Most medical interventions for fertility are well established at this point, though mysteries remain. New recommendations continue to emerge, and research into the causes and potential treatments of infertility are ongoing.
Part of the challenge is that there are so many possible causes for infertility, and simply ruling out all the potential barriers to conception can be time consuming and frustrating. Complicating the issue is the highly variable and relatively expensive healthcare coverage in the US. The cost of visits to family doctors, specialists, tests, treatments or prescriptions, and care at a fertility clinic may be covered with a minimal copay, a significant copay, or not at all.
Because of the expense and time involved in medical investigations of barriers to fertility, many people choose to look for natural, at-home ways to increase the likelihood of conceiving. While these do little to address underlying medical issues, they can be surprisingly effective in many cases.
Some precautionary treatments are becoming more widespread, such as harvesting and freezing eggs in women who do not anticipate a pregnancy in the near future and are concerned about the effects of aging. It’s also becoming easier to measure and monitor potential fertility by measuring a woman’s temperature, with a new generation of apps and mobile peripherals to help you make the most of days when you’re most likely to conceive. But at some point, if you’re not conceiving naturally, you will want to explore medical causes and interventions. Both partners should receive a physical and undergo additional testing as recommended by their doctor or specialist to check for structural inconsistencies in the reproductive organs, as well as viability of the sperm and eggs.
In the case of obstructions or other abnormalities with the reproductive organs, surgery to remove barriers or mend channels may be an option. If the sperm and eggs of the couple are viable, but natural physical conception or full pregnancy is not possible, the use of a surrogate is common. In this case, sperm and eggs are harvested and combined, and the resulting embryo(s) carried by a third party.
If there is a problem with either sperm or eggs, but not the woman’s reproductive system at a structural level, donor sperm or eggs may be used in combination with the viable material from one member of the couple, using assisted reproductive technology such as in-vitro fertilization (IVF) to artificially cause conception, from which point the mother can carry the child to term naturally.
Sometimes this approach will also be chosen even if the reproductive material from both members of the couple is viable and the mother’s body is capable of carrying a pregnancy. Physician-supported IVF can harvest eggs and sperm from the couple, combine them externally, and place them back in the uterus to encourage a pregnancy where there are no known or not insurmountable barriers, yet conception is not occurring naturally.
Unfortunately, IVF treatments tend to be expensive and do not offer a 100% success rate. Drugs are generally given to increase ovulation, but the volume and efficacy of harvested eggs and sperm may not be all that could be hoped for. Fertilized eggs may not successfully implant, and multiple attempts might be needed to successfully bring a pregnancy to term – with each attempt incurring an additional fee.
While 15 states do mandate at least some coverage for infertility insurance, the remainder have no such law, meaning coverage under public and private, individual employer-sponsored plans can vary widely. Unlike pregnancy-related coverage, which falls under the national Pregnancy Discrimination Act, fertility-related coverage is not considered a right at this time. A plan may limit your options to only pre-selected types of tests, drugs and treatments, and may not offer any coverage of infertility treatments at all. Common levels of coverage include none, coverage for the diagnosis only, coverage for the diagnosis and some treatment, and full coverage
Medication coverage is another category to keep an eye on – it may or may not cover fertility drugs, or may cover one type but not another. For instance, the most common oral fertility drugs might be covered, but not the injectable forms. It’s important to read your insurance policy carefully, paying attention to covered items, exclusions, and copays or deductibles. As a couple, you also may be able to draw on multiple policies to increase your total coverage.
You should seek clarification over what your insurance plans cover and what they don’t, before embarking on infertility investigations and treatments. You may have the option to upgrade your plan, or to speak to your employer about adjusting the plan to include infertility treatments in future cycles. However, many couples end up dipping into savings to fund the treatments. A single round of IVF often ranges from $12,000 to $17,000.
The medical sector offers support in identifying barriers to conception, including testing, some medication-based treatments, surgical interventions and physician-supported conception, such as IVF. Research is ongoing as medical professionals seek to understand more about the causes and potential solutions to infertility.