There is a common misconception that seeing a fertility specialist automatically means that they’ll recommend IVF. We asked our friends at Spring Fertility to break down the different treatment methods and options, and teach us more about why specific treatments are recommended for specific cases or underlying conditions. Dr. Malinda Lee explains below:
Many patients fear that seeing a fertility specialist commits them to pursuing IVF. While IVF is a large part of our field, and certainly a great option for certain patients, there is much more to reproductive medicine than just IVF.
As a patient, part of the process with your fertility doctor is understanding your unique circumstances and family-building goals. There are many reasons why a patient may come into our offices: it could be an ovulation disorder (not ovulating regularly, not getting spontaneous menstrual cycles); a history of recurrent pregnancy losses; or infertility of many different etiologies. The workup of infertility allows us to recommend targeted treatments and therapies tailored to the patient’s history.
Sometimes it is necessary to start with IVF. This is most common in the cases of tubal factor infertility (when the fallopian tubes are blocked or damaged) or severe male factor infertility. However, outside of these circumstances, often we can start with less “invasive” methods of treatment—again, dictated by the unique circumstances of each patient.
For example, for anovulatory women, we are often able to start with less invasive methods of treatment. For instance, one of the most common reasons for anovulation (absence of ovulation) or oligo-ovulation (rare or unpredictable ovulation) is polycystic ovary syndrome (PCOS). Many women will respond to oral medications that we use to induce ovulation (OI = ovulation induction). These oral medications include letrozole, an aromatase inhibitor (AI), and Clomid, an estrogen modulator (CC = clomiphene citrate), which are often used initially with timed intercourse (TIC) for patients with ovulatory disorders. IVF may be used for patients who do not respond to less aggressive treatments such as oral OI.
Sometimes, intrauterine insemination (IUI) is part of fertility treatment. This can be used in the case of unexplained infertility (where no clear etiology for infertility is uncovered, making up 20-30 percent of fertility patients) or mild male factor infertility. IUI is typically combined with oral medications (again, Clomid or letrozole).
Patients utilizing donor sperm may also proceed with TDIs (therapeutic donor inseminations) which is essentially an IUI using thawed donor sperm. Depending on the patient’s circumstances, TDIs may be done on a natural cycle (insemination occurs after a spontaneous surge of luteinizing hormone, or LH) or in combination with oral medications (again, CC or letrozole).
Ultimately, fertility specialists should be able to identify the underlying cause of infertility and approach treatment in a way that encourages shared decision-making with the patient. While IVF is certainly a helpful option for many patients, it is by no means the only form of treatment we have in our armamentarium.