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Posted by on Dec 28, 2019 in Infertility | 0 comments

In a nutshell

This article reviewed different treatment options for couples experiencing infertility.

Some background

Infertility affects approximately 1 in 7 couples trying to conceive. Treatment of infertility depends on the cause. Men, women or both partners can have symptoms of infertility. In women, infertility can be due to eggs not being released or abnormal hormone levels. In men, infertility can be caused by a lack of sperm production. Unexplained fertility is diagnosed when all known causes appear normal.

Methods & findings

While trying to conceive, it is recommended to limit drinking alcohol or not drink it at all. Alcohol should be limited to 4 units or less per week for women and 3 units or less per day for men. Reducing or quitting smoking and limiting use of over-the-counter or prescription drugs are also recommended. Individuals with a BMI of 30 or higher are advised to lose weight. Women with a BMI less than 19 are advised to gain weight. If this does not help, hormonal therapy with medications such as clomifene citrate (Clomid) may be recommended.

There are a number of conditions that can affect hormone levels in women. Hypothalamic amenorrhea (HA) occurs when not enough hormones are produced for ovulation (egg release from the ovaries). Cognitive-behavioral therapy can help treat HA before hormonal therapy is tried.

In polycystic ovarian syndrome (PCOS), imbalanced hormone levels interfere with ovulation and fertilization. Many women with PCOS are overweight, so weight loss may be recommended. If hormonal therapy is unsuccessful, in vitro fertilization (IVF) should be considered. IVF involves fertilizing an egg in a test tube or petri dish, and then the ertilized egg is implanted into the woman. 

Premature ovarian insufficiency (POI) occurs when women have low numbers of eggs. Women with POI may be able to get pregnant, but egg donation is one option if pregnancy is difficult. Some women experience infertility because of problems with their fallopian tubes (link the ovaries to the uterus). These patients may benefit from surgery or IVF.

Men may also have problems with hormone levels. In hypogonadotropic hypogonadism (HH), there are not enough hormones produced to make sperm. One treatment option is hormonal therapy, such as follicle-stimulating hormone (FSH) or luteinizing hormone (LH). Testosterone levels are then measured every 8 weeks until they become normal, indicating normal sperm production. If this fails, intra-cytoplasmic sperm injection (ICSI) is another option. This involves directly injecting a single sperm into an egg to fertilize it.

Some men may experience infertility because they have an extra chromosome (a piece of DNA) or have low numbers of sperm. These patients can be treated with androgen hormone therapy or ICSI. 

For couples with unexplained infertility, there are a number of treatment options available. Intrauterine insemination is one option. This involves the injection of sperm directly into the uterus around the time of ovulation. IVF and ICSI are additional options for these couples.

The bottom line

This article reviewed different treatment options for couples experiencing infertility. These included treatments for male, female and unexplained infertility.

What’s next?

Talk to your doctor about the right treatment options for you and your partner.

Published By :

Journal of Clinical Pathology

Date :

Jul 11, 2019

Original Title :

Investigation and management of subfertility.

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