Fertility Treatments

When you learned about the birds and the bees, chances are no one mentioned that sometimes what the birds and bees (and humans) do doesn’t make a baby. The common wisdom is that if you have been trying to get pregnant for a year without results, you should see a doctor for a fertility work up. According to Mary Jane Minkin, M.D., a clinic professor of obstetrics and gynecology at Yale University School of Medicine, a healthy couple will have a 15 percent to 20 percent chance of getting pregnant in the first month of trying, a 50 percent chance within six months, and an 80 percent chance of pregnancy by the end of that year. “A lot is predicated on age,” says Minkin. “If the woman is 35 or older, and hasn’t gotten pregnant within six months, she should see her doctor.”

Looking for the cause

Since the causes of infertility are just as likely to lie with the man as with the woman, both halves of a couple should have some basic tests if they are having trouble getting pregnant. All of these can be done at your regular gynecologist’s office (or, in the case of semen analysis, at the urologist), are inexpensive, and in many cases will be covered by insurance. “It makes sense to start with these non-invasive tests since they can yield a lot of meaningful information very easily,” says Minkin.

• Semen analysis: It takes two to make a baby, so it’s important for the male partner to have his semen analyzed to screen for any potential problems. A lab will analyze the sample to check for the volume of sperm, the thickness of the fluid, the motility of the sperm (how fast they swim around), and the shape of the sperm.
• Ovulation predictor kit: You can buy these over the counter at the drug store for about $30. These kits will help you determine whether or not you are ovulating on a regular schedule (and, if you are, alert you as to your most fertile times of the month).
• Blood test: Around day 22 of your cycle, your doctor can do some simple blood tests to look at your levels of hormones like progesterone and prolactin—which can affect ovulation.
• Hysterogram: If you appear to be ovulating just fine, your doctor may want to assess the condition of your fallopian tubes. In this procedure, the doctor injects dye into the tubes and uses as x-ray to look for any blockages that could be preventing the passage of the egg and sperm as they attempt to fertilize and then travel to the uterus.

Trying for a cure

Once your doctor has determined what seems to be the cause of the fertility troubles, it’s time to move on to possible solutions. “At this point, your gynecologist will probably refer you to a reproductive endocrinologist who specializes in assisted reproductive technology,” Minkin says.

Fertility drugs: If tests show that you are having trouble ovulating, the first step your doctor will probably advise is a few months of Clomiphene (brand name Clomid). You take one pill a day around days four through eight of your cycle to stimulate the ovaries to release an egg. A more invasive option is Pergonol, which is given as an injection to stimulate ovulation and requires monitoring by your doctor.

• Risks: Both at least slightly increase the possibility of releasing more than one egg (which could result in twins or more). Side effects are generally mild, and may include headaches, hot flashes, mood swings, and cramps. Rarely, they can cause ovarian cysts.
• Success rate: If irregular ovulation is the only fertility issue, using one of these drugs can result in a 20 percent to 60 percent rate of pregnancy.
• Cost: Clomid can cost $50 or less per month. Injections of Pergonol are more expensive, and can cost up to a few thousand dollars each month.