Starting fertility treatments begins with needing fertility treatments. According to the American Society for Reproductive Medicine, a couple is considered infertile if they’ve been having unprotected sex for a year (six months if you’re 35 or older) without conceiving. Since egg quality diminishes over time, doctors recommend getting treatment earlier if you’re in that 35-plus age group. Some women—those who have very irregular periods or have already been diagnosed with a fertility problem, for example—will need treatments as soon as or before they even start trying.
When that BFP isn’t happening it can be extremely upsetting, but remember that infertility is not the same as sterility. If you’re diagnosed as infertile, chances are you can still have a baby, says Norbert Gleicher, MD, FACOG, FACS president, medical director and chief scientist of the Center for Human Reproduction in New York City. You just may need a little help from one or more of these types of treatments.
Low-level treatments: Clomid and other oral meds
The first stop on the fertility treatment journey—a journey that can be super short (weeks) or pretty long (years)—is often oral medications. Surprised to hear that? Many patients assume they’re going to have to do IVF as soon they walk into a fertility center, but very often these “low-level treatments” are what do the trick to get them pregnant, explains Joshua Hurwitz, MD, staff physician and infertility specialist at Reproductive Medicine Associates of Connecticut. “Many patients get help with all sorts of issues in ways that are very low-tech and not invasive,” he says.
How they work: Oral medications such as Clomid, serophene and tamoxifen essentially "trick" your body into ovulating, or ovulating more regularly, Hurwitz says. This is essential to conception since the egg needs to “come out to play” with the sperm, he adds. These meds can be prescribed for a variety of ovulation issues such as PCOS (polycystic ovary syndrome) or amenorrhea. Sometimes they’re used when there’s unexplained infertility too, Gleicher says.
How often you’ll take them: The standard starting dose for most women is 50 milligrams a day, which you’ll take on about five specific days of your cycle. If you’re still not ovulating in response to the meds, your doctor could begin increasing the dosage up to as much as 200 mg to give you that extra stimulation you might need.
Side effects may include: Higher chances of twins or multiples, greater risk of miscarriage, hot flashes, breast tenderness and mood swings.
How much it costs: Fees and insurance coverage can vary wildly depending on what you’re taking and where you live, but we break down some of the average costs for all levels of treatment here.
Medium-level treatments: Injectables and possibly IUI
If oral meds don't work after usually three to six cycles or you’re diagnosed with a condition that needs a stronger treatment, your doctor might put you on injectable medication. Injectables like Pregnyl, Ovidrel, Profasi and Novarel are synthetic versions of the hormones your body naturally makes. Similar to oral meds, they’re a stronger option used to kick-start ovulation.
How it works: After your nurse or doctor gives you a thorough run-through of how to do it, you’ll inject yourself at home. If the idea of the needle makes you queasy, feel free to ask your partner for help (depending on your pain threshold, it can hurt considerably or just a little). About six to eight times a month, you’ll get blood drawn to test your hormone levels and an ultrasound to see if your ovaries are growing follicles—those are what turn into eggs. That probably seems like a lot of time spent in the doctor’s office, but it’s important for your RE to monitor you closely for bad reactions as well as to see potential follicle growth.
Now, to make a baby, you don’t just have to make an egg, right? It’s got to join with the sperm at the right time. So with both oral and injectable medication, your doctor will tell you the perfect “window” of time to have sex with your partner. If he’s been diagnosed with a minor or mid-level sperm problem—or, in some cases, if you just want extra assurance—you might choose to have IUI (intrauterine insemination) with your fertility meds. “With IUI, you gain a few percentage points in pregnancy chance,” Gleicher says.
How often you’ll take them: It’ll vary depending on the injectable you’re prescribed, but many are used once or twice a day. You’ll usually start on the second or third day of your cycle (while you’re on your period) and continue injections for 7 to 12 days.
Side effects may include: Same as oral meds, plus swelling or bruising at the injection sites, headaches, bloating, stomach pain and ovarian hyperstimulation syndrome (this last one is rare, but symptoms can be severe).
How much it costs: See above.
High-level treatments: IVF and its add-ons
IVF (in-vitro fertilization) is a practice of precision. Instead of hoping sperm will swim their way to the egg inside your body, they’re mixed together in a lab dish. “With IVF, your chances of conception are higher than with anything else,” Hurwitz says. You might undergo IVF if lower- and medium-level treatments haven’t worked, or you might go straight to it if you’re diagnosed with a condition such as blocked fallopian tubes or scar tissue. This is also an option if your partner has a low sperm count. When and if you decide to try IVF will depend on what’s causing your infertility; if it’s unexplained, it’s up to you and your partner.
How it works: IVF starts with injectable medications at high doses to jump-start your body into making as many as 10 to 15 eggs at once. About 10 to 12 days after you get the shots, your doctor will retrieve the eggs in a minor, pain-free procedure that requires you to be sedated. A thin needle is inserted through the vagina and into the ovaries; then eggs and fluid are “sucked” out through the needle one at a time. From there your eggs are combined with your partner’s sperm in the lab, and they’re stored for about five days. Why the wait? If those fertilized eggs grow into embryos and are still surviving at the “blastocyst stage” (day five), they’re more likely to survive inside your body. Then one or two embryos (your choice) are transferred into your body. If all goes well, they implant to your uterus. (Some people are okay with the possibility of twins, but others choose not to take the risk and go with one embryo.) Doctors say having two embryos implanted doesn’t necessarily increase your chances of having a baby, but having multiples increases your likelihood of pregnancy complications. If you have extra embryos, they can be frozen and used later. You may need to wait at least one cycle, as it can take up to six weeks for inflammation to go down, but some research suggests consecutive IVF cycles are okay. Talk it over with your doctor to figure out the right timing for you.
How to increase your odds: With IVF, there are procedures you can add on. CCS (comprehensive chromosome screening) tests embryos for chromosomal imbalances that could cause miscarriage. PGD (pre-implantation genetic diagnosis) screens them for specific diseases such as sickle cell anemia or Tay-Sachs disease.
Side effects may include: Same as other injectables.
How often you’ll take them: It depends on your hormone levels and condition, but you’ll likely inject yourself once a day for a set number of days during your cycle.
How much it costs: See above.