies were born through assisted reproductive technology (ART) in the United States in 2003, over 2,000 more than in 2002 and 7,000 more than in 2001. These figures indicate that advances in infertility treatment have led to higher pregnancy rates.
Early Diagnosis and Timely Treatment
Experts note that many couples who have difficulty conceiving hear advice from friends and family such as, "Relax, take a vacation, and pregnancy will happen." However, this advice may not apply to couples with an underlying fertility problem. Dr. Eric Surrey, an obstetrician-gynecologist in Denver and former president of the Society for Assisted Reproductive Technology, said, "For couples with fertility concerns, seeking professional care early is wiser than continuing to try without evaluation." Women under 39 who have tried to conceive for one year without success should consider professional care. Women over 39 are advised to seek care after six months of trying.
A Range of Treatment Options
Infertility can sometimes be treated with medication or surgery to repair the reproductive organs. Another common treatment is ovarian stimulation with intrauterine insemination (IUI), in which medication such as clomiphene stimulates egg development and sperm is placed in the uterine cavity through a thin catheter.
In Vitro Fertilization (IVF) Can Significantly Increase Pregnancy Rates
Many couples prefer more proactive treatment, particularly because of age and higher success rates. In vitro fertilization (IVF) can substantially increase the chance of pregnancy. Eggs are surgically retrieved from the ovaries, combined with sperm for fertilization outside the body, and the resulting embryos are transferred to the uterus. Dr. Guy Ringler, a reproductive endocrinologist at the University of California School of Medicine in Santa Monica, said, "For women under 40, the pregnancy rate with a first IVF treatment is about 40%." For women over 40, success is closely related to age. The rate is approximately 15% for women aged 40 to 42 and below 5% for women over 42.
Treatment with Donor Eggs
Donor eggs may be a more realistic option for older women. Dr. Ringler said, "Although many women have concerns about using another person's eggs, they often go through a process of acceptance, and their desire to have a child ultimately outweighs concerns about genetics."
Dr. Steven J. Ory, a reproductive endocrinologist in Margate, also noted that success rates with a woman's own eggs are extremely low after age 45, making donor eggs a more practical option.
Reducing the Number of Embryos Transferred
As infertility treatment success rates improve, transferring fewer embryos has become a new trend. Updated guidelines presented at the 2006 annual meeting of the American Society for Reproductive Medicine (ASRM) recommended transferring no more than two embryos in women under 35 and also considering single-embryo transfer. For women over 40, the recommendations were no more than five embryos at the 2- to 3-day stage and no more than three embryos at the 5- to 6-day stage.
Combining Eastern and Western Medicine
More fertility centers are exploring or accepting traditional Chinese medicine, particularly when conventional medical treatment has been unsuccessful. Dr. Ringler said that acupuncture and herbal medicine are widely used in infertility care and that acupuncture before and after embryo transfer may improve pregnancy rates. Although research findings on acupuncture are mixed, studies generally indicate that it has no known adverse effects.
Advances in Medication for Ovarian Stimulation
Doctors have widely used clomiphene (Clomid) to stimulate egg development. In recent years, Femara, a medication used to treat breast cancer, has also been used for ovulation induction. Although some studies suggested a higher incidence of birth defects with Femara, more recent findings indicate no significant difference in birth defect rates between babies born to mothers who used Femara and those who used clomiphene.
Guide | Advances in Infertility Treatment: More Options and Higher Success Rates
Guide | Advances in Infertility Treatment: More Options and Higher Success Rates
In the United States, about one in eight couples experiences infertility. For these couples, pregnancy may seem like a distant and frustrating goal. However, advances in infertility treatment, a wider range of options, and improved clinical expertise have made the outlook increasingly encouraging. Experts note that seeking medical care earlier may improve outcomes, and timely treatment is especially important for older women.
Substantial Improvement in Treatment Success
Dr. Mousa Shamonki, a reproductive endocrinologist at the David Geffen School of Medicine at UCLA, said, "Success rates have improved significantly over the past decade." According to Dr. Shamonki, average success rates at fertility clinics roughly doubled during that period.
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 48,000 babies were born through assisted reproductive technology (ART) in the United States in 2003, over 2,000 more than in 2002 and 7,000 more than in 2001. These figures indicate that advances in infertility treatment have led to higher pregnancy rates.
Early Diagnosis and Timely Treatment
Experts note that many couples who have difficulty conceiving hear advice from friends and family such as, "Relax, take a vacation, and pregnancy will happen." However, this advice may not apply to couples with an underlying fertility problem. Dr. Eric Surrey, an obstetrician-gynecologist in Denver and former president of the Society for Assisted Reproductive Technology, said, "For couples with fertility concerns, seeking professional care early is wiser than continuing to try without evaluation." Women under 39 who have tried to conceive for one year without success should consider professional care. Women over 39 are advised to seek care after six months of trying.
A Range of Treatment Options
Infertility can sometimes be treated with medication or surgery to repair the reproductive organs. Another common treatment is ovarian stimulation with intrauterine insemination (IUI), in which medication such as clomiphene stimulates egg development and sperm is placed in the uterine cavity through a thin catheter.
In Vitro Fertilization (IVF) Can Significantly Increase Pregnancy Rates
Many couples prefer more proactive treatment, particularly because of age and higher success rates. In vitro fertilization (IVF) can substantially increase the chance of pregnancy. Eggs are surgically retrieved from the ovaries, combined with sperm for fertilization outside the body, and the resulting embryos are transferred to the uterus. Dr. Guy Ringler, a reproductive endocrinologist at the University of California School of Medicine in Santa Monica, said, "For women under 40, the pregnancy rate with a first IVF treatment is about 40%." For women over 40, success is closely related to age. The rate is approximately 15% for women aged 40 to 42 and below 5% for women over 42.
Treatment with Donor Eggs
Donor eggs may be a more realistic option for older women. Dr. Ringler said, "Although many women have concerns about using another person's eggs, they often go through a process of acceptance, and their desire to have a child ultimately outweighs concerns about genetics."
Dr. Steven J. Ory, a reproductive endocrinologist in Margate, also noted that success rates with a woman's own eggs are extremely low after age 45, making donor eggs a more practical option.
Reducing the Number of Embryos Transferred
As infertility treatment success rates improve, transferring fewer embryos has become a new trend. Updated guidelines presented at the 2006 annual meeting of the American Society for Reproductive Medicine (ASRM) recommended transferring no more than two embryos in women under 35 and also considering single-embryo transfer. For women over 40, the recommendations were no more than five embryos at the 2- to 3-day stage and no more than three embryos at the 5- to 6-day stage.
Combining Eastern and Western Medicine
More fertility centers are exploring or accepting traditional Chinese medicine, particularly when conventional medical treatment has been unsuccessful. Dr. Ringler said that acupuncture and herbal medicine are widely used in infertility care and that acupuncture before and after embryo transfer may improve pregnancy rates. Although research findings on acupuncture are mixed, studies generally indicate that it has no known adverse effects.
Advances in Medication for Ovarian Stimulation
Doctors have widely used clomiphene (Clomid) to stimulate egg development. In recent years, Femara, a medication used to treat breast cancer, has also been used for ovulation induction. Although some studies suggested a higher incidence of birth defects with Femara, more recent findings indicate no significant difference in birth defect rates between babies born to mothers who used Femara and those who used clomiphene.
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