Millions of couples across the United States have struggled to conceive. In fact, about 12% of women have received infertility services in their lifetime, according to the CDC. Fortunately, the public perception of infertility has changed over the past few decades, allowing more open, honest conversations that benefit couples trying to conceive, as well as their family and friends. Fertility struggles used to be considered a private matter, especially for men, but now couples have found a new comfort in sharing their experiences while trying to conceive.
Today an abundance of infertility resources are available online and there is a constant flow of new research surrounding reproductive technologies. While helpful, these conditions can also make it challenging to sort through the information and figure out which treatment methods are currently viable and recommended. Below, we’ll take a look at current fertility testing and treatment options, as well as discuss some exciting new developments in the field.
Fertility tests in 2018: what are your options?
If you and your partner have been trying to conceive for over a year without success (6 months if you’re over the age of 35), it may be time for you to start talking with your physician about fertility testing. Traditionally, infertility was thought to be a female condition, causing fertility testing and treatment methods to be centered around the woman. Today, a variety of tests exist to diagnose female infertility and determine its causes, such as:
- Ovulation evaluation—A record number of techniques for ovulation evaluation are on the market today. While your physician can perform a variety of tests to monitor your ovulation, there are also many newer at-home options available. For example, online ovulation calculators and ovulation-tracking bracelets allow women to take a more informed approach to their fertility.
- Transvaginal ultrasound—Advances in ultrasound technology have enabled this imaging test to provide more detailed pictures than ever before. A transvaginal ultrasound is often recommended as one of the first fertility tests for women trying to conceive. It can be used to determine the size and shape of the uterus and ovaries, as well as detect any cysts, fibroids, or other abnormalities. The test is also used to monitor the development of the uterine lining, called the endometrium, and the development of eggs.
- Hysterosalpingogram (HSG)—This test uses fluoroscopy, a type of real-time x-ray, to examine the uterus and fallopian tubes for abnormalities that may be causing infertility. HSG has become increasingly common over the past decade, especially in women who have miscarried more than once.
- Hysteroscopy/Laparoscopy—If imaging tests detect abnormalities in the reproductive tract, a hysteroscopy or laparoscopy may be recommended to examine the uterus, fallopian tubes, and ovaries. These minimally-invasive techniques have become more popular in recent decades as technology advances allow doctors to move away from older, more invasive diagnostic procedures.
In a hysteroscopy, a physician inserts a thin tube into your uterus through your vagina. With a laparoscopy, the tube is inserted through a small incision in the abdomen. In both procedures, a small camera at the end of the tube is used to evaluate the reproductive organs and detect abnormalities.
Male factor infertility is often defined by abnormal sperm count, motility, or morphology. According to the CDC, about 40% of all couples struggling to conceive are affected by male factor infertility in some way. In the past, infertility resources for men were more difficult to find, but advances in male fertility research over the last two decades have started to change the landscape of fertility services. For the best chances of conceiving, couples should explore sperm testing options at the same time as female fertility testing. Some of these options are:
- Semen analysis—Semen analysis for sperm concentration, motility, and morphology has been a staple of reproductive medicine since the 1930s. It is still the recommended first test for couples who may be experiencing male factor infertility.
- Sperm DNA fragmentation—This method of sperm testing, commercialized in 2005, is used to explore the viability of a sperm sample on a genetic level. Sperm DNA fragmentation has been found to be more useful in predicting the success of assisted reproductive technologies than traditional semen analysis techniques.
Some fertility tests can be used for both genders to detect abnormalities in hormone levels or genetic makeup that may contribute to a couple’s infertility. At-home hormone and genetics tests have become easily accessible in recent years, though you should always confirm your results with your physician.
Fertility treatments in 2018: what are your options?
Like fertility testing, fertility treatment options have expanded rapidly over the past couple of decades. New research and discoveries can help couples find different, more effective ways to achieve pregnancy. Some of the most common fertility treatments used today are:
- Fertility drugs—Your physician may recommend fertility medications such as clomiphene citrate, follicle stimulating hormones, or human menopausal gonadotropins to stimulate your ovaries and trigger ovulation. However, in recent years, more women have started questioning the safety of these drugs and are opting for more natural treatment methods.
- In vitro fertilization (IVF)—One of the most well-known fertility treatments, in vitro fertilization, involves collecting eggs from a woman after one or multiple rounds of fertility drugs, fertilizing them, and then implanting the embryo back into the woman’s body. The first successful IVF procedure took place in 1978, and since then over 8 million babies have been conceived using this method.
- Mini-IVF—This is an option for women who are unable to undergo traditional IVF, whether because of the high price tag, the use of fertility drugs, or a variety of underlying health conditions. Mini-IVF success rates are slightly lower than those of conventional IVF, but they are still high enough to make the procedure a better option than IVF for some couples.
- Intrauterine insemination (IUI)—Intrauterine insemination involves inserting a semen sample directly into the uterus, near the fallopian tube, when an egg is mature and ready for fertilization. Ovulation-regulating drugs can be used to effectively increase the chances of IUI success, according to a 2018 study.
- Intracytoplasmic sperm injection (ICSI)—Intracytoplasmic sperm injection is an assisted reproductive technology in which a physician inserts a single sperm directly into a mature egg. This technique is commonly chosen for its high success rates and effectiveness in treating most causes of infertility.
- Cervical cap insemination—Cervical cap insemination is a fertility treatment option that has similar success rates to other ART technologies such as IVF and IUI at a fraction of the price. This technique enables a higher concentration of sperm to reach the opening of the cervix quickly, increasing chances of conception. Cervical cap insemination options, such as Stork OTC, are inexpensive, minimally-invasive, and do not require the use of fertility drugs.
The future of fertility: 2018 and beyond
The advances in infertility research and assisted reproductive technology in the past year alone are enough to cause excitement in couples struggling with infertility. For example:
- A new test, called DNA flow cytometric analysis, was found to effectively diagnose and determine the causes of azoospermia (a lack of sperm in semen). The test is extremely accurate, and the results are available quickly, making it a key development in the diagnosis and treatment of male factor infertility.
- In vitro activation (IVA) was found to enable women with primary ovarian insufficiency, also called premature ovarian failure, to conceive genetic offspring. The technique holds promise for treating women experiencing ovarian dysfunction, especially aging women and cancer survivors.
- A process called in vitro maturation (IVM) was used to grow human eggs in a lab for the first time. Though it is still a few years from being commercially available, IVM may give hope to women who are unable to ovulate naturally by providing their eggs with a safe place to grow to maturity.
When you and your partner decide to start trying to conceive, the last thing you want to think about is dealing with infertility. However, the good news is that fertility tests and treatments have a come a long way. Couples have become more comfortable talking openly about their experiences and struggles with infertility, leading to an inexhaustible amount of available resources. Independent research and open communication with your physician can help you create the infertility treatment plan that’s right for you.