What Are Infertility Treatments? – Definition, Types & Costs

By MD, MSc (gynecologist), BSc, MSc (embryologist), MD, PhD, MSc (gynecologist), BSc (embryologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 02/06/2020

When a couple does not get pregnant after a year of unprotected sex, fertility treatment will be necessary in order to have a baby.

There are various human assisted reproductin techniques that can be classified into two groups:

Low-complexity techniques
timed intercourse, sperm capacitation, artificial insemination, sperm freezing, etc.
High-complexity techniques
in vitro fertilization, intracytoplasmic sperm injection, preimplantation genetic diagnosis, vitrification, etc.

Also, each of these techniques is composed of protocols and methods that may have different degrees of difficulty.

Below you have an index with the 7 points we are going to deal with in this article.

Choosing the right technique

Experts decide what type of technique is most appropriate for each patient depending on several factors such as the degree of infertility or age.

It is also important to value the sum of the reproductive potential of both members of the couple: the man and the woman.

In addition, several combined techniques may be necessary in a sterility treatment. For example, in vitro fertilization with preimplantation genetic diagnosis and/or embryo vitrification.

Low-complexity techniques

In an assisted reproduction clinic, fertility treatments with low-complexity techniques are defined as those that do not pose any risk or great discomfort to patients.

Methods without great technical difficulty for medical specialists or laboratory staff are also considered low-complexity methods.

There are many techniques that meet these requirements in assisted reproduction. However, we will deal with the most relevant ones below.

Artificial insemination (AI)

AI is a very simple technique to achieve a pregnancy and the first choice if the minimum age and seminal quality are met.

AI consists of the deposit of sperm in an unnatural way in the woman's reproductive system, specifically in the uterus.

During the procedure, the woman's ovarian cycle is stimulated and ovulation is controlled.

The ovarian stimulationis done by administering low doses of the hormones involved in the menstrual cycle with injections from the first days of menstruation. This is monitored by periodic transvaginal ultrasounds.

When the size of the follicles and the endometrial thickness are adequate, insemination is scheduled with the partner's sperm or that of an anonymous donor.

Between 34 and 36 hours before insemination, ovulation must be induced by injecting the hCG hormone. By doing so, the follicle of the ovary breaks and the egg comes out into the tubes where it will be fertilized by a spermatozoon.

As for the sperm sample for insemination, it is collected by masturbation and trained in the laboratory. This process consists of preparing a medium enriched with the best quality spermatozoa, which will be introduced into the woman with an insemination cannula.

If donor sperm is used, it will be frozen. Therefore, it is necessary to perform a semen thawing prior to AI.

The AI technique does not require any type of anesthesia as it is painless.

About two weeks later, the fertility patient will take a blood pregnancy test to see if the process has been successfully completed.

If you want to dive deeper into the topic of IA, have a look at the following post: What is artificial insemination?

Fertility preservation

Fertility preservation is a technique that consists of freezing eggs and/or sperm. In this way, the cells can be kept undisturbed for an indefinite amount of time until you wish to have offspring.

Fertility preservation is a technique that indicated in oncological patients, in women who wish to delay motherhood, or who suffer from endometriosis.

Sperm freezing

Sperm freezing is a quick and simple technique that also offer many advantages. For example, it allows the preservation of fertility in cancer patients who are about to undergo chemotherapy.

It has also allowed for the development of sperm donation, as donor sperm samples must be frozen for at least 6 months in order to confirm that they are HIV-free.

In particular, sperm cryopreservation is carried out by a slow freezing process. This requires mixing the sperm sample with cryoprotectants to prevent damage to the sperm. The temperature of the sample is then gradually lowered depending on the type of technique (vapours, dry ice, etc.) and finally introduced into liquid nitrogen at -196°C.

For more information on the type of techniques and how the process works, see the following post: Sperm freezing.

Egg vitrification

The preservation of fertility in women is carried out through the vitrification of eggs, i.e. by ultra-fast freezing of the eggs from 15ºC to -196ºC. In this way, the eggs are maintained without suffering physical or functional alterations for an unlimited period of time. Egg survival is elevated and delaying motherhood is allowed at an high success rate.

This technique consists of administering hormonal medication in a controlled manner to the woman to make several eggs mature. Subsequently, the ovum pick-up is performed to obtain the eggs that will be vitrified and stored in a bank.

It should be kept in mind that age is a very important factor in fertility preservation, as Dr. Sergio Rogel confirms:

The best age for freezing eggs is the youngest possible age. Obviously, women should be over 18 and the younger the better.

We could define the best age for freezing eggs as between 20 and 30 years old.

More information on egg freezing here: What is egg vitrification? Advantages over freezing.

High-complexity techniques

Highly complex techniques are performed with high-tech instruments and by more specialized personnel. Normally, they are done in the embryology laboratory and in the operating room, which must meet the conditions of maximum sterility.

These are more expensive treatments with higher risks. However, they offer higher success rates than low-complexity techniques.

Classic in vitro fertilization (IVF)

IVF is a technique that consists of the extraction of the woman's eggs by puncturing the ovarian follicles and fertilizing them with the male's sperm in the laboratory. The embryos obtained are then transferred to the mother's uterus to achieve pregnancy.

This procedure consists of several parts, which are detailed below:

Ovulation induction
Hormonal medication to induce ovulation are administered in order to trigger egg production and monitor the menstrual cycle.
Ovum pick-up
depending on the size of the follicles and the value of the estradiol in the blood, the hormone hCG is injected to trigger ovulation and the puncture is scheduled about 34-36 hours later. With this surgical intervention, the eggs that have developed are removed from the patient’s ovary. This is done under light sedation or local anesthesia.
IVF
in the laboratory the egg and sperm are incubated together for about 19 hours. Past this time it can be observed whether fertilization has been achieved when two pronuclei appear.
Embryo culture
the embryos obtained are kept in culture and their development is observed through cell divisions. During 5 days, the embryos go through the zygote, 4 and 8 cell, morula and blastocyst stages.
Embryo transfer
can be done after 3 or 5 days of development.

Embryos that are not transferred to the woman can be cryopreserved through a process known as vitrification. This way, the woman will not have to go through the whole process of ovarian stimulation again if she has to make a second attempt or wants another child after a few years.

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a variation of IVF with a more complex step in fertilizing the eggs.

The eggs are obtained in the same way as IVF: by ovum pick-up. However, fertilization does not take place naturally. Instead, a sperm is selected under the microscope and inserted into the egg by means of a micro-needle.

The subsequent embryo development, quality assessment and embryo transfer are carried out in the same way as in IVF.

The advantage of this technique is that it offers very good results in cases of poor male prognosis, that is, when the male's sperm are not able to fertilize the eggs by themselves because of their poor motility or morphology.

Its disadvantage is that, for being more tricky, it also means a higher economic cost.

Embryo transfer

This is the final process of both in vitro fertilization techniques, both conventional and ICSI. The final aim of the embryo transfer is to achieve a evolutionary pregnancy by transferring the embryos who will then implant itself in the uterus.

The transfer of the embryos into the uterus can be carried out on the third or fifth day of development. This is decided on the basis of the type of infertility the couple has, the number of fertilized eggs and the evolution of the embryos in previous IVF cycles.

The patient may need to be prescribed progesterone after the ovum pick-up. Its function is to prepare the endometrium to improve endometrial receptivity and embryo implantation.

As Dr. Miguel Dolz comment on:

Every patient who is going to undergo a technique must have an adequate endometrial preparation.

The embryos have divided into 6-8 cells three days after fertilization and are already prepared for consumption of glucose in the uterine cavity.

On the fifth day of development, the embryo is in the blastocyst stage and its quality can be measured based on other parameters that could not be taken into account before, such as the degree of expansion and the appearance of the internal cell mass.

When the embryo is in the blastocyst stage, three differentiated structures can be seen: the trophoectoderm (cells that will give rise to the placenta), the internal cell mass (the embryo itself) and the blastocele or central cavity filled with liquid.

The day chosen for the embryo transfer has some advantages and disadvantages depending on whether it is on the 3rd or 5th day. Read more about the best day for embryo transfer here: Embryotransfer on the 3rd or 5th day?

Once it has been decided whether one or two embryos will be transferred, the ones with the best quality are selected and placed in a very fine catheter that will be introduced via the vagina into the uterus.

The Embryo transfer is a simple technique that takes a few minutes. It is completely painless, does not require any type of anesthesia and the patient leaves after about 20 minutes of rest on the stretcher.

From the moment of the transfer, the so-called two week wait period begins until the woman can take a pregnancy test after about 15 days. During this time, the woman is advised to carry on with her normal routine.

Preimplantation genetic diagnosis (PGD)

PGD is a complementary technique that can be performed after IVF or ICSI. Its purpose is to detect if there exist genetic abnormalities in the embryo.

In order to perform this test, it is necessary to extract a cell from the embryo when it has about 8 cells. In this way, the viability of the embryo is not compromised.

Embryo biopsy does not produce any damage at this stage because the cells are totipotent, which means that they can give rise to any cell type in the human body until they form a complete organism.

Once the results of the analysis are received, the genetically healthy embryos are selected for transfer and the rest are discarded. Normally, the transfer of these embryos takes place on day 5 of development because we have to wait for the results.

Those embryos without chromosomal alterations that are not transferred can be vitrified for future use.

PGD is a more complex technique than ICSI itself. For this reason, the price of treatment is increased in patients who choose to do so. You can read more about this in the following article: What is preimplantation genetic diagnosis?

Considering undergoing a fertility treatment? By getting your individual Fertility Report your will see different clinics especially selected for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

FAQs from users

IVF pregnancy vs. natural pregnancy, is there any difference?

By Blanca Paraíso MD, PhD, MSc (gynecologist).

There exist no differences between a natural pregnancy and a pregnancy that has been achieved using reproductive technologies such as IVF. After the embryo transfer, fetal development will be the exactly the same.

Neither the risk of malformations nor the risk of miscarriage increase when using a fertility treatment. Some studies have discovered a slightly higher risk of preterm birth or low birth weight. Anyway, these complications do not seem to be directly linked to the use of fertility treatments, but with the cause of infertility: women aged 40 or older, uterine anomalies and other pathologies... This type of pregnancies must be monitored very closely.

What is PGD used for?

By Ana Mª Villaquirán Villalba MD, MSc (gynecologist).

Preimplantation Genetic Diagnosis (PGD) is a technique that complements IVF/ICSI and helps us detect the presence of genetic abnormalities in embryos before their transfer to the maternal uterus.

Currently, it is done by performing an biopsy to the trophoblast of a blastocyst embryo, that is, on days 5-6 of embryo culture. The cells removed can be examined to detect the presence of chromosomal abnormalities using PGS (Preimplantation Genetic Diagnosis), or genetic diseases, such as Duchenne muscular dystrophy (DMD).

When is it time to see a fertility specialist?

By Andrea Rodrigo BSc, MSc (embryologist).

A couple is considered infertile/sterile if they have been trying to conceive for over 12 months with no luck or in cases of recurrent pregnancy loss (RPL).

In general, it is at that point when you are recommended to see a fertility doctor and undergo all the necessary tests to detect what is causing infertility/sterility. Once done, the specialist will be able to determine what would be the best infertility treatment for you.

When the woman is over 37, this period of time trying to conceive is reduced to 6 months. Third-party assisted reproduction is usually advisable for women aged 40 to 50 or over.

What are the pros and cons of assisted reproductive technology (ART)?

By Andrea Rodrigo BSc, MSc (embryologist).

Obviously, the main advantage of ART is that it gives you the chance to have a baby. On the other hand, the most common disadvantage is associated with fertility drugs, due to the side effects it can cause: headache, bloating, nausea, vaginal bleeding/spotting...

However, fertility drugs are commonly the first choice because of their relative convenience, especially for IVF.

Secondly, reproductive surgery, required to correct anatomical abnormalities or clear blockages in the man or the woman, are usually too invasive, which increases their risk, recovery time and cost. On the other hand, they help increase the chances of getting pregnant.

Perhaps the main disadvantage of all infertility treatments is related to the financing options, since they are always covered by insurance everywhere. Also, in the case of IVF, the likelihood of having twins is higher if multiple embryo transfers are chosen.

How long after fertility treatment can you adopt?

By Andrea Rodrigo BSc, MSc (embryologist).

Traditional adoption is an option for individuals or couples suffering from unexplained infertility after several repeated fertility treatment cycles.

Many couples ask themselves at what point do they stop pursuing infertility treatments and start considering adoption, but there is no specific period of time, as it depends on the particularities of each case.

However, it should be taken into account that surrogacy may be another option for these patients. Choosing one or another is a very personal decision, and both are long processes from start to finish.

What are the long-term side effects of fertility treatments?

By Andrea Rodrigo BSc, MSc (embryologist).

To date, the long-term side effects of IVF treatment have not been studied to a large extent. However, they can be classified into two main types: effects on women and effects on babies.

There has been considerable discussion on whether IVF medications (especially Clomid) are liked to cancer, including ovarian cancer and breast cancer.

According to the HFEA, the potential short-term side effects of fertility treatment are: drug reaction, multiple births, ovarian hyperstimulation syndrome (OHSS), ectopic pregnancy and birth defects.

What types of fertility treatments for males exist?

By Andrea Rodrigo BSc, MSc (embryologist).

On the one hand, when a man is diagnosed with some kind of fertility issue after a semen analysis, the doctor may prescribe vitamin supplements or a special diet to be followed before turning to infertility treatments.

While trying to boost sperm quality through natural remedies, avoiding the consumption of saturated fats is of utmost importance. In case there exist one or various seminal alterations (low sperm count, low sperm motility...), multivitamin supplements is recommended.

In case it is caused by an infection (presence of leukocytes in the semen sample), antibiotics may be prescribed as well. If it does not work or is a case of non-obstructive azoospermia, maybe you should consider IVF/ICSI.

To learn more about this topic, do not miss this post: Foods to boost sperm quality.

Can fertility treatments be done at home?

By Andrea Rodrigo BSc, MSc (embryologist).

No, fertility treatments are carried out at a fertility clinic or medical facility. In the case of AI, it can be done at the gynecologist's office, due to the simplicity of the technique. Conversely, special equipment is required for all of the IVF steps involved to be carried out properly.

There is, however, an alternative to artificial insemination which is known as at-home artificial insemination. It is mainly a do-it-yourself version of AI in which the woman can get herself inseminated with donor or partner sperm by just buying an insemination kit at the pharmacy.

It should be taken into account that its chances of success are exactly the same as those you would achieve through natural conception. Besides, it involves a series of health risks, as the equipment has not been previously sterilized and therefore the risk of introducing germs into the vaginal tract is higher.

Suggested for you

One of the most discussed issues in a laboratory when doing an IVF treatment is the number of embryos to be transferred. If you are interested in this topic, you can read more here: How many embryos should be transferred?

If you're thinking about getting fertility treatment, you can find out what the prices are for these techniques in the next article: Costs in assisted reproduction.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

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Grupo de Interés de Centros de Reproducción Humana Asistida del Sistema Nacional de Salud (2002). Criterios para la utilización de los recursos del Sistema Nacional de Salud Español en técnicas de reproducción humana asistida Rev Iberoam Fertil; 19(1): 5-31.

Jones H.W. and Schrader C. (1988): In-Vitro Fertilization and Other Assisted Reproduction. Annals of The New York Academy of Sciences, Vol. 541, New York.

Ley 14/2006, de 26 de mayo, sobre técnicas de reproducción humana asistida. Jefatura del Estado «BOE» núm. 126, de 27 de mayo de 2006 Referencia: BOE-A-2006-9292

Matorras R. (2002). La reproducción asistida en el sistema sanitario público español. Rev Iberoam Fertil; 19 (2): 103-108.

Matorras R, Hernández J (eds) (2007). Estudio y tratamiento de la pareja estéril: Recomendaciones de la Sociedad Española de Fertilidad, con la colaboración de la Asociación Española para el Estudio de la Biología de la Reproducción, de la Asociación Española de Andrología y de la Sociedad Española de Contracepción. Adalia, Madrid.

National Callaborating Center for Women’s and Children’s Health. Fertility: assessment and treatment for people with fertility problems. Clinical Guideline February 2004. Recuperado el 22 de agosto de 2018 de http://www.rcog.org.uk

Pellicer A, Alberto Bethencourt JC, Barri P, Boada M, Bosch E, Hernández E, Matorras R, Navarro J, Peramo B, Remohí J, Riciarelli E, Ruiz A y Veiga A (2000). Reproducción Asistida. En: Documentos de Consenso SEGO; 9-51.

Santamaría Solís, L. (2000). Técnicas de reproducción asistida. Aspectos bioéticos. En: Cuadernos de Bioética/1ª. Asociación Española de Bioética y Ética Médica (AEBI).

Schmidt L, Münster K. Infertility, involuntary infecundity, and the seeking of medical advice in industrialized countries 1970-1992 (1995): a review of concepts, measurements and results. Hum Reprod; 10: 1407-18.

Sociedad Española de Fertilidad (SEF) (febrero de 2012). Saber más sobre fertilidad y reproducción asistida. En colaboración con el Ministerio de Sanidad, Política Social e Igualdad del Gobierno de España y el Plan de Calidad para el Sistema Nacional de Salud.

The ESHRE Capri Workshop Group. Intrauterine insemination. Human Reproduction Update, 2009; 15 (3): 265–277.64

Vayena E, Rowe PJ, Griffin PD, (eds.) (2002). Current Practices and Controversies in Assisted Reproduction. Report of a meeting on "Medical, Ethical and Social Aspects of Assisted Reproduction", World Health Organization, Geneva.

W.N. Spellacy, S.J. Miller,A. Winegar (1986). A pregnancy after 40 years of age. Obstet Gynecol, 68, pp. 452-454

Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, Sullivan E, Vanderpoel S, for ICMART and WHO. Glosario de terminología en Técnicas de Reproducción Asistida (TRA). Versión revisada y preparada por el International Committee for Monitoring Assisted Reproductive Technology (ICMART) y la Organización Mundial de la Salud (OMS). Red Latinoamericana de Reproducción Asistida en 2010 Organización Mundial de la Salud 2010.

FAQs from users: 'IVF pregnancy vs. natural pregnancy, is there any difference?', 'What is PGD used for?', 'When is it time to see a fertility specialist?', 'What are the pros and cons of assisted reproductive technology (ART)?', 'How long after fertility treatment can you adopt?', 'What are the long-term side effects of fertility treatments?', 'What types of fertility treatments for males exist?' and 'Can fertility treatments be done at home?'.

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Authors and contributors

 Ana Mª Villaquirán Villalba
Ana Mª Villaquirán Villalba
MD, MSc
Gynecologist
Bachelor's Degree in Medicine from the University of Valle, Colombia. Specialist in Obstetrics & Gynecology. Master's Degree in Human Reproduction from the University of Valencia and IVI. Currently, she is the medical director of Tahe Fertilidad. More information about Ana Mª Villaquirán Villalba
License: 303007571
 Andrea Rodrigo
Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
 Blanca Paraíso
Blanca Paraíso
MD, PhD, MSc
Gynecologist
Bachelor's Degree in Medicine and Ph.D from the Complutense University of Madrid (UCM). Postgraduate Course in Statistics of Health Sciences. Doctor specialized in Obstetrics & Gynecology, and Assisted Procreation. More information about Blanca Paraíso
License: 454505579
 Mireia Poveda García
Mireia Poveda García
BSc
Embryologist
Bachelor's Degree in Biology from the University of Valencia (UV). University Expert Certificate in Biology of Human Reproduction from the Miguel Hernández University of Elche (UMH). Teacher in Master's Degree of Human Reproduction Biology from the UMH. Member of and Senior Clinical Embryologist by ASEBIR. Honor collaborator at the Celular Biology Department of the UMH's Medical School. More information about Mireia Poveda García
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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