Are treatments for infertility improving?

New effective treatments arrive almost yearly. Some, such as mletrozole (12A) are surprisingly simple to use and cost very little whereas others like ICSI (25) are extremely complex and expensive.

Until the 1960s treatment options were very limited. Anovulatory infertility (Q9.17) has only been treatable by drugs since the early 1960s; success rates from medication are high. If investigation showed evidence of blocked Fallopian tubes, surgery may prove successful for between ten and twenty percent. If there was evidence of severe male infertility, donor insemination was a possibility; until the last few years no more than 2% of men with severe infertility problems could be treated by other means. The arrival of IVF twenty years ago and the subsequent development of ICSI seven years ago have changed the picture completely now only 2% of couples with severe male factor infertility cannot be treated. Cryopreservation (freezing for storage and later thawing and utilisation) of embryos and ova, and embryo biopsy (28) are remarkable technical achievements that merit consideration. The latest development involves culturing the embryos for five days to the blastocyst stage. Implantation of blastocysts provides higher implantation rates than with embryo transfer at two days. It is hoped that eventually only one embryo will be transferred on the fifth day with a 70% chance of an ongoing pregnancy. Each development requires scientific analysis and raises difficult ethical questions.

Sadly, a successful outcome from infertility treatment cannot be guaranteed. Even with IVF there is only an average 20% success rate per cycle or about 50% with three treatment cycles. The emotional toll during treatment cycles cannot be adequately estimated and, when there is failure, devastation and at times despair are inevitable. Some couples will give up relatively early. For others parenthood seems their only purpose in life and they travel the world seeking success.

The latest data from the USA shows that

Overall, 42% of ART transfer procedures resulted in a pregnancy, and 35% resulted in a live-birth delivery (delivery of one or more live-born infants).^2006-01In the 1990s typical pregnancy rates were in the order of 20% (Figure 10.5)

A couple I have known for many years were found to have male factor infertility. They chose to wait for a miracle rather than accept AID (23). Now aged fifty the lady poured her heart out to me. The miracle never happened. For this couple, developments including ICSI have come too late. I explained that even if they had elected to pursue donor insemination, success would not have been guaranteed but they are left with an empty feeling, as they never tried.

For those unfortunate couples who do not meet with success from treatment they will at least know that they tried although it was not to be. There may be an option for them to pursue adoption.