Interview has been edited for clarity.
As Dr. Tiffanny Jones explains, intrauterine insemination (IUI) is a treatment for people who have unexplained infertility, meaning testing the male and female partner has turned up normal results. “We try to do that [IUI] to help more sperm get to the cervix and overcome a cervical factor or a problem with the cervical mucus that we generally wouldn’t pick up otherwise.”
She says that the other really big indicator that IUI could be useful is a mild to moderate male factor. In the event of decreased sperm counts or the reduced motility, getting the sperm to the top of the uterus can help it reach the uterine tubes to meet the eggs.
She adds, “Also, in same-sex couples where there is no male partner, using donor sperm with intrauterine insemination is a preferred method because it has better success rates than putting the sperm in the vagina and the cervix.”
Dr. Tiffanny Jones says that ovulation stimulation is prescribed for people with anovulatory cycles, generally associated with endocrine problems like hypothyroidism and hyperprolactinemia.
On the subject, Dr. Jones says, “So, either you can correct these issues, or you can help them ovulate using oral medications.”
She says that people who have polycystic ovary syndrome also don’t ovulate because their androgens are higher, adding, “And for those people taking medications to help them ovulate, either oral or injections or a combination thereof, treatment can help them release eggs that they aren’t otherwise, which is quite successful for some people.”
According to Dr. Jones, clomifene is generally used. It’s a medication that blocks estrogen receptors to make the body feel like there are low levels of estrogen, which then increases the amount of endogenous hormones that are released from the pituitary gland:
“And when there are higher hormones from the pituitary, mainly follicle stimulating hormone and luteinizing hormone, then either it’s enough to help a follicle to grow and to ovulate or to help several follicles grow and ovulate.”
Letrozole is another medication that’s used. Dr. Jones says, “It’s actually the drug of choice for people who have polycystic ovary syndrome. And it also works by blocking the enzyme that converts androgens to estrogen. So again, the body thinks that the estrogen level is low. And so, since estrogen mainly comes from the ovaries, the pituitary gland will secrete more FSH and LH to help stimulate the ovary so one or more follicles can grow.”
According to Dr. Jones, “IVF is definitely the preferred treatment for people who have tubal infertility, meaning they have both of their tubes either permanently removed or blocked. Since that’s the only way to get an egg into the uterus, you have to go straight to IVF for that.”
She explains that sometimes there’s a severe male factor infertility, where the sperm has to be retrieved directly from the testicle. “In those situations, we generally get very few sperm — not enough to do anything other than IVF to put these sperm into the egg to create an embryo.”
The success rates are much higher for IVF than any of the other treatment strategies.
Dr. Jones says that women who have already tried other options without success usually go on to IVF because it generally has much higher success rates than any of the other treatment strategies. And people who have genetic disorders or are carriers of genetic disorders that they don’t want to pass on to a child do IVF so that the embryos can be screened for that specific genetic disorder before implantation.
“And then some people want to choose the sex of the embryo, and the only way to do that is IVF with genetic testing.”
ICSI is the procedure that takes sperm and puts it directly into the egg to help with fertilization.
“We do that in times where we have very few sperm or there’s a very severe male factor infertility,” says Dr. Jones.
“We also do it when we need to do testing to make sure the embryo doesn’t carry a specific genetic disorder. So we use it when there’s male factor infertility or a genetic diagnosis for an actual genetic syndrome. And also if someone has done IVF in the past and they did conventional insemination, which is basically putting the eggs and the sperm together in a petri dish to let them meet more naturally, and nothing fertilized, then the next time we would do ICSI because sometimes there are some problems.”
Recounting her experience, Dr. Jones says, “I haven’t had a patient with a failed fertilization. ICSI is actually quite common.
“So, there was a couple, where he had a very severe male factor infertility. He had to go to a male infertility specialist to have his sperm taken directly from the testicle, which is called a TESA.
“When we got those sperm, we did the ICSI, and they made lots of embryos and were able to have a pregnancy with more embryos to freeze.
“That was a nice story because, otherwise, they wouldn’t have been able to get pregnant naturally because there were too few sperm.”
A gestational carrier is someone who carries an embryo for a couple. The embryo has no genetic relation to the person carrying it.
A surrogate sometimes means that it’s the carrier's egg and their uterus, and so, that’s done for same-sex couples in some countries. “But we really don’t do that a lot here [in the US],” according to Dr. Jones.
“Gestational carriers are needed for women who don’t have a uterus or for same-sex male couples.
“Also, sometimes, despite all that we do, a couple can make great embryos, and we transfer them and they don’t implant, which is called recurrent implantation failure. If you can’t discover why embryos aren’t implanting in the uterus, sometimes the next step is to use a gestational carrier. Usually, those are people who have had pregnancies in the past, and they have been successful.”
Egg donation is another fertility option for people who find it hard to get pregnant.
“Egg donation is generally used when someone’s own egg supply is at a level where we’re not going to get any eggs or we’re not going to get eggs of high enough quality to create an embryo,” explains Dr. Tiffanny Jones in her interview on egg donation.