Fertility Treatment Options

We explore 10 different types of fertility treatment options and examine the pros, cons, and costs of each one.
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Some 7.3 million Americans, or 12 percent of the population in their reproductive years, are infertile, according to the Centers for Disease Control and Prevention (CDC). Although these statistics are staggering, and infertility can take a huge toll on your emotional health, there are lots of reasons to be hopeful if you're infertile and you hope to have a baby. Science keeps advancing, treatments keep getting better, and more and more babies are being born using techniques such as the ones listed below. In fact, according to the National Institutes of Health, more than half of couples with infertility issues become pregnant after treatment--and that's not including high-tech, high-priced procedures like IVF.

Which technique you may need will depend largely on the cause of your infertility. How much it will cost varies widely too, by where you live, for example, and by the number of clinics are in your area (many clinics offer "shared risk" programs in which the clinic will give you back a portion of the fee if the treatment is unsuccessful). And because the CDC compiles success rates only for treatments involving IVF, pregnancy and birth rates for other procedures--although they have been compiled, for example, by individual clinics--are not as well documented or standardized and may be based on small populations.

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Fertility Drugs

Artificial Insemination

Donor Sperm

In Vitro Fertilization (IVF)

Intracytoplasmic Sperm Injection (ICSI)

Donor Eggs

Surrogacy

Donor Embryos

Reproductive Surgery

Gamete Intrafallopian Transfer (GIFT)

Zygote Intrafallopian Transfer (ZIFT)



Fertility Drugs

How they work: Injected or taken in pill form, the drugs release hormones that induce ovulation to boost egg production and make the uterus more receptive to embryo implantation.

Best for: Women who don't ovulate regularly or who have partners with very poor sperm quality. Avoid if you have damaged or blocked fallopian tubes or scarring from endometriosis (they require IVF).

Success Rates: 40 to 45 percent of women who take the pills and ovulate get pregnant; as many as 50 percent of women who ovulate as a result of the shots get pregnant.

Pros: The drugs are typically the first choice in fertility treatment because of their low cost and relative convenience.

Cons: Possible bloating, headaches, hot flashes, and nausea. Side effects are worse with the shots, and include risk of multiple births, premature delivery, and formation of large ovarian cysts.

Costs: Vary widely (for example, from $60 to $6,000 per cycle), depending on whether the drug is a pill or injectable and whether blood tests and ultrasounds are included.



Artificial Insemination (also known as Intrauterine insemination or IUI)

How it works: Specially prepared ("washed") sperm is inserted directly into the uterus through a thin, flexible catheter during IUI, the most commonly fertility method. If you choose this method, your doctor might recommend that you take fertility drugs as well, to increase the chances of fertilization.

Best for: Cases in which men have slow-moving or lower quality sperm or a low-sperm count. Alsofor women who have produced antibodies to their partners' sperm or whose cervical mucus is too scant, acidic, or thick to transport the sperm to the egg.

Success Rates: Depends on a woman's age and the quality of the man's sperm; in general there's a 15 to 20 percent chance of conception per cycle, with a 60 to 70 percent chance of pregnancy after 6 cycles.

Pros: A simple procedure that can be performed in a doctor's office.

Cons: Can result in multiple births; possible side effects of fertility drugs.

Costs: On average, $865.



Donor Sperm

How it works: Sperm from a man other than the intended father is used during IUI or IVF.

Best for: Couples experiencing male-factor infertility, men carrying genetic disorders they don't want to pass on to their children, single women, or lesbian couples.

Success rates: An estimated 15 percent of women who try this method get pregnant after one cycle, with up to 80 percent achieving pregnancy after 6 cycles.

Pros: Enables infertile men, carriers of genetic disorders, and single or lesbian women to have a child.

Cons: Some men may be uncomfortable with a donor who has no genetic relationship to them.

Costs: $300 to $400, generally. Factors that may affect the cost include whether you want a donor consultation and photo match, need storage for the sperm, and want washed sperm.



In Vitro Fertilization (IVF)

How it works: Multistep process (called a cycle) in which your eggs are extracted and fertilized with sperm in a lab. Once embryos develop, one or two are implanted in your uterus and the rest are stored.

Best for: Older women or women with blocked or severely damaged fallopian tubes or scarring from endometriosis; men with very poor sperm quality; couples with unexplained infertility.

Success Rates: Varies by age. Forty-one percent of women (under age 35); 32 percent (ages 35 to 37), and 23 percent (ages 38 to 40) become pregnant.

Pros: Couples with serious fertility problems can become parents.

Cons: Treatments are costly and physically demanding, and require a rigorous regimen of fertility drugs before the start of each cycle.

Costs: $8,000, on average, per cycle, not including medications.



Intracytoplasmic Sperm Injection (ICSI)

How it works: An embryologist selects a healthy-looking, single sperm from the male's semen and injects it directly into the egg with a microscopic needle. Once an embryo develops it's transferred into the uterus through IVF.

Best for: Couples in which the man has a very low sperm count or poor sperm quality.

Success Rates: About 35 percent of those undergoing ICIS with IVF will become pregnant.

Pros: Men who have a very low sperm count can become biological fathers.

Cons: Costly and involved procedure; the drugs required for IVF have many side effects.

Costs: $1,000 to $2,000 per cycle, excluding the cost of IVF.



Donor Eggs

How it works: Eggs are obtained from the ovaries of another woman (usually younger) and fertilized by sperm from the recipient's partner. Resulting embryos are then transferred into the recipient's uterus.

Best for: Women whose ovaries are damaged or prematurely failing, or who have undergone chemotherapy and/or radiation; older women with poor egg quality; and women who carry genetic disorders that they don't want to pass along.

Success Rates: 55 percent of women using fresh donor eggs will give birth; the number drops to 34 percent for frozen eggs.

Pros: Enables older women and those with ovarian problems to become mothers.

Cons: The procedure is expensive; the recipient must take a rigorous drug regimen with many potential side effects; and some women with no genetic link to the donor eggs may be uncomfortable using them.

Costs: $15,000 to $30,000, which includes IVF and compensation for the donor.



Surrogacy

How it works: The surrogate carries a baby for another woman. The surrogate becomes pregnant by artificial insemination, using the father's sperm or through IVF with the couple's embryo. Donor eggs and sperm may also be used.

Best for: Women who can't carry a baby because of disease, hysterectomy, or infertility. In rare instances, both partners are infertile.

Success Rates: Depends on the quality of the eggs and sperm being used. On average, though, live birth rates range from 5 to 30 percent per cycle.

Pros: Couples with fertility issues (for example, the woman may not have a uterus or have a disease that makes it risky to carry a pregnancy to term) can become parents.

Cons: Costs are prohibitive. Couples may feel removed from the pregnancy and have to deal with an array of state surrogacy laws and legal contracts.

Costs: Between $50,000 and $100,000, depending on issues such as whether IVF is needed, fees to the surrogate agency, and compensation for the surrogate mom.



Donor Embryos

How it works: Embryos are donated by couples undergoing IVF who become pregnant and no longer need unused fertilized eggs. The donated embryo is then transferred into the recipient.

Best for: Couples in which both woman and man are infertile but want to experience a pregnancy.

Success Rates: The live birth rate is about 30 to 50 percent, depending on how many embryos are implanted and whether they are fresh or frozen.

Pros: Enables infertile couples to have a childbearing experience.

Cons: Medical screening, a rigorous fertility drug regimen, and lots of legalities; it may also be hard to find donated embryos, as couples may be reluctant to give them up.

Costs: $15,000 to $30,000.



Reproductive Surgery

How it works: Surgery--sometimes requiring a hospital stay, sometimes done on an outpatient basis--is used to correct anatomical abnormalities, remove scarring and clear blockages in either the man or the woman.

Best for: Couples with diagnosed diseases or abnormalities (such as endometriosis, wherein uterine tissue grows outside the uterus, causing scarring and blockages).

Success Rates: Depends largely on the condition and its severity, and on one's age. In one study, women who were treated laparoscopically for endometriosis, for example, had about double the pregnancy rate of those who were not treated with laparoscopic surgery.

Pros: Besides reducing any pain or discomfort associated with the disease, it may increase the likelihood of pregnancy.

Cons: Some surgeries are more invasive than others, which can increase the risk, cost, and recovery time.

Costs: Depends on the surgery, the surgeon, and what's involved. Laparoscopic surgery for endometriosis can cost anywhere from $1,700 to $5,000.



Gamete Intrafallopian Transfer (GIFT)

How it works: Eggs from the woman are collected, mixed with sperm from the man in a petri dish, and then placed directly inside the fallopian tubes, where fertilization can occur.

Best for: Couples in which the woman has at least one functioning fallopian tube and/or the man has a low sperm count or sperm with poor motility; and couples who have a moral or religious objection to IVF or who have unexplained infertility.

Success rate: About 25 to 30 percent of GIFT cycles will result in pregnancy; younger, healthier women have a higher success rate.

Pros: Allows fertilization to occur in a natural environment.

Cons: No immediate verification that fertilization has occurred. Also a more complicated procedure than IVF because a laparoscope is used to insert the egg/sperm mix into the tubes. If more than one egg is used, and it typically is, there is a higher-than-normal risk of a multiple birth.

Costs: $15,000 to $20,000



Zygote Intrafallopian Transfer (ZIFT)

How it works: Like IVF, but in this case the embryo is inserted into the fallopian tube, not the uterus.

Best for: Couples who have unexplained infertility or those in which the man has a low sperm count, the woman has at least one tube open, and/or there are ovulation problems.

Success rate: As with most assisted reproductive techniques, much depends on age and health. In general, 36 percent of couples using ZIFT become pregnant during a cycle, with 29 percent going on to deliver.

Pros: Fertilization of the egg/sperm mixture, now called a zygote, can be confirmed before it's placed into the fallopian tube (as is not the case with GIFT). Therefore, fewer eggs may be used, which lowers the risk of a multiple birth.

Cons: Because a laparoscope is used, it is considered invasive surgery, which increases risks and costs, compared to IVF. GIFT and ZIFT are rarely used.

Costs: $8,000 to $13,000 for one cycle.

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