When people think about fertility treatment, they often just think of in vitro fertilization (IVF), a procedure in which retrieved eggs are fertilized by sperm in a lab and then transferred to the uterus as an embryo. However, it’s important to understand that IVF is often not the first step for people trying to get pregnant. There are a number of other medications and procedures that can work well, helping patients to avoid more intense or invasive procedures altogether. Similarly, taking a preventive and proactive approach to fertility health can also benefit many, sometimes eliminating the need for more involved fertility treatments.
Preventive and proactive options
Preventive care doesn’t always eliminate the need for treatment, but it’s an important starting point.
Some OB/GYNs and other providers may recommend making small, sustainable changes to lifestyle prior to pursuing further treatment. The American Society for Reproductive Medicine (ASRM) recommends balanced nutrition and limited intake of substances (e.g., alcohol, tobacco, marijuana) among their guidelines for optimizing fertility without medical assistance.
Other health conditions
Many health conditions can impact fertility. If you’ve been diagnosed with diabetes, high blood pressure, or an autoimmune disease (like a thyroid disorder), your provider can help you manage the condition and any aspects that affect fertility or even pregnancy outcomes before moving forward with fertility treatments.
Fertility testing is a broad category that includes the evaluation performed in clinics, as well as at-home testing kits that allow people to evaluate their hormone levels or semen parameters at home.
Traditionally, performing a proactive fertility evaluation at clinics isn't common unless someone is experiencing irregular cycles, which could indicate an underlying condition that needs to be treated before trying to get pregnant. However, proactive at-home testing can be a good option for those who want genetically related children but aren’t ready to start trying to get pregnant. The results of these tests can help identify issues that can be addressed and treated now to avoid possible fertility issues later. If you have access to a fertility benefit like Carrot, you may be able to complete proactive fertility testing using your benefit dollars.
Ovulation tracking is a method used by specialists in fertility clinics as well as by people who are trying to get pregnant at home. Ovulation is when a mature egg is released from the ovary, and for a limited period of time — typically only 12 to 24 hours — the egg is viable for fertilization. This typically occurs 14 days before the start of the next menstrual period but can vary. A person’s “fertile window” is often defined as the five days leading up to ovulation and the day of ovulation itself. Identifying when this occurs helps to pinpoint when people have the best chance of getting pregnant. Tracking options include ovulation test strips, wearable ovulation trackers, cycle-tracking apps, or even a simple calendar if your cycle is regular and predictable.
First-line fertility treatments
Before recommending IVF, fertility doctors may suggest ovulation induction with medication coupled with timed intercourse or a procedure called intrauterine insemination (IUI).
Timed intercourse with ovulation induction
In the case of isolated ovulatory dysfunction and an otherwise negative (no detected issues) workup with my patients who are in different-sex partnerships, we may try ovulation-inducing medication with timed intercourse before pursuing further procedures. In some cases, ovulation induction can also be used in combination with IUI.
Ovulation-inducing medications typically work by modulating the body’s production of the hormones that trigger egg recruitment and ovulation. The most commonly used ones are:
- Selective estrogen receptor modulators (SERMs) like clomiphene citrate (brand name: Clomid)
- Aromatase inhibitors like letrozole (brand name: Femara)
- Gonadotropins like follicle-stimulating hormone (FSH), Human chorionic gonadotropin (hCG), a pregnancy hormone that can be used to mimic a luteinizing hormone (LH) surge
Intrauterine insemination (IUI) is a fertility procedure that can be done with or without ovulation induction or other fertility medication. Compared to IVF, a traditional IUI is less costly, uses less medication (including injectables), and is less invasive.
I may recommend IUI to patients in some of the following situations:
- Donor or frozen sperm in same-sex partnerships
- Unexplained infertility
- Cervical factors (like scarring or structural anomalies)
- Mild male factor or ovulatory dysfunction
When IVF is the right option
If medications and IUI don’t lead to a pregnancy and live birth, or they’re not possible due to someone’s history or current circumstances, IVF may be the best option. Studies have shown that most pregnancies through IUI occur within three to four cycles. In many cases, IVF is typically recommended if three or four IUI cycles don’t result in a live birth.
Single embryo transfer (SET)
With a procedure like IVF, there are several important decision points. One example is deciding how many embryos to transfer. Transferring multiple embryos at once used to be the standard of care for IVF many years ago. However, as the techniques and procedures that comprise IVF have significantly improved, single embryo transfer (SET) has become the standard for most cases since it can lead to higher rates of healthier, singleton pregnancies — and lead to lower rates of cesarean births, preterm deliveries and low birth weights due to multiple gestation pregnancies.
What about IVF add-ons?
An IVF “add-on” is an adjunct treatment that’s considered nonessential — and may, in some cases, require out-of-pocket payment.
Some add-ons haven’t yet been demonstrated to be effective or safe by clinical research, but two may offer some benefit in specific cases:
- Intracytoplasmic sperm injection (ICSI): ICSI is a form of insemination in which an embryologist will choose one sperm with better quality parameters to inject into the egg rather than introducing it to thousands of sperm. This may be used in cases where there are abnormal sperm parameters, a previous IVF cycle with a low fertilization rate, or when using previously frozen eggs.
- Preimplantation genetic testing for aneuploidy (PGT-A): PGT-A involves doing a biopsy to test the chromosomes in an embryo before an embryo transfer. This is typically done at the blastocyst stage, but can also be done at other stages of embryo development.
Support at Carrot
Carrot offers comprehensive fertility benefits employees can use to build their families in whatever way works for them. With Carrot, members can:
- Speak with experts in fertility and other disciplines: Carrot members can message experts and care navigators on demand to help them assess next steps.
- Access fertility testing and ovulation tracking: Carrot also offers at-home fertility hormone and sperm testing — as well as clinically backed ovulation and cycle tracking.
- Receive SET education: You’ll learn everything you need to know about SET, as well as other key clinical decisions, from our team of experts.
- Get support for all journeys: Carrot’s benefits aren’t just designed for one path to parenthood. In addition to fertility treatment, we also cover adoption, donor-assisted reproduction, and gestational surrogacy to help members grow their families.
If you’re a Carrot member, sign in to your account to learn more about your options.