When Fertility Treatments Don’t Work

As we grow older, we desire to take the next steps of our lives. We get married and plan to start a family. However, the desire to have children may not be granted because of a condition called infertility. Luckily, there are a variety of available fertility treatments the couple can rely on. But, when fertility treatments don’t work, what will be the next step?

In this article, we will tackle the things we need to know about infertility. We will also discuss the various fertility treatment options and what to do if these options don’t work.

What is Infertility?

Infertility is simply defined as not being able to conceive a child after engaging in sexual intercourse without protection. Primarily, after about a year of regular unprotected sex and there are still no signs of conception, it may be because of infertility.

In the United States, about 15% of couples are infertile. It may be because an issue on either one cannot contribute to the conception or both. It may also be because the woman is unable to carry a full-term pregnancy.

There are also cases of infertility when couples who had previously conceived but are unable to conceive another. This is called secondary infertility.

Fortunately, there are a variety of tests couples can avail of. There are also different treatment options that they can try. However, there is still an issue of when fertility treatments don’t work. 

Before we jump into these treatment options and what to do if they don’t work, let us first discuss infertility. This will help us understand more about this condition and help in deciding on what treatment options to try first.

Causes of Infertility

Let us first review what the causes of infertility are. Some reasons are unique for a man and a woman. The following lists all the possible causes of infertility.

Causes of Infertility for Men

  • Low sperm count. The sperm count after ejaculating is meager. It can be proven by laboratory tests when the result is under 15 million.
  • Low sperm mobility. When the sperm is released during sexual intercourse, it swims through to reach the egg. However, with little movement, the sperm could not swim well.
  • Abnormal sperm. The sperm is of a strange shape, which makes it hard to fertilize an egg.
  • Testicular problems. This includes testicular infections, undescended testicles, and enlarged veins (varicocele).
  • Blocked ejaculatory ducts. This affects sperm delivery, which results in the sperm being ejaculated into the bladder.
  • Hormonal imbalance. These are caused by conditions that can result in testosterone deficiency.
  • Genetic factors. These can contribute to abnormal development of the testicles, low testosterone levels, and small to zero sperm count.
  • Mumps. This can cause testicle inflammation that affects sperm production.
  • Hypospadias. It is a condition wherein the opening is located under the penis instead of the tip. Studies reveal that 1 in 500 newborn boys are affected by this condition. This is treated through surgery during infancy. However, if this is not corrected, it is hard for the sperm to reach the cervix.
  • Cystic fibrosis. This is a disease that results in the development of sticky mucus that affects the lungs. However, in males, this condition may result in a missing or obstructed vas deferens, the one responsible for carrying the sperm to the ejaculatory duct.
  • Radiation therapy and chemotherapy. These are treatment therapies for cancer; however, they can damage sperm production.
  • Overexposure to substances. Overexposure to pesticides, chemicals, cigarette smoke, alcohol, marijuana, certain medications for bacterial infections, and steroids can affect fertility.
  • Frequent exposure to heat. This includes regular hot baths and sauna or anything that raises the body temperature. This affects sperm production.
  • Age. There is a decline in fertility when a man reaches 40 years of age.
  • Stress. It can be a factor since it can lead to reduced sexual activity.
  • Obesity. This can contribute to the increased risk of infertility.

Causes of Infertility for Women

  • Premature ovarian failure. It is when the ovaries stop functioning before reaching 40 years of age.
  • Polycystic ovary syndrome. Also known as PCOS, is a condition characterized by abnormal ovary function that leads to ovulation failure.
  • Hyperprolactinemia. High prolactin levels can affect ovulation and fertility when the woman is not pregnant or breastfeeding.
  • Poor egg quality. Genetic defects or damaged eggs may cause this; these are factors that make pregnancy unsustainable.
  • Infrequent menstrual periods. If the menstrual cycles are at an interval of more than 35 days, it may indicate problems in ovulating the egg or not ovulating.
  • Thyroid problems. This can lead to imbalances on hormonal levels, which can cause infertility.
  • Fallopian tube and uterus problems. This can prevent the travel of the egg to the womb. Questions may also arise because of surgery, especially pelvic surgery that can scar fallopian tubes.
  • Submucosal fibroids. These are tumors that arise in the muscular walls of the uterus, which can block the fallopian tube.
  • Endometriosis. A condition where cells that are usually lined in the uterus start developing elsewhere.
  • Infections. Sexually Transmitted diseases can damage the fallopian tubes and can cause infertility.
  • High cholesterol levels. A study revealed that high cholesterol levels could affect a woman’s fertility.
  • Radiation therapy and chemotherapy. These are treatment therapies for cancer; however, they can cause ovarian failure.
  • Overexposure to substances. Overexposure to pesticides, chemicals, cigarette smoke, alcohol, marijuana, certain medications for bacterial infections, and steroids can affect fertility.
  • Age. There is a decline in the ability to conceive when a woman reaches 32 years of age.
  • Stress. It can be a factor since it can lead to reduced sexual activity.
  • Eating disorders. Lack of vitamins and minerals, including folic acid, zinc, iron, and vitamin B-12, can affect fertility.
  • Obesity. This can contribute to the increased risk of infertility.

Prevention for Infertility

Based on the stated causes of infertility for men and women, some may be avoidable, and some are not. There are ways that the couple must do to increase the chances of fertility. This involves lifestyle changes and promoting overall health and well-being. This can be done through:

  • Quitting cigarette smoking
  • Avoiding alcoholic drinks
  • Avoiding drugs and marijuana
  • Limiting medications, both prescriptive and non-prescriptive
  • Avoiding exposure to harmful environmental substances
  • Exercising regularly and moderately
  • Limiting caffeine intake
  • Managing weight properly

Diagnosis for Infertility: Fertility Evaluation

Before the couple undergoes several fertility tests, the doctor will review both partners’ medical and sexual histories. 

Tests for Men

The goal of fertility tests for men is to assess whether the testicles produce healthy sperm and this sperm is ejaculated without obstructions.

  • Physical examination of the genitals. The testicles will be checked for lumps and deformities. The structure of the penis will also be checked.
  • Semen Analysis. The sperm will be tested for its volume, concentration, mobility, and physical quality, such as shape and color. It will also be checked if there are any infections or blood present in the sample.
  • Blood test. This will reveal testosterone levels as well as other hormone levels.
  • Ultrasound. This will reveal if there are obstructions in the ejaculatory duct that may affect ejaculation.
  • Chlamydia test. This test will be done if there are signs of chlamydia that may affect fertility. If there are positive signs, medications will be given.
  • Genetic tests. This will reveal if genetic factors are present that contribute to infertility.
  • Testicular biopsy. This is done in some instances only. It is conducted to reveal abnormalities that may lead to infertility.
  • Vasography. An imaging test performed to the vas deferens

Tests for Women

The goal of fertility tests for women is to assess whether the ovaries produce a healthy egg, and there are no obstructions in the fallopian tubes and uterus.

  • Physical examination of the genitals. This is first done to reveal if there are deformities or abnormalities.
  • Gynecologic examination. This will reveal the health of the female reproductive system as well as if there are diseases.
  • Blood tests. This will reveal hormonal levels as well as to assess a woman’s ovulation.
  • Hysterosalpingography. This will reveal if there is a blockage in the fallopian tubes. This is done by injecting fluid into the uterus and scanning via an X-ray to show if the fluid smoothly travels out of the uterus and fallopian tubes.
  • Laparoscopy. This will reveal signs of endometriosis, scars, and blockages in the uterus and fallopian tubes. It is done by inserting a camera in a thin tube into the abdomen and pelvis.
  • Ovarian reserve testing. This will assess the quality of eggs after ovulation.
  • Genetic tests. This will reveal if genetic factors are present that contribute to infertility.
  • Pelvic ultrasound. This will reveal the condition of the ovaries, uterus, and fallopian tube.
  • Chlamydia test. This test will be done if there are signs of chlamydia that may affect fertility. If there are positive signs, medications will be given.
  • Thyroid function test. This will reveal if there are imbalances on hormonal levels.

List of Fertility Drugs and Medications

Medications are prescribed that are used to improve sperm count and quality for men and to treat ovulation disorders for women. The following are common fertility drugs and medicines.

  • Clomid (Clomiphene citrate). It is the first recommended drug for fertility treatment. It is used to treat infertility for both men and women.
  • Femara (letrozole) and Arimidex (anastrozole). These aren’t officially fertility drugs but can help in inducing ovulation in women.
  • MetforminIt is given to improve insulin resistance that can affect infertility, which is common to women diagnosed with PCOS.
  • Gonadotropins such as FSH, LH, and hCG. When Clomid fails, these hormonal medications are used.
  • Progesterone. It is an essential medication when the in vitro fertilization (IVF) is chosen as a treatment. During IVF, there might be a decline in progesterone production.
  • Bromocriptine. It is prescribed when there is an excess production of prolactin that may cause ovulation problems.

Treatment for Infertility

The following are the list of treatment options that the couple may undergo depending on the doctor’s diagnosis. The treatment options are categorized as non-surgical and surgical.

Non-Surgical Treatment

Medication and behavioral therapies and counseling when the man has erectile dysfunction or premature ejaculation problems.

  • Ovulation stimulation. This is done using fertility drugs to induce and control ovulation.

Surgical Treatment

  • Removing varicose veins in the scrotum in men
  • Repairing a blocked epididymis for men
  • Hysteroscopic surgery for women with uterine problems
  • Laparoscopic surgery for women with endometriosis and pelvic adhesions

Assisted Reproductive Technology

These are methods that are done by assisting or handling the sperm and egg to conceive.

For men, a process called sperm retrieval is done. These are methods done when ejaculation problems are the cause of infertility. This can be done by extracting sperm from the testicles or bladder and injecting it into an egg in a laboratory.

  • In vitro fertilization (IVF). It is the most common method that involves retrieving and stimulating multiple mature eggs. These eggs are then fertilized with a sperm in a petri dish in the laboratory. The resulting embryos after several days of fertilization are then implanted in the uterus.
  • Intrauterine insemination (IUI). During ovulation, a fine catheter is used to place the sperm directly into the uterus. Only the best specimens will be used and then washed with a fluid.
  • Intracytoplasmic sperm injection (ICSI). A single sperm is injected into an egg to achieve fertilization during an IVF procedure. The likelihood of fertilization improves significantly for men with low sperm concentrations.
  • Assisted hatching. This technique involves helping the embedding of the embryo into the lining of the uterus. It is done by opening the exterior covering of the fetus.
  • Sperm or egg donation. Most assisted reproductive technology is done with the couple’s sperm and egg. However, if necessary, sperm or eggs can be received from a donor. Fertility treatment with donor eggs is usually done using IVF. The eggs, sperm, or embryos may come from a known or anonymous donor.
  • Electric or vibratory stimulation to achieve ejaculation. If a man cannot ejaculate normally, electrical or vibratory stimulation is used to achieve ejaculation.

Risks and Complications

Fertility treatments may also come with risks and complications. The following are some scenarios:

  • Multiple pregnancies. Talk to the doctor before the procedure if you have any concerns about multiple pregnancies because it is the most common complication of infertility treatment. The more significant number of fetuses (twins, triplets, or more) causes an increased risk of premature labor and delivery. Also, it can develop other pregnancy-related problems such as gestational diabetes. Remember that if a baby was born prematurely, there is a high risk of health and developmental issues.
  • Ovarian hyperstimulation syndrome (OHSS)This is caused by fertility medication to induce ovulation, in which ovaries swell and become painful. The symptoms are bloating, mild abdominal pain, and nausea. The severe form includes sudden weight gain and shortness of breathing.
  • Bleeding or infection. Like any painful procedure, assisted reproductive technology and surgery are accompanied with a limited risk of bleeding or infection.
  • Long-term risks of ovarian tumors. While most studies about fertility drugs intake of women are associated with only a few long-term dangers, few studies reveal harmful effects. It states that women taking fertility drugs more than a year without a successful pregnancy may be at higher risk of borderline ovarian tumors in the future. On the other hand, women who never have undergone pregnancies have a higher risk of ovarian cysts, this may be related to the vital problem rather than the treatment. Since success rates are generally higher in the first few treatment cycles, medications used are re-evaluated and focus on the procedures that are successful and appropriate.
  • Ectopic pregnancy. Women who undergo fertility treatment have a slightly higher risk of Ectopic pregnancy. This occurs when a fertilized egg is implanted outside the womb, usually at the fallopian tube. If it stays there, complications arise, such as the rupture of the fallopian tube. Discontinuation of pregnancy may happen, and it needs immediate surgery where the affected machine will be lost. However, there is still a chance of pregnancy with the other ovary and tube in the future. Ectopic pregnancy can be scanned through ultrasound.
  • Coping mentally. It is difficult to know how long will and how successful the treatment will be. This can be stressful for both partners and may affect their relationship. It is essential to talk to your doctor about this, and they will recommend a counselor that will help and give you appropriate support. Some people join a support group that lets them talk or open up with the people who experience the same situation.

Signs to Stop Fertility Treatment

When should you stop fertility treatments? Continuing trying different fertility treatment options can have adverse effects on you and your partner. Here’s a list from the experiences of other couples that may help you to recognize when to stop the treatments.

  • Experiencing physical pain and mood swings caused by fertility drugs.
  • Treatments are expensive, and it causes you to be in debt.
  • You rarely talk or socialize with other people but not with your partner or doctor.
  • Loss of interest in recreational activities which do not go round with infertility.
  • Less sexually arousing with your partner.
  • Infertility interferes with your daily life, such as your job, social life, and relationship with your partner.
  • You are expressing signs of depression and anxiety.

Coping Up

Coping with infertility can be stressful and can affect a couple’s emotional health. There are uncertainties to whether they can still conceive a child or not.

When you first try to consult the doctor for fertility treatment options, you and your partner should be prepared. A lot of things might cross your mind and can be difficult and stressful but always be prepared for what your doctor will say.

You and your partner might just do anything you can do to be able to conceive a child. Your dedication to this may be admirable. However, there should be a limit to everything. Remember, these treatments may be expensive and can affect you financially. The procedures and trials of different methods can also affect you emotionally.

You and your partner’s mental health is essential. The emotional effects of undergoing fertility treatments may cause depression and anxiety. You and your partner will inevitably face psychological challenges, no matter what the results will be. The impact of emotional impact may be too substantial and stressful for you and your partner.

Seek support from counseling services. Open up with your friends and family. It is best to keep ourselves healthy, both physically and mentally, all the time.

When the fertility treatments succeeded, it is normal for a couple to be happy. However, during pregnancy, emotional stress can still build-up on the woman from having a fear of pregnancy failure. Even if the child is born, the mother can always have emotional stress and anxiety. It is best to seek help and advice from family and friends. The partner should also be mindful of his wife and baby’s needs.

When fertility treatments don’t work, emotional stress can be devastating. You and your partner might feel hopeless, disappointed, and, most of all, pain.

At first, you and your partner may be uncertain of what should be the next step that both of you will try. Will you keep on trying other fertility treatment options? Will you pursue adoption? 

It is normal to grief but keeps in mind that we have to keep moving forward.