Infertility Treatment

Infertility means no pregnancy after a year of regular intercourse without contraception. If the woman is over 35, an assessment is advised after only 6 months, because time matters at this stage.

Delayed pregnancy is not the woman's responsibility alone. A male factor plays a part in a large share of cases, so the assessment always starts with both partners.

The most common causes

• Ovulation problems: most often polycystic ovary syndrome (PCOS), as well as thyroid and prolactin disorders.
• Tubal problems: blocked or damaged fallopian tubes after infections or previous surgery.
• Uterine problems: fibroids, polyps, a uterine septum or adhesions.
• Endometriosis.
• Male factor: low sperm count, motility or morphology.
• Unexplained infertility: when every test comes back normal.

A modern assessment

1. History and examination of both partners.
2. Hormone tests at the start of the cycle, with the ovarian reserve hormone (AMH), thyroid and prolactin.
3. Transvaginal ultrasound to assess the uterus and ovaries and count the follicles.
4. A tubal patency test with a dye X-ray or a saline ultrasound.
5. Semen analysis following the current World Health Organization criteria.
6. Hysteroscopy or laparoscopy only when needed, to diagnose and treat in the same procedure.

The treatment plan: from simplest to most advanced

• Lifestyle changes: reaching a healthy weight and stopping smoking clearly improve the chances of pregnancy.
• Treating the cause: for example correcting the thyroid, or removing a polyp by hysteroscopy.
• Ovulation induction with timed intercourse.
• Intrauterine insemination (IUI).
• IVF and ICSI when a cause calls for them, or after the earlier steps have not worked.

The right step depends on the cause, the woman's age and how long the couple has been trying, not on one rule for every case.