Infertility treatments: options, effectiveness, research

Nov 3, 2019

Infertility is something millions of Americans struggle with, but treatments are available and advancing. To help guide us through the basics, infertility treatments and where we’re headed, we brought in Dr. Maribelle Verdiales, a doctor with the CNY Fertility Center.

Verdiales, who is also a speaker and wellness coach, told “Take Care” that roughly 10 to 15% of couples will struggle with infertility.

That number, at least in her practice, has only increased over the years. In addition, the age range of people dealing with infertility has broadened, with Verdiales saying she’s seen younger and older patients than ever before.

“I’ve seen the range go bigger, and maybe that’s what’s driving the numbers a little higher,” she said.

What causes infertility can vary widely, she said, and it can come from both parties involved.

“It takes four things to make a baby: healthy sperm, healthy egg, healthy uterus and tubes and a healthy vessel,” she said. “If any of those issues is compromised, and sometimes more than one, then we’re going to have problems conceiving naturally.”

Any of these areas can be affected by things like a person’s job, medical condition, genetics and age, Verdiales said. Systemic diseases like autoimmune conditions can especially affect the woman’s body, the “vessel.”

Infertility affects males and females about equally, Verdiales said, which means that in many infertility cases, it can be caused by both.

“In my experience, it’s kind of split down the middle or I see more and more a compounded effect, meaning there is some issues with the male and some issues with the female,” she said.

There’s also a chance that infertility, regardless of testing, doesn’t have a clear cause. Verdiales called this unexplained infertility.

“That means that after we do all of the testing and all of the evaluation, everything seems to be fine … and the couple just simply can’t get pregnant,” she said.

Out of all infertility cases, about 10 to 15% of them will be unexplained infertility, and though there are lots of hypotheses on the causes in these cases, Verdiales said it’s still largely up in the air.

When faced with an infertility diagnosis, it can seem overwhelming, but Verdiales said there are treatments that can help a couple reach their goals. If a women’s tubes are open, she said, she can start with something like oral medication and timed intercourse.

"I think that there is a general awareness that is increasing, but definitely, we need to put more efforts to make people aware of things that could impact their fertility, even behavior-wise."

If that doesn’t work, other treatments include oral medication that provokes ovulation. Artificial insemination is a step up from there, and there are other, more intense protocols like injections and using donor eggs, sperm, etc.

Another popular option is IVF, or in vitro fertilization. According to Planned Parenthood, IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in the uterus.

First, the woman takes medication to make some eggs mature and ready for fertilization. Those eggs are then taken out and mixed with sperm in a lab to help with fertilization, and after being fertilized, the embryos are placed directly into the uterus. Pregnancy happens if any of the embryos implant in the lining of the uterus.

IVF has many steps, and it takes several months to complete the whole process, Verdiales said. It sometimes works on the first try, but many people need more than one round of IVF to get pregnant. IVF does increase a couple’s chances of pregnancy if they’re having fertility problems, but there’s no guarantee, she cautions, because everyone’s body is different.

The popularity or effectiveness of each treatment varies depending on both population and individuals, Verdiales said, but on average, IVF as a 50% chance of success.

“There’s still a lot of unknowns in the human biology and reproduction,” she said.

Still, the popularity of IVF has led to increased research to improve the procedure and its effectiveness, Verdiales said. CNY Fertility Center does something different that has proved popular with its patients.

“We handpick the best sperm and actually put it inside the egg,” she said. “In a lot of clinics, that would be an additional cost. We just do it like that for everybody to optimize success rates.”

In addition to more established treatments, there are some more experimental treatment options and even clinical trials that are promising, Verdiales said. CNY offers something particularly dealing with autoimmunity.

“We use medications traditionally used by rheumatologists to deal with autoimmune disorders,” she said. “We use them off-label to try to help these women get pregnant and stay pregnant.”

Verdiales tends to add glandular therapy and nutritional manipulations to try to help the patient succeed no matter what treatment they’re using.

Emotional and therapeutic treatments can go hand in hand with medical treatments, Verdiales said, and are often a big help in alleviating some of the mental strain infertility can have on all parties involved.

“This is a very, very stressful process emotionally, physically, and then, on top of that, some of the medications that we use alter the emotions of the women,” she said. “They’re already stressed out because of what they’re going through, and then, the medications on top of that can get them a little edgy.”

CNY has multiple venues to help with this type of therapy, like wellness centers that provide fertility massage, acupuncture and relaxation methods, support groups and referral services. Overall, just a little support can go a long way through what is often an emotionally turbulent time.

Once a couple finds treatments that they’d like to move forward with, getting those treatments covered by insurance can be a challenge. Some individual insurances and policies will cover infertility treatments, Verdiales said, “but for the most part, there is no coverage at all.”

The best way to make progress on infertility research, treatments and coverage is to increase awareness and decrease the stigma associated with infertility, Verdiales said. As the number of people affected by infertility continues to increase, the larger population needs to realize that this could happen to anybody.”

“I think that there is a general awareness that is increasing, but definitely, we need to put more efforts to make people aware of things that could impact their fertility, even behavior-wise,” she said. “Education will be key.”

More research is being done to get to the “why” in unexplained cases, and there are even efforts in the anti-aging realm that could help with infertility moving forward, she said.