The desire to raise a child is a noble one, and it’s not for the faint of heart. If you are considering bringing a child into your home, you are most likely a strong, brave individual who desires to put their time and energy into sharing love with another human being. We applaud you for this desire and understand the myriad of feelings and emotions that accompany it. The journey to becoming a parent is not always a simple one, though. In fact, for adults who struggle with infertility, same-sex couples and single adults, becoming a parent may seem downright impossible. After all, the traditional expectation of love, marriage and then the baby carriage still looms large over society, even as modern medicine has turned that reality on its head.
The good news is that today, the baby carriage comes through many different routes — treatments with medicine, assisted reproductive technology and even egg donation, among others. Understanding the options for conception that are available to you is the first step in making wise, informed decisions that will get you closer to starting the family you have always wanted.
Infertility is simply defined as the inability to get pregnant the “traditional way.” In other words, intercourse isn’t producing a healthy baby. Infertility can be the result of problems with the reproductive system of either partner and, in some cases, both partners may have medical issues that prevent them from being able to conceive.
Twelve percent of women in the United States are considered “infertile.” Most of the time, infertility is either caused by a block in the fallopian tubes or ovulation problems. However, in five to 15 percent of infertility cases, the cause of the problem cannot be determined.
Men can also be diagnosed as infertile if they have problems with their sperm, unbalanced hormone levels or problems with ejaculation. In fact, in one-third of infertility cases, the man is the one experiencing an issue that is preventing pregnancy.
Infertility and Options for Getting Pregnant
Even if you are struggling with infertility, you still have several ways you can experience the joy of bringing a child into your home. Here’s a look at some of these child conception procedures:
1. Fertility Drugs
In some cases, many causes of infertility can be treated with surgery or a combination of drugs and hormones. Depending on the diagnosed cause of infertility, a woman may be prescribed medication to stimulate ovulation or to stimulate the development of mature eggs. Among the various side effects these medications can cause, many of the fertility drugs prescribed today have been found to increase a woman’s chance of getting pregnant with multiples — twins, triplets and even quadruplets. Multiples can cause problems during pregnancy, and a woman who is pregnant with multiples runs the risk of going into premature labor. Babies who are born prematurely are at a higher risk of developmental delays and health problems as they grow.
Men can also receive medication to treat hormonal imbalances, issues with erection and ejaculation, and even antibiotics if an infection of some kind is believed to be preventing a couple from becoming pregnant.
During this time, doctors may also recommend that a couple undergo certain lifestyle changes to increase their chances of getting pregnant. For example, they may recommend that a couple increase the frequency they have intercourse, reduce the amount of alcohol they consume and stop smoking. However, for some couples, these steps, even when combined with medication, may not be enough to conceive. And, for single adults or same-sex couples, medication alone is not enough to start a family.
2. Assisted Reproductive Technology
For some couples, lifestyle changes and medication may be the first step in a longer journey, or they may not be an option at all. Depending on the reason behind a couple’s infertility, it may take more involved treatments to result in a pregnancy. For these couples, a more involved procedure may be recommended.
Assisted Reproductive Technology (ART) is defined as any procedure in which eggs and embryos are handled outside of the womb. Typically, eggs are removed from a woman’s body, combined with sperm in a lab, and then returned either to the same woman’s body or to a surrogate’s womb. Depending on the circumstances surrounding a couple’s infertility, the eggs and/or sperm may be taken from the couple themselves or from a donor. They may then be implanted into the woman or into a surrogate — a woman who is carrying a baby on behalf of a couple who cannot carry a baby. We will discuss surrogacy later on.
Depending on the reasons behind a couple’s infertility, there are a number of types of ART available:
In-Vitro Fertilization (IVF)
If a couple opts to use their own eggs and sperm, then the woman will spend several weeks on medication prior to having her eggs collected to stimulate egg production. When it is time, an infertility specialist or reproductive endocrinologist will retrieve the eggs via a needle inserted into a woman’s pelvic cavity. The eggs are combined with the sperm and placed in a laboratory where they are allowed to grow for anywhere from three to five days. At that time, the embryos are implanted into a woman’s uterus.
IVF is typically attempted only after couples have tried all other options without success. It is an extremely expensive procedure, and insurance rarely covers it. IVF is also used in cases of surrogacy to implant an embryo into the surrogate mother’s uterus.
Intrauterine Insemination (IUI)
To perform IUI, sperm is placed in a woman’s uterus while she is ovulating. The sperm can be obtained by a woman’s partner, a donor or a sperm bank, depending on the situation and the couple’s preference. An IUI is performed in an OBGYN’s office by inserting sperm via a catheter. Some doctors will recommend that women lay down for 10 minutes after the sperm is inserted and tilt her pelvis to improve the chances of getting pregnant. The only known side effect is some minor cramping, and many people compare the discomfort it causes to that of a typical pap smear.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a type of ART used when male infertility is the factor preventing pregnancy. In this procedure, sperm is injected into a mature egg to fertilize it outside of the woman’s body. This is different than IVF because IVF allows the sperm to fertilize the egg itself in the laboratory.
Egg donation is the process of removing viable eggs from a healthy, fertile woman and then implanting them to another person who is unable to conceive. Once the eggs are removed from the donor, they are fertilized in a lab and then implanted into another woman using IVF. Sometimes people will use eggs donated by someone they know. Other times, people will choose an anonymous egg donor.
Prior to having their eggs retrieved, egg donors go through a rigorous screening process, where they are evaluated based on physical health, mental health and their risks for genetic defects and diseases. While each part of the process is important, the mental health screening is especially so. Donating eggs is an emotional experience, both for the donor and for the couple who receives her eggs. Understanding the process and verifying that everyone involved understands it is crucial to its overall success.
Similar to egg donation, sperm donation is the process of removing viable sperm from a healthy man and then using it to fertilize an egg. This is typically done in cases where a single woman wants to get pregnant or same-sex female couples wish to have a baby. It may also be done in cases where a man has been diagnosed as being infertile, and his female partner can carry a baby. Donated sperm can either be injected via IUI or used to fertilize an egg and then inserted using IVF.
Gamete Intrafallopian Transfer and Zygote Intrafallopian Transfer
Although rarely used in the United States today, gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) have been options used in the past. With GIFT, sperm and eggs are harvested and then both inserted into the fallopian tube and allowed to undergo fertilization in the woman’s body. With ZIFT, the egg is fertilized in the lab and then inserted into the fallopian tube 24 hours after fertilization.
There is so much that goes into each of these six options. Anyone who is considering using ART to start their family should first talk with a team of experienced and trustworthy medical professionals to determine which procedure is best for them. While none of these options are incredibly painful in the physical sense, they can be expensive and invasive, and it is important that you fully understand what you are getting into before moving forward.
In some cases, infertility may also be addressed through surgery. This is most commonly done when a woman has tissue blocking her fallopian tubes or suffers from endometriosis, which is a condition in which uterine tissue forms outside of the uterus. This causes extreme pain and discomfort, along with infertility.
4. Non-Medical Options
While there are many successful medical options for addressing and overcoming infertility, these methods are not always an option. In many cases, carrying a child is simply not possible. When medical intervention is not an option for a couple or single adult, then it may be time to consider adoption or a gestational carrier.
Surrogacy is an option for couples where neither partner can sustain a pregnancy. When this happens, the couple can select a woman who is healthy and willing to carry their baby for a successful pregnancy and then give birth to the child for them. Some couples choose someone they know — a close friend or family member who has volunteered to go through the surrogacy process. Other couples work with a reputable fertility clinic to select a surrogate they have never met. There is no right or wrong choice when it comes to choosing either a known or unknown surrogate. It simply depends on your personal preference.
Depending on the circumstances surrounding a couple’s inability to have a child, the surrogate may be impregnated with an embryo made from sperm or an egg from the couple, meaning the surrogate is not genetically related to the baby and will ultimately give birth to the couple’s biological child. This means the surrogate will undergo IVF, so this option is partly “medical.” Other times, an egg or sperm donor may be used to create an embryo that is then placed into the surrogate.
Each state has different laws governing the use of surrogates to start a family, so it is important to understand the laws in your state, as well as the state where the surrogate will be giving birth. It is also important to work with a reputable agency throughout the process, especially if you are working with a surrogate you have not met before. Even with the best of intentions, surrogacy is filled with many twists and turns that can be confusing and overwhelming. Not only that, but there are many expenses related to surrogacy, including travel expenses, legal fees and medical care. Depending on state laws, you may also be expected to pay a surrogate fee as well. However, in some states a surrogate fee is illegal, so it is important to know up front what is and is not allowed in your case.
Although last on this list, adoption should by no means be viewed as a “last resort” when it comes to building your family. Adoption is the process of legally welcoming a child into your family. Some couples who cannot have their own children choose to adopt a baby, while others welcome older children into their homes. Some couples adopt children from the United States, while others opt to take on a child from overseas.
There are a wide variety of agencies available to help couples and individuals navigate the various options and determine the best situation for them. Adoption laws vary from state-to-state, so it is essential to work with a reputable adoption agency to make sure you and your partner meet the criteria for each state, as well as the criteria set by the agency itself. While marital status, age and other factors are not necessarily the deterrents to adoption that they were in the past, an agency can help you navigate the process to make sure everything goes smoothly.
Adoption does not involve medical procedures, although it can still be expensive, depending on the specifics. Many organizations have grants available to families wishing to adopt, and some employers have even started offering assistance to employees who wish to pursue the process.
How Do I Choose?
A diagnosis of infertility can be overwhelming and disheartening for couples who long to have a family. The good news is that there is hope. Today, there are many options to build a family. This list is only intended to provide an overview of each process. The process of navigating infertility and alternative options for having children is one that no one should have to face alone.
At Western Fertility Institute, our physicians and support staff aim to provide professional and compassionate care throughout the process. Our job is to walk with you as you evaluate each option and make important decisions that will impact you and your family. In addition to providing medical services, we provide reproductive counseling and support from the day of your first inquiry.
If you have received a diagnosis of infertility, allow us to help you navigate your family’s next steps. For more information or to explore medical and non-medical options, contact us today.