Fertility treatments for men
Treatment will depend on the underlying cause of the infertility.
- Erectile dysfunction or premature ejaculation: Medication, behavioral approaches, or both may help improve fertility.
- Varicocele: Surgically removing a varicose vein in the scrotum may help.
- Blockage of the ejaculatory duct: Sperm can be extracted directly from the testicles and injected into an egg in the laboratory.
- Retrograde ejaculation: Sperm can be taken directly from the bladder and injected into an egg in the laboratory.
- Surgery for epididymal blockage: A blocked epididymis can be surgically repaired. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is blocked, sperm may not be ejaculated properly.
Fertility treatments for women
Fertility drugs might be prescribed to regulate or induce ovulation. They include:
- Clomifene (Clomid, Serophene): This encourages ovulation in those who ovulate either irregularly or not at all, because of PCOS or another disorder. It makes the pituitary gland release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
- Metformin (Glucophage): If Clomifene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance.
- Human menopausal gonadotropin, or hMG (Repronex): This contains both FSH and LH. Patients who do not ovulate because of a fault in the pituitary gland may receive this drug as an injection.
- Follicle-stimulating hormone (Gonal-F, Bravelle): This hormone is produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles.
- Human chorionic gonadotropin (Ovidrel, Pregnyl): Used together with clomiphene, hMG, and FSH, this can stimulate the follicle to ovulate.
- Gonadotropin-releasing hormone (Gn-RH) analogs: These can help women who ovulate too early—before the lead follicle is mature—during hmG treatment. It delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH.
- Bromocriptine (Parlodel): This drug inhibits prolactin production. Prolactin stimulates milk production during breastfeeding. Outside pregnancy and lactation, women with high levels of prolactin may have irregular ovulation cycles and fertility problems.
Infertility tests for men
The doctor will ask the man about his medical history, medications, and sexual habits and carry out a physical examination. The testicles will be checked for lumps or deformities, and the shape and structure of the penis will be examined for abnormalities.
- Semen analysis: A sample may be taken to test for sperm concentration, motility, color, quality, any infections, and whether any blood is present. Sperm counts can fluctuate, so that several samples may be necessary.
- Blood test: The lab will test for levels of testosterone and other hormones.
- Ultrasound: This may reveal issues such as ejaculatory duct obstruction or retrograde ejaculation.
- Chlamydia test: Chlamydia can affect fertility, but antibiotics can treat it.
Infertility tests for women
A woman will undergo a general physical examination, and the doctor will ask about her medical history, medications, menstruation cycle, and sexual habits. She will also undergo a gynecologic examination and a number of tests:
- Blood test: This can assess hormone levels and whether a woman is ovulating.
- Hysterosalpingography: Fluid is injected into the woman’s uterus and X-rays are taken to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If a blockage is present, surgery may be necessary.
- Laparoscopy: A thin, flexible tube with a camera at the end is inserted into the abdomen and pelvis, allowing a doctor to look at the fallopian tubes, uterus, and ovaries. This can reveal signs of endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.
Other tests include:
- Ovarian reserve testing, to find out how effective the eggs are after ovulation
- Genetic testing, to see if a genetic abnormality is interfering with fertility
- Pelvic ultrasound, to produce an image of the uterus, fallopian tubes, and ovaries
- Chlamydia test, which may indicate the need for antibiotic treatment
- Thyroid function test, as this may affect the hormonal balance