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Advancing the Fertility Treatment Plan: Moving On to the Next Step
Much of what I do on a daily basis is planning the next step in treatment for a fertility patient. While some patients know from the start what they want to do and when they want to do it, many eventually come to a crossroads in their care. The first line of treatment has not gotten results and and they are ready to take the next step. When, what, and how to proceed become the most important questions that we need to answer together.
Should I move on?
Simple treatments, such as using Clomid and intrauterine insemination (IUI), are relatively low risk, low cost, and can be accomplished with minimal discomfort and inconvenience. Fortunately for many patients, this is all that is needed. However, for those that do not get pregnant after multiple attempts with more mild therapies, the chance of getting the results we want becomes smaller and smaller with each passing month. There is no magic number, but studies have clearly shown that more than 6 months of using such mild treatment is less likely to work. In some patients (e.g. those that are >38, have decreased ovarian reserve, tubal disease, or male factor), I recommend moving on before 6 months. In other patients (
What should I do next?
There are two main options to pursue at this point: daily injectable medications (“gonadotropins”) with intrauterine insemination and in-vitro fertilization (IVF). When deciding between the two, I give patients an estimate of pregnancy rates with injections and insemination (based on different studies and our clinic’s experience) and IVF (based on our clinic’s national registry available online – SART.org). While IVF rates are typically much better, it is also more intense, more invasive, and allows for the early steps of fertility to occur outside the woman’s body (proven to be safe with over 1 million babies born, but still not completely known!). Moreover, depending on insurance coverage, IVF can be quite costly. For some patients, doing the injections and insemination for a few months is more practical, more affordable, and simpler. For others, who truly need to maximize their chances with each month, pursing IVF immediately is the better option.
Every case is unique
The real joy for me is working with an individual patient or couple to determine the best plan. After many years of working in this field, I have found that every patient has a unique situation and brings a unique perspective to conquering infertility. My job is to help the patient determine the best course of action … and find our own path to success!