Overview of treatment of female infertility
- Wendy Kuohung, MD
Wendy Kuohung, MD
- Associate Professor of Obstetrics and Gynecology
- Boston University School of Medicine
- Mark D Hornstein, MD
Mark D Hornstein, MD
- Professor of Obstetrics, Gynecology & Reproductive Biology
- Harvard Medical School
Infertility is a complex disorder with significant medical, psychosocial, and economic aspects. Great strides have been achieved in infertility therapy, particularly the development of assisted reproductive technology (ART).
Once the cause of infertility is identified, therapy aimed at correcting reversible etiologies and overcoming irreversible factors can be implemented. The couple is also counseled on lifestyle modifications to improve fertility, such as smoking cessation, reducing excessive caffeine and alcohol consumption, and appropriate frequency of coitus (every one to two days around the expected time of ovulation) (table 1). (See "Optimizing natural fertility in couples planning pregnancy".)
The patient should be involved in fertility treatment choices. These choices involve four major factors: effectiveness (eg, live birth rate), burden of treatment (eg, frequency of injections and office visits), safety (eg, risk of ovarian hyperstimulation and multiple gestation), and financial costs .
This topic will provide an overview of the treatment of female. The evaluation of female infertility, as well as the causes and treatment of male infertility, are discussed separately:
●(See "Causes of female infertility".)
- Dancet EA, D'Hooghe TM, van der Veen F, et al. "Patient-centered fertility treatment": what is required? Fertil Steril 2014; 101:924.
- ESHRE Task Force on Ethics and Law, including, Dondorp W, de Wert G, et al. Lifestyle-related factors and access to medically assisted reproduction. Hum Reprod 2010; 25:578.
- Ethics Committee of American Society for Reproductive Medicine. Child-rearing ability and the provision of fertility services: a committee opinion. Fertil Steril 2013; 100:50.
- Pandey S, Maheshwari A, Bhattacharya S. Should access to fertility treatment be determined by female body mass index? Hum Reprod 2010; 25:815.
- Ethics Committee of American Society for Reproductive Medicine. Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion. Fertil Steril 2013; 100:1524.
- Ethics Committee of American Society for Reproductive Medicine. Human immunodeficiency virus (HIV) and infertility treatment: a committee opinion. Fertil Steril 2015; 104:e1.
- Collins JA, Wrixon W, Janes LB, Wilson EH. Treatment-independent pregnancy among infertile couples. N Engl J Med 1983; 309:1201.
- Frisch RE. The right weight: body fat, menarche and ovulation. Baillieres Clin Obstet Gynaecol 1990; 4:419.
- Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992; 36:105.
- Pasquali R, Antenucci D, Casimirri F, et al. Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab 1989; 68:173.
- Clark AM, Ledger W, Galletly C, et al. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 1995; 10:2705.
- Crosignani PG, Colombo M, Vegetti W, et al. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod 2003; 18:1928.
- Guzick DS, Wing R, Smith D, et al. Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril 1994; 61:598.
- Mutsaerts MA, van Oers AM, Groen H, et al. Randomized Trial of a Lifestyle Program in Obese Infertile Women. N Engl J Med 2016; 374:1942.
- Snow RC, Barbieri RL, Frisch RE. Estrogen 2-hydroxylase oxidation and menstrual function among elite oarswomen. J Clin Endocrinol Metab 1989; 69:369.
- REIFENSTEIN EC Jr. Psychogenic or hypothalamic amenorrhea. Med Clin North Am 1946; 30:1103.
- Yen SS, Rebar R, Vandenberg G, et al. Pituitary gonadotrophin responsiveness to synthetic LRF in subjects with normal and abnormal hypothalamic-pituitary-gonadal axis. J Reprod Fertil Suppl 1973; 20:137.
- Crowley WF Jr, Filicori M, Spratt DI, Santoro NF. The physiology of gonadotropin-releasing hormone (GnRH) secretion in men and women. Recent Prog Horm Res 1985; 41:473.
- Berga SL, Girton LG. The psychoneuroendocrinology of functional hypothalamic amenorrhea. Psychiatr Clin North Am 1989; 12:105.
- Laughlin GA, Dominguez CE, Yen SS. Nutritional and endocrine-metabolic aberrations in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 1998; 83:25.
- Reame NE, Sauder SE, Case GD, et al. Pulsatile gonadotropin secretion in women with hypothalamic amenorrhea: evidence that reduced frequency of gonadotropin-releasing hormone secretion is the mechanism of persistent anovulation. J Clin Endocrinol Metab 1985; 61:851.
- Berga SL, Marcus MD, Loucks TL, et al. Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy. Fertil Steril 2003; 80:976.
- Abraham S, Mira M, Llewellyn-Jones D. Should ovulation be induced in women recovering from an eating disorder or who are compulsive exercisers? Fertil Steril 1990; 53:566.
- Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014; 371:119.
- Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 2008; 89:505.
- Steiner AZ, Terplan M, Paulson RJ. Comparison of tamoxifen and clomiphene citrate for ovulation induction: a meta-analysis. Hum Reprod 2005; 20:1511.
- Oktay K, Buyuk E, Davis O, et al. Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen. Hum Reprod 2003; 18:90.
- Oktay K, Buyuk E, Davis O, et al. A prospective comparison of tamoxifen alone and tamoxifen-FSH combined protocol for IVF and fertility preservation in breast cancer patients. Fertil Steril 2003; 80:S63.
- Farquhar C, Vandekerckhove P, Lilford R. Laparoscopic "drilling" by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 2001; :CD001122.
- Farhi J, Ben-Haroush A, Lande Y, Fisch B. Role of treatment with ovarian stimulation and intrauterine insemination in women with unilateral tubal occlusion diagnosed by hysterosalpingography. Fertil Steril 2007; 88:396.
- Honoré GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril 1999; 71:785.
- Pinto AB, Hovsepian DM, Wattanakumtornkul S, Pilgram TK. Pregnancy outcomes after fallopian tube recanalization: oil-based versus water-soluble contrast agents. J Vasc Interv Radiol 2003; 14:69.
- Letterie GS, Sakas EL. Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization. Fertil Steril 1991; 56:831.
- Practice Committee of the American Society for Reproductive Medicine. Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril 2012; 97:539.
- Johnson NP, Mak W, Sowter MC. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev 2004; :CD002125.
- Tsiami A, Chaimani A, Mavridis D, et al. Surgical treatment for hydrosalpinx prior to in-vitro fertilization embryo transfer: a network meta-analysis. Ultrasound Obstet Gynecol 2016; 48:434.
- Heinonen PK, Saarikoski S, Pystynen P. Reproductive performance of women with uterine anomalies. An evaluation of 182 cases. Acta Obstet Gynecol Scand 1982; 61:157.
- March CM, Israel R. Gestational outcome following hysteroscopic lysis of adhesions. Fertil Steril 1981; 36:455.
- Pérez-Medina T, Bajo-Arenas J, Salazar F, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 2005; 20:1632.
- Coutifaris C, Myers ER, Guzick DS, et al. Histological dating of timed endometrial biopsy tissue is not related to fertility status. Fertil Steril 2004; 82:1264.
- Practice Committee of the American Society for Reproductive Medicine. Current clinical irrelevance of luteal phase deficiency: a committee opinion. Fertil Steril 2015; 103:e27.
- Helmerhorst FM, Van Vliet HA, Gornas T, et al. Intra-uterine insemination versus timed intercourse for cervical hostility in subfertile couples. Cochrane Database Syst Rev 2005; :CD002809.
- OVULATORY DISORDERS
- Weight modulation
- - High body weight
- - Low body weight
- Ovulation induction agents
- - Clomiphene
- - Aromatase inhibitors
- - Gonadotropin therapy
- Other agents
- - Metformin
- - Tamoxifen
- - Laparoscopic surgery
- - Dopamine agonists
- Assisted reproductive technologies
- TUBAL FACTOR INFERTILITY AND ADHESIONS
- Procedures for improving tubal patency
- - Distal obstruction
- - Proximal obstruction
- In vitro fertilization
- - Salpingectomy for hydrosalpinx
- UTERINE FACTOR INFERTILITY
- Synechiae, septa, congenital anomalies
- Endometrial polyps
- Luteal phase defect
- CERVICAL FACTOR INFERTILITY
- UNEXPLAINED INFERTILITY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS