Family-Building Options for Infertile Couples
Infertility can collapse people’s wishes to rear a child and can feel like the end of many dreams. People want children for many reasons. When fertility is not an issue, most couples fulfil their dreams by raising a child. Once fertility becomes an issue, it feels like a full stop to their dreams. Apart from the traditional way to have a child, there are various ways in modern technology to have a child in infertile couples as well. You don’t have to be childless if you or your partner is infertile. You can surely keep a check on other available options!
One thing to keep in mind is that not all of these choices will work for all couples, so you and your spouse must communicate openly with each other and consult with an infertility counselor before starting down any of the modern paths.
What Are My Infertility Options?
Earlier, there were no options besides the traditional method for having a child. But, now more than ever, there are so many options for infertile couples who want to build their families. All credit goes to modern medical technology and a greater acceptance of “non-traditional” families. Today, there is no right or wrong way to have a child; any option that leads to a couple’s dreams of becoming parents can be a great choice. We’ll be exploring six various infertility options in this article.
Here are the 6 different options for infertile couples:
1. Fertility drugs
This option is mostly for women with infertility issues. Doctors may prescribe medicine to such women which helps them get pregnant. These medicines, called fertility drugs, work by causing a women’s body to release hormones that trigger or regulate ovulation. In short, it regulates or triggers the procedure of releasing an egg from your ovary.
There are a lot of drugs but, a few of them are the most common such as –
a) Clomid or Serophene – This drug has been used for more than 40 years. This is most commonly prescribed in case of irregular ovulation. The pill is usually taken on the 3rd, 4th, or 5th day after a woman starts her periods. Ovulation in the next 7 days after the last dose can be expected in this scenario. About 60-80% of women will ovulate after taking this and half of them will be able to get pregnant. The side effects of this drug are usually mild but include hot flushes, blurred vision, nausea, bloating, headache, etc. Like many fertility drugs, Clomid can raise your chance of multiple births.
b) Injected hormones – If Clomid doesn’t work on its own, doctors may recommend injected hormones. These drugs are not pills that you can swallow. But, you take them like a shot. Some shots are given beneath the skin, while others are injected into the muscle. A few common areas to get the injections are your stomach, upper arm, upper thigh, or buttocks. Taking these injections usually start during the menstrual cycle, the second or third day after bright red blood is seen, and continue taking them for straight 7 to 12 days. Sometimes, Clomid along with hormones needs to be taken orally. Injections also have a high success rate and help women to ovulate. 50% of those women get pregnant. The side effects are mild, however, include problems like tenderness, infection, blood blisters, swelling, or bruising at the injection site. There’s also a risk of a condition called ovarian hyperstimulation, which makes your ovaries grow and become tender. The drugs also raise your chances of multiple births.
c) Antagon – It’s an injected drug that can prevent early ovulation in women who are having fertility procedures. Side effects can include stomach pain, headache, and possibly the loss of your pregnancy.
2. Medical procedures
Sometimes, fertility drugs don’t work. At that time, a couple typically begins to consider their options for infertility in the form of Assisted Reproductive Technology (ART). Depending on the couple’s circumstances, a reproductive endocrinologist may advise any of the following ART procedures:
a) In vitro fertilization (IVF): IVF stands for in vitro fertilization. This is one of the most widely known types of assisted reproductive technology (ART). IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in your uterus. Firstly, medication is taken that makes several eggs mature and ready for fertilization. Then the doctor takes the eggs out of the body and mixes them with sperm in a laboratory, to help the sperm fertilize the eggs. Then they put one or more fertilized eggs (embryos) directly into your uterus. Pregnancy happens if any of the embryos are implanted in the lining of your uterus.
IVF has a lot of steps, and it takes several months to complete the whole process. It sometimes works on the first attempt, but many people need more than a single round of IVF to get pregnant. IVF increases your chances of pregnancy if you’re having fertility problems, but there’s no guarantee when will it happen as everyone’s body is different and it won’t work for everyone.
b) Intracytoplasmic sperm injection (ICSI):
This is a technique used during IVF where a single sperm is injected directly into the egg for fertilization. During the traditional IVF method, the egg is placed in a culture dish with multiple sperm and fertilization occurs when one sperm penetrates the egg naturally. In this method, a tiny needle is used to inject a single sperm into the center of the egg. Once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 1 to 5 days before it is transferred to the woman’s uterus (womb).
ICSI is comparatively a safe and effective procedure for couples with male factor infertility and can improve the chance of fertilization. It fertilizes 50-80 percent of eggs.
But, a few problems may occur such as-
- Some or all eggs may be damaged
- The egg might not grow into an embryo even after it is injected with a sperm
- The embryo may stop growing.
If a woman gets pregnant naturally, there is a 1.5% to 3% chance that the baby will have a major birth defect. The chance of birth defects associated with ICSI is similar to IVF but slightly higher than in natural conception. The slightly higher risk of birth defects may be due to infertility and not the treatments used to overcome infertility.
c) Intrauterine insemination (IUI):
IUI is also called donor insemination, alternative insemination, or artificial insemination. IUI works by putting sperm cells directly into a women’s uterus around the time a woman is ovulating, helping the sperm get closer to your egg. This reduces the time and distance sperm has to travel and makes it easier to fertilize your egg. Before having the insemination procedure, women may take fertility medicines that stimulate ovulation. Semen is collected from a partner or a donor. It goes through a process called “sperm washing” that collects a concentrated amount of healthy sperm from the semen. Then your doctor puts the sperm right into your uterus. Pregnancy happens if sperm fertilizes your egg and the fertilized egg implants in the lining of your uterus.
IUI is a simple and low-tech procedure, which can be less expensive than other types of fertility treatments. It increases your chances of pregnancy, but everyone’s body is different, so there’s no guarantee that IUI will work.
d) Assisted hatching:
In assisted hatching, the outer shell of the embryo is artificially weakened by making a small hole in the zona pellucida (The protective shell surrounded by the cells while the embryo develops). This can be done in several different ways. One method involves the application of an acid solution, called Tyrode’s solution, to help melt a small hole in the shell. Another method involves the use of a laser to “crack” the shell. The hope is that assisted hatching might help the embryo expand, implant into the uterine wall, and finally lead to a pregnancy.
Experts do not recommend the use of assisted hatching in all patients undergoing IVF treatments to conceive. Studies suggest that assisted hatching might help improve pregnancy chances for certain groups of patients. Assisted hatching may help improve pregnancy chances in women who have failed to get pregnant in previous IVF cycles and those who are not likely to conceive.
e) Gamete intrafallopian transfer (GIFT):
GIFT involves retrieving an egg from the woman. The embryos are placed in the woman’s fallopian tubes within 24 hours. First, the woman has been prescribed a fertility drug that helps trigger egg production. Next, the doctor monitors the growth of the ovarian follicles (which contain an immature egg), and once they mature, the woman is given a small amount of hCG (human chorionic gonadotropin) which helps in the production of progesterone to maintain the pregnancy. These mature eggs are then harvested after around 36 hours, which are combined with the sperm and it is placed into the Fallopian tubes with the help of a laparoscope.
F) Zygote intrafallopian transfer (ZIFT):
This is a technique wherein a women’s egg is fertilized outside the body and then implanted in one of her fallopian tubes. First, the egg and the male sperm needed to fertilize it are harvested. Then the egg and the sperm are united in a petri dish, a multi-purpose glass or plastic container with a lid. If all goes well, the sperm fertilizes the egg, and the physicians then implant it in a fallopian tube and the egg eventually is deposited by the fallopian tube into the uterus (womb) for development.
A zygote is a combination resulting from the union of sperm and egg. A zygote later develops into an embryo. An embryo, a mass of cells with no recognizable human features, begins the formation of a human body. After about seven or eight weeks, the embryo exhibits recognizable features such as a mouth and ears. At this stage, the developing human becomes known as a fetus.
3) Sperm, Egg, or Embryo Donation
The phrase “third-party reproduction” refers to involving someone other than the couple that plans to raise the child in the process of reproduction. This includes using donated eggs, sperm, or embryos. This option can become socially, ethically, and legally complex.
In the case of sperm donation, donated sperm is offered to couples where there is no possibility of retrieving sperms naturally or by a surgical procedure for a man. The donated sperm is used to either inseminate the woman (IUI) or to fertilize her eggs in an IVF process. The couple is counseled together about the implications and process involved in such a treatment. All donor sperm samples are to be availed from established and registered sperm banks. These sperm samples are from fertile donors that have been screened for viral infections and common genetic disorders. Fresh donors or known donors should never be used. The samples are identified by a number code provided by the sperm bank.
The process of egg donation also starts with the selection of a donor. The candidate will be an anonymous donor who has been approved after a series of medical and genetic screenings. The donor’s ovaries are stimulated by a stimulation regimen to produce multiple eggs. The eggs are then retrieved, fertilized and the embryos are cultured. The embryos with the highest quality are transferred into the recipient’s uterus for fertility. This can be used for older women who have reduced quality and quantity of eggs or women with reproductive problems, who have a poor response to previous IVF procedures, or women with genetic diseases that they do not want to pass to the child.
In the case of embryo donation, some patients may create more embryos (fertilized eggs) than they need. The extra embryos may be frozen so that they can be transferred later. However, sometimes these embryos may not be used. These patients have the option to have their embryos discarded, donated to research, or donated to another woman to achieve pregnancy.
In all three cases, both the donor and recipient should be counseled by mental health professionals regarding the complexity of the decision to donate and receive embryos, eggs, or sperm. This consultation should include a discussion about the release of donor information and a discussion about future contact between donors and the children resulting from their donated eggs, sperm, or embryos. The recipients are counseled about issues concerning disclosure or nondisclosure to the potential children. In cases where the donors are known, the potential relationship between the donors, recipients, and subsequent children should be explored.
Surrogacy is an arrangement, often supported by a legal agreement, whereby a woman agrees to bear a child for another person or people, who will become the child’s parent(s) after birth. People often choose the option of surrogacy when pregnancy is medically impossible, when there is a high risk for the mother or when a single man wants to have a child. In surrogacy arrangements, monetary compensation may or may not be involved. Receiving money for the arrangement is known as commercial surrogacy. The legality and cost of surrogacy vary widely between jurisdictions.
There are two kinds of surrogacy –
a) Traditional surrogate – It’s a woman who gets artificially inseminated with the father’s sperm. They carry the baby and deliver it for you and your partner to raise. A traditional surrogate is the baby’s biological mother. That’s because it was her egg that was fertilized with the father’s sperm. Donor sperm can also be used in this case if the father also has a problem with the sperm.
b) Gestational surrogate – In vitro fertilization (IVF) now makes it possible to gather eggs from the mother (or an egg donor), fertilize them with sperm from the father (or a sperm donor), and place the embryo into the uterus of a gestational surrogate. The surrogate then carries the baby until birth. They don’t have any genetic ties to the child because it wasn’t their egg that was used. She is called the “birth mother”. The biological mother here is the one whose eggs were being fertilized.
Adoption is the social, emotional, and legal process that refers to taking someone as your own. It refers to the legal process of becoming a non-biological parent to someone. In this method, the adoptive parents have nothing to do with the conception of the child. There are various legalities related to adoption which vary from country to country. Adoption can be difficult for both, the parents as well as the adopted child. But, it is a good option. Often, if not reared properly, adoption can lead to Psychological trauma as well.
6) Living Child-Free
The ultimate choice for a couple considering their infertility options is to live child-free. If you and your partner conclude, after a lot of discussions, that you would prefer to live child-free, that is perfectly alright and no one has the right to talk about it. It’s you and your partner who decide it and not society.Not everyone has to be a parent, and it is completely possible to feel happy and fulfilled without adding children to your family.
Living without children is not always awful. It can be a choice also.
What Are Unexplained Infertility And Treatment Options?
Sometimes it happens that a couple is trying to get pregnant for years but, they’re not successful. The doctor also has not found any obvious problem. In this case, doctors call this ‘unexplained infertility’. This does not mean you will never conceive. Talk to your doctor about alternatives and consider holding off on treatment if you have a good chance of getting pregnant without it.
A few tips might help to improve the chance of pregnancy, such as –
1) Getting the timing right – A women are most fertile at the time of ovulation (when an egg is released from your ovaries), which usually occurs 12 to 14 days before your next period cycle starts. This is the time of the month when you’re most likely to get pregnant. If you hit the timing right,there is a higher chance to be pregnant.
2) Having a healthy lifestyle – A few lifestyle factors can affect your chance of being pregnant and the health of your baby. When trying to conceive, men and women should both strive to:
- Maintain a healthy weight range
- Not to smoke
- Eat a healthy nutritious diet and exercise regularly
- Take necessary supplements
- Say no to alcohol
- Avoid contact with toxic chemicals in the work and home environments
- See a doctor if you suspect an infection or other
Which Infertility Options Are Right for You?
A simple answer to the question is it differs from couple to couple. Few people find it easier to adopt, whereas few people will choose IVF over all the other treatments. The only way to decide is through clear communication between partners and asking plenty of questions about the procedures and costs to the clinics. Always make sure that clinics that you’re choosing offer the latest techniques and involve you and your partner in all the decisions. Infertility treatment is a long-term process, and you want to feel comfortable with your choice. What works for one couple might or might not work for you. The appropriate therapy will differ from person to person.
Infertility Options: FAQs
Infertility options are a relatively new field and people have infinite doubts about the same. So, let’s address a few most common questions about infertility options –
Q1. What is the most common treatment for infertility?
The infertility treatment plan depends upon the cause or causes behind infertility, whether the problem is from the woman’s side, the man’s side, both sides, or remains unexplained.85 to 90% of couples dealing with infertility are treated with low-tech treatments, like medication or surgery. Less than 5% are treated by assisted reproductive technologies like IVF.
Q2. What are Alternatives to IVF?
Several infertility treatments may help increase your chance of getting pregnant. Other ART procedures also work well along with a few lifestyle changes, medications, surrogacy, adoption, or other alternatives.
Q3. What are the unexplained infertility treatment options?
Unexplained infertility is treated empirically. This means a the treatment plan is mostly based on clinical experience. The most common treatment for unexplained infertility looks like this:
1) Lifestyle changes
2) Continue trying in the right days from 6 months to a year
3) Infertility medicines according to the doctor’s recommendation
4) Last option is seeking ART such as IVF
Q4. If your husband is infertile what are the options?
Frequently, an exact cause of infertility can’t be found.Even if an exact cause isn’t clear, your doctor might be able to recommend treatments or procedures that will lead to conception.
In men, fertility is treated with:
1) Surgery, if the cause is a varicocele (widening of the veins in the scrotum) or a blockage in the vas deferens, tubes that carry sperm.
2)Antibiotics to treat infections in the reproductive organs if any
3)Medications and counseling to treat problems with erections or ejaculation such as any sexual issue
4)Hormone treatments if the problem is a low or high level of certain hormones.
Q5. Is donor egg the only option for PCOS infertility?
No! That is not the only option women with PCOS have. Having PCOS doesn’t mean you can’t get pregnant. As it affects every woman differently, many women with the condition can conceive naturally, but many also need help through treatment such as IVF. And for some women with PCOS, may need an egg donor. Using an egg donor is certainly the safest option in case of repetitive IVF failures.
Q6. What makes surrogacy a better option for females with infertility?
Surrogacy is a valuable gift and a life-changing episode. Women who become surrogate mothers share a compassionate and empathetic approach and their sole purpose is to benefit the childless couples by giving them their babies. The surrogate mothers can relate to the pain and sufferings of such couples and they wish to make their parenthood journey
filled with love and happiness.
Surrogacy is a blessing for couples having the following symptoms:
1)Female with poor ovarian reserve
2)Female is diagnosed with unexplained infertility
3)Female is beyond her reproductive age
4)Female has blocked fallopian tube
5)Female is suffering from a severe medical illness
Infertility can be traumatic. But, today due to advancements in Science and Technology, a couple can have a child by various methods. Along with the traditional methods, there are multiple methods to have a child. Most of them are also accepted by society. Talking with a doctor who specializes in pregnancy and/or infertility can help you figure out which treatments are best for you. Your family doctor or gynecologist can also refer you to a fertility specialist.
Counseling for Infertile Couples in India
Infertility counseling is relatively a new field in India.
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