Are you having difficulty navigating the landscape of fertility treatment? You’re not alone. About 12 percent of couples struggle with infertility, and between the anxiety this can cause and the vast number of fertility options available, it can be overwhelming. The good news is that the wide variety of choices means you have plenty of options to improve your chances of conception. Here, we offer a guide to fertility options and what they entail, as well as information about the costs. Once you’ve familiarized yourself with the basics detailed here, you should be able to talk to your doctor with full confidence that you understand what’s available.
- Intrauterine insemination (IUI) and artificial insemination (AI) are very similar processes. Each of these procedures involves placing sperm inside the female reproductive tract to assist in conception. The difference is that AI, which is an older technique, uses unprepared semen inserted into the vagina or cervix. IUI, by contrast, uses a process called sperm washing to retrieve a concentrated amount of sperm, then injects these through a thin catheter directly into the uterus. Both AI and IUI are helpful for couples whose infertility is the result of low sperm count or poor sperm motility. They’re also used by same sex couples, couples using a surrogate, and single women wishing to become mothers without a partner. AI and IUI are also typically the first fertility treatment used for couples with unknown fertility issues, because they’re minimally invasive. The success rate of IUI is slightly higher than that of AI. Because AI does not require sperm washing, it can sometimes be done at home. In some instances, doctors prescribe fertility drugs for the woman before the procedure, in order to increase the chance of success. There is a risk of multiple pregnancy if fertility drugs are used, but other than that, there are no significant risks associated with AI or IUI, other than a small chance of developing an infection. These procedures won’t work for everyone, though, and they’re less likely to be effective if the woman is over 40 or has fallopian tube blockages, endometriosis, or a history of pelvic infections. They also cannot compensate for significant issues with sperm, though sperm donation can be used if this is the problem. Counselling is recommended before a couple decides to use donor sperm, though, since the father and child will be biologically unrelated. The costs of IUI and AI are not very high, running between about $300 and $1,000, and are sometimes covered by insurance.
- In vitro fertilization (IVF) was responsible for the birth of over one million babies between 1987 and 2015, and more are born every year. The basic procedure involves the fertilization of eggs by sperm in a laboratory or fertility clinic and the transfer of viable embryos into the uterus. There are different ways in which IVF can be used, and it’s often recommended if AI or IUI haven’t resulted in pregnancy. It can be used for women with severe fallopian tube blockages, ovulation problems, poor egg quality, diminished ovarian reserve, polycystic ovary syndrome (PCOS), endometriosis or in cases of insurmountable sperm deficiency. Same-sex couples can use IVF, as can couples who use donor eggs and those who may need to screen embryos for genetic disorders. IVF is most successful for women under 35, with about a 54 percent success rate. Between 35 and 40 the rate of success is 26 to 40 percent and it declines to 4 to 13 percent for women over 40. The average cost of IVF is $15,000 to $25,000 per cycle, and it often takes more than one cycle to be successful. This cost varies, depending on the type of IVF. For traditional IVF, hormone shots are used before the eggs are harvested, and for some people this can cause side effects that are unpleasant. It’s an invasive procedure, and when more than one embryo is implanted there’s a risk of twins or multiples, which increases the risks associated with pregnancy. Let’s look at some of the variations of IVF.
- Natural cycle IVF bypasses hormone injections. Instead, it relies on a physician tracking the natural cycle and retrieving just one egg during ovulation. The egg is then fertilized and transferred into the uterus, as with traditional IVF. This is a good option for women who wish to avoid taking hormones or risking multiples, and it costs up to $7,000 less than traditional IVF. However, the success rate is only 7 to 10 percent.
- IVF can be performed using donor sperm, donor eggs or donor embryos. For those couples who choose to go the route of donor sperm or eggs, the donor can be a person they know, or they can be matched anonymously through an agency. Donor embryos are donated by couples who have already completed IVF themselves. As with using donor sperm for IUI, it’s recommended that the couple seek counselling when choosing any of these three options, since one or both of the parents will not be biologically related to the child. It’s also important to make sure all of the legalities in these situations are properly handled, so that it’s clear that the children born from donated eggs or sperm are legally the children of the couple. Using donor eggs, sperm, or embryos raises the success rate significantly. It’s more expensive, though, because the cost of medical care and compensation for the donors is added to the cost of traditional IVF.
- IVF with ICSI is an effective method of fertilization. Intracytoplasmic sperm injection (ICSI) is a procedure done in a laboratory that involves injecting a single sperm into an egg. This is more efficacious than simply combining washed sperm with eggs, so it’s often the fertilization method used with IVF. ICSI is useful when the eggs or sperm have been frozen, when previous IVF cycles have been unsuccessful, and in certain other situations. It adds somewhere between $1.400 and $2,000 to the cost of IVF but it increases the odds of fertilization, with a fertilization rate of 50 to 80 percent, which is higher than conventional insemination. From that point forward, the success rates are the same.
- IVF with blastocyst transfer is a fairly new development in IVF technology. In this technique, IVF embryos are transferred later than with traditional IVF. Rather than transferring them at a stage in which they have two to eight cells, blastocyst transfer involves waiting for a later stage of development, the blastocyst stage, in which the embryos have 200-300 cells. One or two blastocysts are transferred to the uterus, eliminating the possibility of triplets. Waiting also increases the likelihood that the embryos will successfully implant, because embryos with chromosomal abnormalities don’t make it to day five or six, and the ones that do make it to the blastocyst stage have the highest potential for implantation.
- Surrogacy can also be accomplished using IVF. In this process, a surrogate carries a child for another woman, almost always an embryo resulting from IVF. The surrogate will not have any genetic ties to the baby, but both parents will. Surrogacy is used for women who cannot sustain a pregnancy, have no uterus, or have a condition that would make a pregnancy either dangerous or impossible, as well as for gay couples. The success rates are about 50 percent when the egg used is from a woman under 35, but lower as the woman’s age increases, dropping below 10 percent after age 42. Surrogacy is expensive, because it includes fertility costs, medical costs for the surrogate, legal fees, and so on. It can start in the tens of thousands of dollars, but can also exceed $100,000, depending on the circumstances. Surrogacy takes 18 months or more, is legally complicated and, in fact, illegal in some states, and is an intensely emotional process.
- Egg freezing can protect fertility. Egg retrieval involves a procedure similar to IVF, in which 10 to 20 of a woman’s eggs are retrieved. They’re then flash-frozen and stored until the time comes to have a baby. If you are someone who wants children but also wants to wait, this can be a good option for you, and it’s also good if you’re preparing to go through cancer treatment. Women who have a family history of early menopause, endometriosis, or ovarian cysts benefit from egg freezing, as do those who have a genetic problem like Turner Syndrome or a medical condition like lupus. The success rate using a frozen egg is about 2 to 12 percent for women younger than 38, and the odds of successful fertilization drop as the woman ages. Egg retrieval and fertilization costs are similar to IVF, running between about $9,000 and $12,000, and the cost of egg storage runs about $500 to $1,000 per year.
- Fertility drugs are used alone or in conjunction with other methods. Typically, a patient will start by taking oral medications like Clomid and Femara, which supress estrogen production and increase production of ovulation-stimulating hormones, thus stimulating the ovaries and correcting irregular ovulation. For women with polycystic ovary syndrome (PCOS), Metformin, a drug normally used to treat diabetes, may be given to promote more regular ovulation. If oral medications don’t work, injections of hormones called gonadotropins can be given to directly stimulate ovulation. These medications improve the efficacy of methods like IUI and IVF, and they can be a good option for women with PCOS. On their own, they have a success rate of 18 to 32 percent, depending on the drug. Fertility drugs are typically covered by insurance, but can cost about $900 for those paying out of pocket. They can cause hormonal side effects like bloating, nausea, headaches, mood swings, or breast tenderness, and they increase the odds of a woman having multiples.
- Sometimes, surgical intervention is the solution. If the issue affecting fertility is blocking or scarring of the Fallopian tubes, a genetic defect, endometriosis, or PCOS, laparoscopic or laparotomic surgery may be the answer. In a laparoscopy, thin instruments are inserted through small incisions in the abdomen and guided by a lighted camera, while a laparotomy involves a larger abdominal incision. The side effects are similar to other such surgeries, ranging from discomfort and sore throat to drowsiness to pain. The success rates vary depending on the surgery and the condition it is being used to treat. Laparoscopic treatment for mild endometriosis improves the chances of pregnancy by 40 percent, for example, and between 21 to 59 percent of women who have had scar tissue removed from their fallopian tubes are able to conceive. The cost of surgery also depends on the procedure, but typically runs between $2,000 and $10,000.
If you are looking for answers about fertility or need assistance starting your family, trust NewLife Fertility to assess your needs and find the most effective services for you. We are committed to providing patient-centered, effective, innovative, and safe reproductive care in order to help people fulfil their dreams of a healthy family. Beyond just providing fertility treatment, we instill hope by offering advice, experience, and a proven track record of success for infertility patients. Since 2004, we’ve provided the comprehensive care that is essential to successful fertility outcomes, and our success rates have made us one of the top fertility centres in Canada. For more information or to schedule an appointment, contact us through our website.