Basic and Advanced Infertility Treatments – What Are My Options?
When it comes to treating infertility, there is no “one-size-fits-all” approach. At the NYU Langone Fertility Center, we understand that every path to parenthood is unique. We work collaboratively with our patients to determine the most effective course of action for achieving their family building goals and continue to evaluate their treatment plan throughout the treatment process. As a patient of NYULFC, you will begin your journey with a comprehensive fertility health screening, the results of which will determine your unique treatment plan. Below, please find a brief overview of a few of the many different courses of care available at NYULFC.
Clomid is an oral medication started at a specific time of the menstrual cycle, typically between days 3 to 5 after the start of a menstrual bleed. This drug is used to recruit and develop the production of ovarian follicles that will produce an egg. Clomid is often prescribed to women who experience irregular ovulation or do not ovulate. This medication can be prescribed by either an OB/GYN or by a fertility specialist. Clomid should be taken at approximately at the same time each day, and the usual treatment course is five days in total.
This popular treatment plan, if deemed medically appropriate, is viewed as the first step in treating infertility. Ovulation Induction (OI) cycles are cost effective and less invasive than other types of fertility treatment cycles. Common side effects may include heightened symptoms of the menstrual cycle such as nausea, bloating, and mood changes. There is also a higher risk of a multiple pregnancy (roughly a 7% chance of twins), and therefore Clomid is not recommended for women who are unwilling or unable to carry a twin pregnancy.
Intrauterine Insemination (IUI)
Intrauterine Insemination (IUI) is often recommended for women or couples who have been unsuccessful with other infertility treatments, such as medications, are unable to have appropriately timed intercourse due to travel distances, or in cases of sexual dysfunction, have unexplained infertility or mild male factor infertility or are women using donor sperm.
Intrauterine insemination (IUI) is a relatively simple procedure that enables conception by directing sperm to the right place at the right time. In this process, a thin tube called a catheter is placed directly into the cervix, and a carefully prepared sperm sample is injected directly through the catheter into the uterus.
IUI increases the chances of becoming pregnant by injecting an optimal sperm sample directly into the uterus at a time when the woman is most fertile. Studies have shown that pregnancy is more likely to occur if timing of exposure to sperm is controlled in this way, and if sperm is placed in higher numbers closer to the egg or eggs
In Vitro Fertilization (IVF)
IVF stands for in vitro fertilization. IVF literally means "fertilization in glass” because IVF involves retrieving eggs from the ovaries and combining them with sperm in a glass culture dish. The IVF process typically includes three major phases: ovarian induction and egg retrieval, fertilization in the embryology lab, and finally, embryo transfer.
During the course of a natural menstrual cycle, your brain produces hormones that stimulate one of your ovaries to release a single mature egg. During an ovulation induction cycle, you are prescribed those same hormones, known as fertility medications. These medications stimulate the ovaries to mature several eggs at once. When these eggs are matured and successfully retrieved, these eggs can be combined with sperm to create embryos.
Immediately after eggs have been retrieved, our embryology team assesses the maturity of each egg, then transfers the mature eggs to an incubator. Typically, sperm are then combined with the eggs and fertilization occurs naturally. If low sperm count or low sperm motility are a factor, our embryologists can employ intracytoplasmic sperm injection ("ICSI") to inject a single sperm directly into each egg. If a sperm sample is considered 'borderline,' some eggs may be injected while others are given the chance to fertilize naturally in the petri dish.
Approximately 18 hours after the egg and sperm were combined in the incubator, the embryology team evaluates the successful fertilization of each mature egg. The embryology team then monitors embryo development for an additional 2-4 days to assess embryo morphology (the shape and appearance of cells within the embryo). Embryos typically remain in observation in the laboratory for a total of 5 days.
After an egg retrieval and embryo creation cycle, you will discuss the quantity and quality of your embryos with your physician. There are two types of embryo transfer: fresh or frozen. In a fresh embryo transfer cycle, an embryo is transferred to the uterus after 3-5 days of observation in the embryology laboratory, and any additional embryos are frozen for future use. In a frozen embryo transfer (FET) cycle, all embryos are frozen after 3-5 days of development in the laboratory. If you wish to perform preimplantation genetic testing (PGT), embryos will be biopsied, then frozen while a culture of cells is sent to the genetic testing lab for analysis. Whether you proceed with a fresh embryo transfer or an FET, the embryo transfer process itself is very simple, and rarely requires sedation or anesthesia.
Preimplantation Genetic Testing (PGT)
Preimplantation genetic testing for aneuploidy (PGT-A) allows us to count the number of chromosomes in an embryo biopsy. A euploid or “normal” embryo contains 23 pairs of chromosomes, though abnormalities in chromosome number (i.e. too many or too few, or structural defects) are common and their incidence increases as women age. In some cases, these abnormalities can lead to miscarriage and other health concerns. PGT-A testing reduces the risk of miscarriage by reducing the chance of transferring a genetically abnormal embryo.
For patients with specific inherited genetic or chromosomal conditions that may impact a pregnancy, preimplantation genetic testing for monogenetic disorders (PGT-M) or structural rearrangements (PGT-SR) may be considered. These tests use customized approaches, tailored to identify specific genetic variants (mutations) or chromosomal imbalances ahead of implantation, ultimately increasing the chance of a successful pregnancy.
Frozen Embryo Transfer (FET)
Following ovarian stimulation and in vitro fertilization (IVF) patients have two options: a fresh embryo transfer, which takes place after 5 days of embryo development, or a frozen embryo transfer (FET), which takes place at the patient’s convenience during the appropriate time in the patient’s menstrual cycle. Frozen Embryo Transfer (FET) is a relatively simple procedure in which a previously frozen embryo is thawed and inserted into a uterus using a catheter. In most cases, medication will be prescribed for 2-3 weeks prior to transfer and may be continued for several weeks post-transfer. Patients who choose to perform preimplantation genetic testing (PGT) will be candidates for frozen embryo transfer.