Infertility Treatment Options: Female and Male Infertility Explained

In short: Treatment of infertility depends on its cause. In women it includes tablets or injections to stimulate ovulation, especially with polycystic ovaries, and surgery such as repair of blocked fallopian tubes. In men it includes changing habits such as avoiding smoking and heat, hormone treatment, surgical repair of blockages, and treatment of erection and ejaculation problems.

Once the cause of infertility has been identified — whether it involves a female factor, a male factor, or both — your doctor can recommend the treatment plan that best fits your diagnosis. Every couple’s situation is different, so treatment is always tailored to individual needs.

Treatment of female infertility:

A- Medical Treatment of female infertility:

The right treatment depends on the underlying diagnosis. Some women need hormonal therapy, while others require treatment for conditions such as endometriosis. Most cases benefit from hormonal therapy, using different hormone medications to stimulate the ovaries and encourage healthy follicular growth (this is called controlled ovarian stimulation, and may involve tablets, injections, or both — tablets such as letrozole, now the first choice for women with PCOS, or clomiphene citrate; injections of gonadotrophins such as FSH or HMG; and GnRH analogues or antagonists, which are used mainly to control ovulation during IVF). These medications also help with timing ovulation, increasing the chance of fertilization occurring at the right moment.

Treatment usually starts with one of these medications, at a dose and duration chosen by your treating physician. Follicular growth is then monitored through ultrasound, hormone level testing, or both. Once the follicles reach an appropriate number and size, an HCG hormone injection is given, with intercourse timed accordingly. It’s worth reassuring patients that these medications do not increase the risk of congenital fetal anomalies or recurrent miscarriage, although they can increase the chance of a multiple pregnancy (twins or more) and, less often, cause ovarian hyperstimulation syndrome (OHSS). This is why ultrasound monitoring is essential.

Women who more often need ovulation induction include:

-Women with hormonal disturbances.

-Women with Polycystic Ovary Disease (PCOs).

B-Surgical treatment for female infertility:

• For example, a blocked fallopian tube may be treated directly, or through in vitro fertilization (explained further below). In cases of endometriosis, surgery may be needed alongside medical treatment, and fibroids that are impeding pregnancy may also require surgical removal:

• -If part of the tube is blocked, that segment can be removed and the remaining healthy parts reconnected. If the blockage is at the far end of the tube, causing it to become swollen (a condition called hydrosalpinx), a surgery known as salpingostomy may be performed. 

  Before IVF, a tube with a hydrosalpinx is usually removed or blocked off, because the fluid it contains lowers the chance of the embryo implanting.

• -If the blockage is where the tube attaches to the uterus and extends into the uterus itself, the blocked area is removed and the open ends reconnected — this surgery is called tubal reimplantation.

• -Reopening a blocked tube can also be done using a special catheter, gently guided through the cervix and uterus to reach the blocked segment of the tube. This procedure is called transcervical selective salpingography, and it serves both as a diagnostic and therapeutic option for proximal tubal blockage.

• The catheter used is a soft, flexible tube guided by a fine wire. Once positioned at the ostium (where the tube meets the uterus), the guide wire is removed, and the catheter is carefully advanced to bypass the blocked area. A colored dye is then injected to confirm the tube is open and functioning normally.
• This procedure has shown good results with minimal side effects and a relatively short recovery time, with a reported success rate of around 75.3%.
• -If fibroids are believed to be the sole cause of infertility, they can be surgically removed either through laparotomy (an abdominal incision) or laparoscopy.
• -Uterine septum, intrauterine adhesions, and intrauterine fibroids are typically removed via hysteroscopy.
• -Ovarian drilling may be recommended for women with Polycystic Ovary Syndrome (PCOS) when ovulation tablets such as letrozole or clomiphene have not worked.
• -The success of any of these surgeries depends greatly on an accurate diagnosis and the experience of the surgeon.

C-Other, less common causes of female infertility — such as sperm antibodies within the female body, or thickened cervical mucus — are treated according to their specific cause.

D-Intrauterine insemination (IUI)

Treatment of male infertility:

As with female infertility, the first step is identifying the underlying cause so it can be treated appropriately.

1-Instructions to increase sperm number and improve its quality:

A-Changing lifestyle:

• Quit smoking.
• Avoid excess alcohol intake.
• Avoid exposure to sources of high temperature.
• Avoid wearing tight underwear’s.

B-Changing environment:

• Avoid exposure to some chemical substances such as, working in industries.

• Stop medications that affect sperms. 

  Testosterone and anabolic steroids (including some bodybuilding products) stop sperm production and should not be used by a man who is trying to have a baby.

2-Treatment that increase sperms production and its function:

A-Medical treatment:

1-Hormonal treatment:

• Clomiphene, tamoxifen or letrozole are sometimes prescribed to increase sperm production, but their benefit is modest and they suit only selected cases. Androgens (testosterone) are not used for this purpose, because they reduce sperm production.
• GnRH or gonadotrophin injections (hCG and FSH) give excellent results in hypogonadotrophic hypogonadism, and cabergoline or bromocriptine corrects a high prolactin level.

2-Other treatments:

• Antioxidants (such as zinc, vitamins and coenzyme Q10) and medicines such as pentoxifylline have been tried to improve sperm motility; the evidence is limited and the response differs from one man to another.
• Antibiotics to treat chronic genital tract infections.

B-Surgical treatment for male infertility:

Surgery may be performed to treat varicocele. However, varicocele on its own is not automatically a reason for surgery — many fertile men also have varicocele. Current European urology guidance advises repair when the varicocele can be felt on examination, the semen analysis is abnormal and the couple is having difficulty conceiving. Surgery is not advised when the semen analysis is normal or the varicocele is seen only on ultrasound.

3-Repairing the path of sperm to Oocyte:

Reconnecting spermatic cord (vasovasostomy).

The earlier the diagnosis is made and surgical intervention performed, the better are the results because the delay may result in anti sperm antibody production.

• Fixing epididymal obstruction (vasoepididymostomy), either the obstruction is congenital or due to infection.
• When the vas deferens is absent from birth, or a blockage cannot be repaired, sperm are retrieved directly and used for ICSI. * Retrieval of sperm from the epididymis (MESA or PESA) or from the testis (TESA, TESE or micro-TESE) and using it in ICSI procedures.
• 4-Treating Erectile Dysfunction if it was the cause for infertility:

A-Medical treatment for erectile dysfunction:

• Tablets such as sildenafil or tadalafil are the first-line treatment. If they do not work, the penis can be injected with prostaglandin (alprostadil).
• Medical treatment for hyperprolactinemia (high prolactine hormone level) such as bromocriptine.
• In cases of low testosterone, treatments that do not stop sperm production (such as hCG or clomiphene) are preferred while the couple is trying to conceive, because testosterone itself lowers sperm production.
• Treating medical conditions affecting erection such as diabetes, thyroid problems, epilepsy.

B-Surgical treatment for erectile dysfunction:

• Surgery done to the arteries supplying the penis to increase the amount of blood reaching the penis in cases of diseases affecting arteries such as, diabetes or smoking.
• Using certain devices to induce erection (like vacuum devices).
• A penile prosthesis (implant) in cases that do not respond to other treatments..
• Electric ejaculator that will stimulate the nerves responsible for ejaculation via localized small electric current, to obtain semen that will be used in IUI, IVF or ICSI.

C-Psychological therapy for erectile dysfunction: When it is the cause.

• 5-Treatment of ejaculatory problems:

A-Premature ejaculation.

B-Treatment of failure of ejaculation according to the cause, or by electric ejaculator.

C-Retrograde ejaculation is treated according to its cause:

• Medical treatment such as, using Alpha-Sympathomimetic Agents.
• Using sperms present in urine for ICSI procedure after preparing it in the lab.
• Electric ejaculator.
• Surgical correction for the valve dysfunction to prevents retrograde ejaculation.

6-IUI (intrauterine insemination).

If you or your partner are struggling with infertility, Dr. Najeeb Layyous and his team can help guide you through diagnosis and the treatment options best suited to your situation. Feel free to reach out to the clinic to discuss your case.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist