Fertility treatment: Your options at a glance

Get a quick glimpse of what to expect from your treatment options below. For more detailed information on a particular treatment, click on the appropriate link.

Fertility drugs

Clomiphene and gonadotropins, the most commonly used fertility drugs, regulate your reproductive hormones and trigger the release of one or more eggs in each ovulation cycle. Most women use them for three to six months before conceiving or trying a different kind of treatment.

Side effects and drawbacks

• These fertility drugs increase your odds of having twins or more.
• Clomiphene can cause hot flashes, mood swings, pelvic pain, breast tenderness, ovarian cysts, nausea, thick and dry cervical mucus, headaches, mild depression, and visual symptoms.
• Gonadotropins can cause rash or swelling at the injection site, mood swings, breast tenderness, abdominal bloating, and headaches. About 10 to 20 percent of women who take gonadotropins develop a mild form of OHSS (ovarian hyperstimulation syndrome), which causes enlarged ovaries and fluid build-up in the abdomen.

Success rates
About 80 percent of women who take clomiphene ovulate in the first three months of treatment. Of them, 30 to 40 percent conceive by their third treatment cycle.

The pregnancy rate for gonadotropins with timed intercourse is 15 percent per cycle.

Cost
Clomiphene pills cost $10 to $100 a month, depending on the dosage and whether you choose brand name or generic. Additional costs: doctor visits, ultrasounds of your ovaries, and procedures such as IUI (intrauterine insemination).

Gonadotropin injections cost about $1,000 to $5,000 a month, depending on the dosage and how long you need to take the shots. Additional costs: doctor visits, blood tests, and ultrasounds.

Surgery

Surgery can help fix genetic defects, open blocked fallopian tubes, remove fibroids, remove the tissue of endometriosis, and treat PCOS (polycystic ovarian syndrome).

Two surgical procedures commonly used to treat gynecological problems are laparoscopy and laparotomy. Laparoscopy uses thin instruments and a lighted camera inserted through several small incisions in the abdomen. Laparotomy is done through a larger abdominal incision.

Side effects and drawbacks

• You may feel discomfort in your back or shoulders after a laparoscopy. It stems from the carbon dioxide gas used during surgery to inflate your abdomen for easier viewing of your organs.
• If you had general anesthesia, the breathing tube used during surgery may give you a sore throat for a few days.
• If you had general anesthesia, you'll feel sleepy for a few hours and may have some nausea.
• The incisions in your abdominal area may feel sore for a few days.

Success rates
Success depends on the condition and the surgery used to treat it.

• Women with minimal or mild endometriosis have about a 40 percent chance of getting pregnant by eight to nine months after laparoscopic treatment.
• Between 21 and 59 percent of women whose fallopian tubes are opened do conceive.
• Women with PCOS who have ovarian drilling surgery have a 50 percent chance of getting pregnant within one year.

Cost
Anywhere from $2,000 to $10,000, depending on the type of surgery, the anesthesia used, whether the procedure is inpatient or outpatient, and your insurance coverage.

Intrauterine insemination (IUI)

IUI involves depositing a concentrated amount of sperm from your partner or a donor directly into your uterus, using a catheter that passes through the cervix.

Side effects and drawbacks
You may feel cramping for a day or so.

Many women undergo "stimulated" IUI cycles in which fertility drugs are taken before the procedure. These drugs:

• Raise your risk of having twins or more.
• Raise your risk of developing OHSS (ovarian hyperstimulation syndrome).
• Can cause side effects such as breast tenderness or mood swings.

Success rates
For couples with unexplained infertility, the pregnancy rate is 7 to 16 percent per stimulated IUI cycle.

Cost
Averages about $865.

In vitro fertilization (IVF)

For in vitro fertilization (IVF), eggs are removed from your ovaries and then combined in a laboratory with sperm from your partner or a donor. If fertilization is successful, the resulting embryo or embryos are transferred to your uterus.

Side effects and drawbacks

• If more than one embryo is transferred, the risk of having twins or more is 9 to 29 percent.
• Most women take gonadotropins before IVF. Gonadotropins have side effects (rash or swelling at the injection site, sore breasts, mood swings, headaches, and bloating) and raise the risk of OHSS (ovarian hyperstimulation syndrome).
• Cramping and spotting after eggs are retrieved.
• Cramping and spotting after embryos are transferred to the uterus (but most women feel better after a day or two).

Success rates
In recent years in the United States, these are the percentages of IVF cycles that lead to a live birth:

• 40 percent for women age 34 and under
• 31 percent for women age 35 to 37
• 21 percent for women age 38 to 40
• 11 percent for women age 41 to 42
• 5 percent for women age 43 and over

Cost
Averages around $12,400 for one cycle of IVF if you're using your own eggs and your partner's sperm.

Intracytoplasmic sperm injection (ICSI)

ICSI is often added to an IVF treatment to overcome male fertility problems or to help the fertilization process along when it might be a challenge. During ICSI, a single sperm is injected into a single egg and the resulting embryo is transferred to your uterus.

Side effects and drawbacks
Your partner's sperm may need to be drawn from his testicle with a microscopic needle or surgical biopsy, usually under local anesthesia. It's less painful than it sounds.

He'll need to avoid strenuous activity for five to 10 days.

Success rates
ICSI successfully fertilizes 50 to 80 percent of eggs. After fertilization, your chance of having a baby is the same as that of couples who used IVF without ICSI:

• 40 percent for women age 34 and under
• 31 percent for women age 35 to 37
• 21 percent for women age 38 to 40
• 11 percent for women age 41 to 42
• 5 percent for women age 43 and over

Cost
Adds about $1,500 to the cost of the IVF procedure, which averages around $12,400.

Gamete intrafallopian transfer (GIFT)

During gamete intrafallopian transfer (GIFT), eggs are mixed with sperm in a lab. Laparoscopic surgery is then used to inject the mixture into the fallopian tubes so fertilization can occur naturally inside your body.

GIFT is rarely used now, since the development of IVF with ICSI.

Side effects and drawbacks

• Twins or multiples are more likely because more than one egg is usually placed in the fallopian tubes.
• Longer recovery time than IVF without GIFT.
• Soreness around the laparoscopy incision.
• Most women take gonadotropins before GIFT. Gonadotropins have side effects (rash or swelling at the injection site, sore breasts, mood swings, headaches, and bloating) and raise the risk of OHSS (ovarian hyperstimulation syndrome).

Success rates
About 26.5 percent of GIFT cycles result in a baby – a similar success rate to that of IVF.

Cost
$15,000 to $20,000

Zygote intrafallopian transfer (ZIFT)

Like GIFT, zygote intrafallopian transfer (ZIFT) involves your eggs and sperm being mixed together in a lab. But during ZIFT, your doctor makes sure the eggs are fertilized and become one-celled embryos called zygotes before using laparoscopic surgery to place them in your fallopian tubes.

Since the development of IVF with ICSI, ZIFT is rarely used.

Side effects and drawbacks

• A higher chance of having twins or more because, typically, more than one zygote is placed in the fallopian tubes.
• Since this procedure involves laparoscopic surgery, there's a longer recovery time than IVF without ZIFT.
• You may feel soreness around the incision.
• Most women take gonadotropins before the procedure. They have side effects (rash or swelling at the injection site, sore breasts, mood swings, headaches, and bloating) and raise the risk of OHSS (ovarian hyperstimulation syndrome).

Success rates
The percentage of ZIFT cycles resulting in a baby is similar to that of IVF – about 22 percent.

Cost
$15,000 to $25,000.

Donor eggs and embryos

Using IVF techniques, an egg donated by another woman is mixed with your partner's sperm and transferred to your uterus. If you use a donor embryo, you take medications to prepare your uterine lining for pregnancy before the embryo or embryos are transferred to your uterus.

Side effects and drawbacks

• You may feel a sense of loss at not having a baby who is genetically yours.
• Choosing the egg (or embryo) donor can be a long process.
• Your risk of having twins or more is higher if you transfer multiple embryos.

Success rates
These are the estimated chances of giving birth to a child using donor eggs or embryos:

• With fresh donor eggs, about 50 percent.
• With a frozen embryo from a previous donor egg cycle, about 38 percent.
• With embryos created from frozen donor eggs, about 43 percent.
• With frozen donor embryos, about 37 percent.

Cost

• A fresh donor egg IVF cycle: $20,000 to $30,000, including compensation for the donor
• A frozen donor egg cycle: around $16,000
• A frozen donor embryo cycle: $5,000 to $9,000

Gestational surrogacy

A gestational carrier carries your embryo, or a donor's embryo, to term and then signs away all her parental rights.

Side effects and drawbacks
Gestational surrogacy is legally complex and emotionally draining. It requires a considerable amount of money, time, and patience to succeed. You may also feel like you don't have control over the pregnancy – from what the carrier eats to how she handles stress. Carefully choose someone you can communicate with.

Success rates
In recent years in the United States, for women who used their own eggs and a gestational carrier, these are the percentages of IVF cycles that lead to a live birth:

• 49 percent for women age 34 and under
• 33 percent for women age 35 to 37
• 29 percent for women age 38 to 40
• 19 percent for women age 41 to 42
• 11 percent for women age 43 and over

Cost
Most couples work through an agency, which can cost about $150,000 for the entire process.

About $25,000 to $35,000 goes to the gestational carrier. The rest goes to your carrier's expenses and insurance costs as well as the cost of IVF treatment and legal, administrative, and counseling fees set by lawyers and the agency.