When standard fertility treatments like artificial insemination or in vitro fertilization aren’t the right fit, you might wonder what kinds of options are left for getting pregnant. The good news is there are more than you might think.
Indeed, the routes to conception are more varied than ever. Here’s a look at some of the lesser-known procedures you might not be aware of, plus how to tell which treatments could be the right fit for you.
Sperm washing
Sperm washing is a process where healthy sperm with good motility are separated from unhealthy sperm with poor motility and semen. The procedure is used to increase the chances for fertilization for treatments like in vitro fertilization (IVF) and intrauterine insemination (IUI).
How it works: Fresh or frozen, thawed semen is placed in a centrifuge to separate out healthy, motile sperm from unhealthy, non-motile sperm. The good sperm is purified to remove potentially toxic substances or fluids, making it better able to potentially fertilize the egg.
Potential risks or downsides of sperm washing Sperm washing is done to boost the chances of success for IUI and IVF, so there aren’t any downsides.
Sperm washing success rate: 5 to 20 percent for IUI, and depending on your age, ranging from 4 to 50 percent for IVF, with women under 35 having the highest chances of conceiving.
Cost of sperm washing: The price of sperm washing is factored into the bigger procedure that’s being performed. A cycle of IVF typically costs between $15,000 to $25,000, while IUI usually costs about $1,000. Some states require coverage for some or all of the costs of fertility treatments like IUI and IVF. If your plan covers the overarching treatment, the sperm washing process would be covered as well.
At-home artificial insemination
Think of it as sex, deconstructed. Couples who want to try a more low-tech or private fertility technique might opt for home insemination. Single women or lesbian couples also might also try at-home AI before doing artificial insemination at the doctor’s office.
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How it works: For at-home artificial insemination, a man provides a semen sample and a woman inserts it into her vagina when she’s ovulating. If you’re using donor sperm, you’ll carefully thaw the vial containing sperm according to the sperm bank provider’s directions. The semen can be inserted with a needleless syringe (which you can buy as part of a home insemination kit), a cervical cap or a diaphragm.
Potential risks or downsides of at-home insemination: There are more than you might think. It’s possible to perforate your uterus or get an infection if the insertion is too deep or done incorrectly. There are also potential legal issues to navigate, since inseminating yourself with donor sperm outside of a medical setting might not terminate a sperm donor’s parental rights. Finally, at-home AI is unlikely to work if you have ovulation problems.
At-home artificial insemination success rate: For heterosexual couples, at-home AI isn’t any more likely to help you get pregnant than having sex. The chances for conceiving through either sex or at-home AI decline with age. One study found a 69 percent success rate for women under 33 and a 25 percent success rate for women over 36 after six tries.
Cost of at-home artificial insemination: At-home AI is a DIY process. If you’re using your partner’s semen, you only have to pay for any equipment you’d need to insert the sperm, like a needless syringe or at-home AI kit. If you’re using donor sperm, expect to pay $600 to $1,000 per vial. Some health plans may cover the cost of donor sperm.
Intracytoplasmic sperm injection (ICSI)
ICSI takes IVF a step further, bypassing some of the initial steps of fertilization to increase the chances for success. It’s performed in more than half of IVF procedures, often when there’s a known issue with male infertility, like very low sperm count, low sperm motility or poor sperm quality. It’s also a next possible step for couples 35 and over who haven’t succeeded with standard IVF.
How it works: Instead of combining eggs and sperm in a petri dish, a single sperm is injected directly into an egg to jumpstart the fertilization process and up the chances for conception.
ICSI success rate: ICSI fertilizes 50 to 80 percent of eggs. Once that happens, the success rate is the same as traditional IVF — as high as 50 percent for women under 35, but as low as 12 percent for women ages 41 to 42.
Possible risks or downsides if ICSI: IVF is an invasive procedure, and you’ll need to take hormone shots before your eggs can be harvested for fertilization, which can cause unpleasant side effects. Implanting more than one fertilized egg also makes you more likely to have twins or multiples, which ups the odds for possible complications.
Some older research suggested a link between ICSI and slightly higher chance for chromosomal abnormalities, autism and some birth defects compared to conventional IVF. But larger, more recent studies have found the risk to be small. And it may not be related to ICSI itself.
Initially, some experts thought that ICSI could have a negative impact on embryo quality. But now it’s suspected that the slightly higher birth defect risk may stem from the fertility problems that caused a couple to undergo ICSI in the first place. Your fertility specialist can help you weigh the pros and cons of ICSI to decide what’s best for you.
Fertility surgeries
Certain health conditions can cause problems that make it harder for sperm to reach the egg. But sometimes, undergoing surgery to fix the problem can up the chances for getting pregnant.
If you have uterine fibroids, pelvic inflammatory disease, endometriosis, Asherman’s syndrome or another condition causing a blockage or scar tissue, reproductive surgery to address these issues might be right for you.
How it works: Surgery can remove fibroids and the blockages caused by them, for example. The same goes for scar tissue in the fallopian tubes, ovaries or uterus, which can occur because of pelvic inflammatory disease, endometriosis or Asherman’s syndrome.
Potential risks or downsides of fertility surgeries: Most surgeries are expensive (unless considered “medically necessary” and covered by your insurance), and many can be invasive. There may be other downsides related to your specific condition or procedure, so talk with your doctor about the possible risks and benefits.
Success rate of fertility surgeries: Again, it varies based on your specific health problem and the severity of symptoms. One study showed 35 to 53 percent of women were able to get pregnant after undergoing surgery for endometriosis, while around 50 percent of women are able to get pregnant after having uterine fibroids removed.
Cost of fertility surgeries: Anywhere from thousands to tens of thousands of dollars, though it varies widely depending on your condition, the surgery needed to correct it and your health insurance plan. Most surgeries performed to improve fertility are covered by insurance, with the exception of surgery to reverse a tubal ligation.
Embryo adoption
Instead of adopting a child that’s already born, a couple or individual adopts an embryo from another couple. Embryo adoption might be right for couples who can’t conceive with their own egg and sperm, but the woman is still likely to be able to carry a pregnancy. It can also be an option for women who want to have a child without a partner, if she’s not able to conceive with her own egg and donor sperm.
How embryo adoption works: Couples undergoing IVF might choose to donate surplus embryos they don’t need, and those embryos can be frozen and adopted by another couple. The adopted frozen embryo is implanted using the same procedures as those in IVF. The process can take much longer than traditional IVF though, since it requires finding an embryo to adopt that fits the criteria you’re looking for.
Potential risks or downsides of embryo adoption: You’re still preparing your body for implantation with hormonal treatments, so you’re subject to the same unpleasant side effects. Getting matched with a donor family could be a lengthy process too. There’s also the fact that most donor embryos are coming from couples who had their own fertility struggles, which could increase the chances for pregnancy complications or birth defects.
Success rate of embryo adoption: On average, around 37 percent. But it can vary depending on the quality of the embryo you receive. Age matters too — women in their late 30s and 40s are less likely to have success compared to those under 35.
Cost of embryo adoption: As little as $3,000 if you’re obtaining an embryo without a fee, or as much as $20,000 if you’re relying on an agency to match you with a donor. Depending on your policy, undergoing fertility treatments to implant the embryo may be covered.
More options
Are there other potential fertility treatments to explore? These options haven’t shown as much success, but for some couples, they might still be worth considering.
- Assisted hatching An IVF cycle can fail when an embryo has trouble implanting itself onto the uterine wall. Assisted hatching is a lab procedure that uses either a laser or an acidic solution to put a small “crack” in the outer protective layer of the embryo. It can potentially make the implantation process more successful. But so far the technology hasn’t improved live birth rates.
- Endometrial scratch This involves “scratching” the uterine lining with a thin catheter, which is thought to spur the release of certain hormones that can make embryo implantation more likely. But it hasn’t been shown to improve pregnancy or live birth rates.
- Gamete intrafallopian transfer (GIFT) This procedure is similar to IVF. But instead of mixing the egg and sperm in a petri dish, the egg and sperm are transferred directly into the fallopian tube (this is done laparoscopically, through a small incision in the abdomen). It was designed for couples who are uncomfortable with conception occurring outside the body for religious reasons and requires normal sperm function and fallopian tubes. Experts used to think that GIFT upped the chances that an embryo would implant. But as IVF technology has improved, GIFT has become outdated and is rarely, if ever, used today.
- Zygote intrafallopian transfer (ZIFT) ZIFT is similar to GIFT, but the egg and sperm are fertilized in a lab before being placed laparoscopically into the fallopian tube. Like GIFT, it’s rarely used now that IVF technology has improved.
If you’re looking into fertility treatment, artificial insemination and in vitro fertilization are far from your only choices. There are options and technologies out there to meet the needs of so many different couples with so many different circumstances.
So figure out what feels right to you and your partner, then start the conversation with your fertility doctor. Together you can decide on the best route to try for a baby.
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