Fertility Treatments – An Overview

The percentage of children born with the help of fertility treatments – or artificial reproduction techniques – varies greatly in the world. In the United States, it’s nearly 2%, while in Denmark, it’s all the way up to around 10%. The method used depends on the cause of the infertility, but also varies between countries and clinics.

In this article we present an overview of the main fertility treatments. The constellations and cost of treatments can differ from clinic to clinic.

Intrauterine Insemination (IUI)

In this procedure, you collect sperm from the male (partner or donor) and insert it directly into the female uterus on ovulation day through a thin, flexible catheter. The female partner may need to take hormones to increase the chances of inseminating the female when she is ovulating.

For this treatment to work, the female must have free passage in the fallopian tubes and no other major fertility problems. It is usually offered to couples where the male has suboptimal semen quality, but still a sperm count above 5 million progressive sperm cells per ml.

This treatment is most often considered in the case of:

• Problems with vaginal intercourse
• People in same-sex relationships
• People infected by HIV

In Vitro Fertilization (IVF)

IVF is a multistep process. With IVF, the female gets hormones to stimulate her immature eggs (follicles) to mature. The woman then injects herself with an ovulation-promoting medicine when the follicles are mature. This ensures the ovulation to be timely and controlled very precisely. After this, the lab extracts the eggs from the ovaries and mix them with sperm, to help the sperm fertilize the eggs. After a few days, the eggs (embryos) are ready for insertion directly into her uterus. Pregnancy happens if any of the embryos implant in the lining of her uterus. One will usually need to wait for 2 weeks before taking a pregnancy test to see if the treatment worked.

The doctor then implants the embryos into the uterus.

IVF is considered in the following cases:

• Low sperm count.
• Problems with ovulation due to conditions like polycystic ovary syndrome (PCOS)
• Problems with the fallopian tubes
• Endometriosis

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a specialized form of IVF. In this process, instead of having the sperm fertilizing an egg in a dish, a tiny needle, called a micropipette, sucks up a single healthy-looking sperm cell, and injects it into the centre of the egg. Similarly to IVF, the fertilized egg (embryo) grows for a few days in the laboratory before it is transferred to the uterus.

ICSI is considered in the following cases:

• Very low sperm count.
• Unsuccessful IVF attempts, where the eggs haven’t been fertilized
• Donor eggs or previously frozen eggs are used

How successful are fertility treatments?

When a couple gets a referral to a fertility treatment, they often ask the doctor how likely it is that a single treatment cycle will result in a successful pregnancy.

This is very difficult to answer because it depends on many factors. These can be female age, sperm quality, response to hormone treatment, previous fertility treatment outcomes, etc.

Specifically, for IUI, over 50% of women aged under 40 years of age will conceive within 6 cycles of IUI (NICE fertility guidelines).

For IVF, a recent analysis of 20,000 Danish couples undergoing fertility treatment found that over the course of 3 years of fertility treatments, 65% had successful pregnancies. Over the course of 5 years, 71% had successful pregnancies.

Age affects the fertility of both men and women. Age is the single biggest factor affecting a woman’s chance to conceive and have a healthy baby. The fact is that a women’s fertility already starts to decline in her early 30s, with the decline speeding up after 35. See an illustration of this in the table below. The higher the female’s age, the less chance of success with IVF.

According to the NHS statistics, these are the percentages of IVF treatments that resulted in live births by age group:

For your individual chances of pregnancy, both naturally or with fertility treatment, you should consult a fertility expert together with your partner.