Infertility: Help for couples starts with you

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Applied Evidence

Infertility: Help for couples starts with you

J Fam Pract. 2012 February;61(2):82-87

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References

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13. Chang MY, Chiang CH, Hsieh TT, et al. Use of the antral follicle count to predict the outcome of assisted reproductive technologies. Fertil Steril. 1998;69:505-510.

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Managing male infertility

Men who have hyperprolactinemic infertility can often be treated with dopaminergic agents such as bromocriptine. Inform them that normal spermatogenesis can take 3 to 6 months. Gonadotropin therapy may be effective for patients with hypothalamic or pituitary diseases. Surgery may correct obstruction, but may not actually increase pregnancy rates. Repairing a varicocele, for instance, increases sperm counts but not conception rates.³⁴ Other obstructive problems may need sperm extraction followed by IUI or IVF, with or without intracytoplasmic sperm injection, where the sperm is injected into the ovum in the lab before implantation.³⁴

Managing unexplained infertility

Fifteen percent of infertility is unexplained.³⁵ Assisting these patients is challenging. Performing IUI with or without clomiphene, or giving clomiphene alone is often attempted. Pregnancy rates are 2% for expectant management, 5% for IUI alone, 9.5% for clomiphene alone, and 19% for combined IUI with clomiphene.³⁶ Gonadotropins are no more effective in achieving conception than clomiphene, but gonadotropin injection and IUI together are more effective than no treatment.³⁷ IVF, if successful, leads to pregnancy in the shortest amount of time. But it is the most costly intervention and the most likely to result in multiple births. In randomized controlled trials, however, IVF has not proved beneficial for unexplained infertility.³⁸

FAST TRACK

In the United States, we may see reproductive technology policies similar to those in other countries—especially as controversy grows regarding multiple births.

Trends likely to affect fertility treatment
Currently in the United States, there is little regulation to guide reproductive technologies. But there is a trend, varying by state, toward legislation similar to child protection laws and adoption services, under which couples are evaluated for suitability as parents for the potential child’s safety.³⁹ Other countries have acts regulating reproductive technologies and infertility services. England focuses on the child’s welfare; Australia restricts access by eligibility requirements.³⁹ In the United States we may see similar policies, especially as controversy grows regarding multiple births. Cost is a factor in the treatment of infertility. Education and household income correlate with the amount of money spent on fertility care.

CORRESPONDENCE Heather Bell, MD, Center for Family Medicine, 1115 East 20th Street, Sioux Falls, SD 57105; heather.bell@usd.edu