What is infertility treatments?

Reproductive research and treatment raise many ethical and legal concerns. The American Society for Reproductive Medicine has issued a number of statements about these issues. Go to its website at www.asrm.org/EthicsReports to review these statements.

Multiple pregnancy

Transferring several fertilized eggs during assisted fertilization techniques (as for in vitro fertilization) increases the chances that you will conceive two or more fetuses at the same time. Multiple pregnancy increases the risk of premature birth, low birth weight, and health problems for you and your babies. And it raises the risk of one or more of the babies having a disability. Talk to your doctor about how you can increase your chances of conception and decrease the chances of having a multiple pregnancy.

Embryos

If you are planning to use assisted reproductive technology, your clinic may offer to freeze extra fertilized eggs for future conception attempts. Be sure to give written instructions for what to do with any eggs that you don't use. Think about what you want done with them in the case of death or divorce. Also think about what you want done with the eggs if the clinic isn't able to contact you in the future.

Donor eggs or sperm, or surrogate

You may plan to use eggs or sperm from someone you know. Or maybe you're planning to have someone else (a surrogate) carry your fetus until birth. If so, talk to your clinic or an attorney experienced in this area. Draw up a contract that defines what rights and responsibilities each party has to the future child and your family.

Before you start infertility treatment, decide how much money, time, and emotional energy you are willing to invest in it.

Financial limits

Think about:

• What your insurance coverage will pay for. Be aware of all exclusions in your policy.
• How much money you can afford to spend on treatment as well as pregnancy, delivery, and infant health care. A financial planner may be of help.
• What various treatments cost, including the cost of medicines and routine testing.
• Some clinics offer creative financing for infertility treatment. This may or may not be right for you. See the National Infertility Association website at www.resolve.org for information on financing the treatment.

Time limits

Before you start treatment, plan how long you can see yourself trying to conceive with medical help. Talk to your doctor ahead of time about what is a reasonable period of time to try treatment for your specific condition.

Infertility treatment is a success if it results in the birth of a healthy baby. Many things affect your chances of conceiving and carrying a healthy pregnancy, with or without treatment. Major ones include:

Your age and how long you've been trying to conceive.

Your age (and the age of your egg supply) has a big impact on your chances of getting pregnant and having a healthy baby. From your mid-30s into your 40s, your chance of pregnancy with your own eggs decreases, and your risk of miscarriage increases.

The cause of infertility.

• Ovulation problems (except those related to age) are the most successfully treated cause of infertility. But problems with the fallopian tubes can be harder to treat.
• The success of treating other causes depends on the type of problem and how severe it is.

Some people complete many cycles of infertility treatment before they conceive or decide that treatment has failed. Before you start treatment, talk to your doctor and decide how much time and money you are willing to spend.

When thinking about medicine or hormone treatment for infertility, ask your doctor these questions.

• Are there are any long-term risks related to the treatment?
• Do I need to change my sexual activities during treatment? Your doctor may have suggestions for timing sex to increase the chance of getting pregnant.
• How long will it take to know if the treatment will work? Continuing treatment when you are unlikely to conceive means that you wait longer to consider other options such as adoption. You can set limits on how long you want to try it. And you can change your mind.
• Does my age affect the treatment options? Depending on your age, a doctor may switch treatments sooner to provide the best chance of getting pregnant.
• What's the success rate of the treatment? Medicine or hormone treatment works very well for some causes of infertility, such as failure to ovulate. But it doesn't work as well for other causes.
• How much monitoring is needed for the treatment? Some treatments require that you be checked every day at your doctor's office. You must decide if you can work around the monitoring schedule.
• What is your experience with medicine or hormone treatment for infertility? This type of infertility treatment requires careful diagnosis, dosage, and monitoring. Your doctor should have specific training and experience in this area.