Associate Director, REI
Weill Cornell Medical Center
Ovulation induction is the easiest on all fronts. In this treatment, a woman takes medication like Letrozole or Clomid. It is helpful if a woman isn't ovulating as it can help trigger a woman's cycle to make that happen. If a woman has unexplained infertility, these pills can help her grow some extra eggs so that she has a higher chance of pregnancy.
Ovulation induction is the easiest on all fronts. In this treatment, a woman takes medication like letrozole or Clomid. It is helpful if a woman isn't ovulating as it can help trigger a woman's cycle to make that happen. If a woman has unexplained infertility, these pills can help her grow some extra eggs so that she has a higher chance of pregnancy.
Intrauterine insemination, or IUI, is next on the spectrum. It's a little bit more involved, expensive, and successful than just ovulation induction on its own. For a deep dive into IUI, check out our course here.
In IUI, washed sperm will be placed in the uterus near the fallopian tubes with the hopes that it will give the sperm a better chance of reaching the egg and also that the timing of insemination will be perfectly coordinated with ovulation.
Next is donor sperm, which could be added to an IUI cycle, or it could be used in more invasive treatments. Donor sperm is often used by lesbian couples or single mothers who simply don't have all the equipment to reproduce on their own.
In heterosexual couples, donor sperm is used if a man has very low levels or no sperm at all, or if it's been determined that there is a major issue with sperm quality. Of course, it's an emotionally fraught and an entirely individual decision of when it makes sense to take this step.
IVF, or in vitro fertilization, is far more expensive and invasive, but it's also much more successful than any of the less complicated fertility treatments.
There are a lot of ways that IVF helps make an otherwise impossible or difficult pregnancy happen. For example, if a woman has blocked tubes, IVF makes that a non-factor. If a man has few sperm or sperm that don't swim IVF makes fertilization easier, placing sperm either around or inside the egg.
It also helps a woman to grow more eggs than would naturally happen with the hopes of growing several embryos and increasing the odds of getting a good one. For full information about IVF, we suggest you take a look at our dedicated IVF course.
Using a surrogate, also called a gestational carrier (see our full course here), is more costly, emotionally charged, and expensive than standard IVF.
In this case, an individual or couple will create embryos through IVF, then place those embryos into the uterus of a woman called a gestational carrier. She's the one who will carry the pregnancy.
For men who want to start a genetic family on their own, or as part of a gay couple, surrogacy is always used.
Surrogacy is often used in the case of recurrent miscarriage, if there's something that makes it unsafe for a woman to carry a pregnancy, or if she has issues of the uterus that are difficult to solve like pervasive scar tissue.
Finally, using donor eggs is more expensive, emotionally charged, and more complicated than a standard IVF cycle. But, in the case that a woman doesn't have enough eggs or doesn't have high quality eggs, using donor eggs from another woman can make success much more likely. This is a complex topic, and for more information, we suggest you take a look here at our dedicated course.
A uterine fibroid is a tissue growth in the uterus, and it can also be referred to as a “leiomyoma” or “myoma.” The presence of fibroids vary among populations and are more common among Black women than Caucasian women—the majority of Black women have at least one fibroid by the time they reach their reproductive years. To see more on fertility topics specifically for Black families, we suggest you take a look here.
It’s important to note that while the term “growth” can be scary, fibroids almost never become cancerous.
For some women, fibroids can be painful or cause heavy bleeding. In this case, a surgical treatment called a myomectomy can dramatically reduce symptom severity. Here is how myomectomy compares to other surgeries to improve symptoms.
From a fertility standpoint, the data is hard to interpret on how treating a uterine fibroid improves a woman’s ability to conceive. The issue likely comes down to where the fibroid resides.
There is “fair” evidence that if a fibroid distorts the uterine cavity (often referred to as being “submucosal or intramural with a submucosal component”), removing it through hysteroscopic myomectomy improves pregnancy rates. Fibroids that distort the shape of the uterine cavity are an issue because they interfere with an embryo’s ability to attach to the uterine wall.
However, if a fibroid doesn’t appear to distort the uterine cavity, the evidence is less convincing that it impairs fertility or that removing it improves the odds of success.
Removing a fibroid is a surgical procedure (though some approaches are more invasive than others), and any surgical procedure on the uterus has to be taken seriously. Removing a fibroid can cause scarring to the uterus and create further fertility challenges. It can also weaken the walls of the uterus, committing the woman to a C-section or early delivery, which in and of itself has issues for the offspring.