What options are available to infertile couples who want to expand their family? Luckily we live in a day and age where medicine has given us many options. It wasn't that long ago where adoption was the only option given to couples dealing with infertility. Below are some of the common treatement options. Which option a couple pursues depends laregely on their diagnosis and comfort level. It is important to note that before starting any infertility treatments, a couple should undergo a full infertility work up, which includes blood work, HSG, and a semen analysis (discussed further in Resolve to Know More About Infertility Testing).
Ovulation Inducing Medications
Many times the first course of treatment is ovulation inducing medication paired with timed intercourse. This can be particularly effective for couples dealing with annovulation as their primary infertility diagnosis. Ovulation inducing meds come in many forms, from pills such as Clomid or Femera, to injectibles such as Follistim, Gonal-F, Bravelle, and Menopur. Any Ovulation inducing meds are not without side effects and risks and should never be taken without being closely monitored by ultrasound and blood work. Some OB/GYNs prescribe the medication Clomid without any monitoring or at times any infertility testing. They often down play the risks of clomid. clomid can be very effective at inducing ovulation, but can have side effects such as over response (too many eggs produced)which canput you at risk for a serious condition called OHSS (Ovarian Hyper Stimulation Syndrome) and higher order multiples (triplets +). If you have an ovarian cyst (which can only be diagnosed by ultrasound), clomid can make it grow large enough that it can result in damage and even loss of the ovary or fallopian tube. Clomid can also thin the uterine lining to the point that Pregnancy can not occur. Do not take fertiltiy medications unmonitored and it is always recommended that you seek fertility treatments from a Reproductive Endocrinologist (RE). REs are OB/GYNs that also completed a fellowship in Reproductive Endocrinology and are true infertility specialists. Unless your doctor is a RE, they do not "specialize in infertility" like many OB/GYNs claim. One cycle of ovulation inducing medications plus the required monitoring can cost a few hundred dollars to a few thousand dollars depending on which medicaiton is used.
Intrauterine Insemination (IUI)
An IUI involves a sample of washed sperm (from a partner or a donor)being inserted into the uterine cavity through a slender catheter. IUIs are often coupled with ovulation inducing medications, but can also be performed without medication. IUI is often the first course of treatment for couples with slight male factor infertility or couples with unexplained infertility. A cycle with IUI can cost $500 to upwards of $4,000 depending on factors such as whether or not medication was used, how much monitoring is needed, and if multiple IUIs are performed in one cycle.
Invitro Fertilization (IVF)
During IVF the woman takes injectible ovulation inducing meds so that she produces many eggs. The development of the follicles/sacs containg the eggs is monitored closely and when the time is right the eggs are "harvested" during a procedure called an egg retreival. During the retreival the doctor guided by ultrasound, inserts a large needle through the vaginal wall piercing each follicle and suctioning out the egg and fluid inside. The eggs are fertilized with the sperm from the partner or donor through either traditional methods (putting sperm and eggs in the same petri dish and allowing them to fertilize on their own) or by ICSI (Intercytoplasmic Sperm Injection) where a single sperm is injected into a single egg. ICSI is often recommended for cases of sever male factor infertility, but some clinics use it standard on all patients. The resulting fertilized embryos are allowed to grow for 3 to 5 days and then are transferred back into the woman's uterus during a procedure called an embryo transfer. The number of embryos transferred depends on the diagnosis, age of the woman and the day of the transfer (day 3 vs. day 5). Any remaining embryos can be frozen for future use. One cycle of IVF usually costs $10,000-$20,000.
Donor Eggs and Donor Sperm
Couples with certain infertility diagnosis may require the use of an egg or sperm donor. Donor sperm will add several hundred dollars to the cost of an IVF or IUI cycle. Donor eggs requries the donating woman to go through the first half of the IVF process (meds through retreival) and can add around $10,000 to the price of an IVF cycle. Donors are compensated for their time and effort, because donating eggs is a much more time consuming process, donor eggs are much more expensive than donor sperm.
Donor Embryos/Embryo Adoption
A relatively new treatment option is donor embryos or embryo adoption. When couples are finished building their family thorugh IVF, they may end up with extra embryos. They must decide what to do with these embryos, keep them frozen indefinitely, thaw and discard them, donate them to research, or they can donate them to another couple. Embryo Adoption, while technically not an adoption in the legal sense, usually involves an agency and often requires a homestudy (like a traditional adoption). Embryo donation is usually done through a clinic and does not require a homestudy. Like traditional adoptions, Embryo Adoption/Donation can be open, semi-open, or closed. The advantage of Embryo Adoption or Donation is that is much less expensive than IVF, usually $3,000-$10,000. Donors can not be "paid" for their embryos, but the recipients often pay for fees such as storage fees for the embryos.
Surrogacy and Gestational Carriers
Depending on the infertility diagnosis, the woman may not be able to carry a pregnancy which is where surragacy and gestational carriers come into play. You may wonder what the difference is between a surrogate and a gestational carrier? A traditional surrogate uses her eggs and carries the pregnancy for the other couple. A gestational carrier uses the infertile couples embryos and only carries the pregnancy. Because a surrogate/carrier is usually compensated for their time, it can add tens of thousands of dollars onto the cost of a cycle.
Traditional Adoption
Like other treatments, their are many paths to adoption (foster to adopt, domestic vs international, agency or private). Many people wonder why infertile couples dont "just adopt." What these people fail to realize is that adoption is a time consuming and grueling process, requireing homestudies, letters, forms, profiles to be created, etc., and at the end of the process there is still no guarantee of a child. Adoptions can easily cost tens of thousands of dollars, particularly for domestic infant adoption.
For more information about Infertility treatment options visit www.resolve.org/family-building-options/
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