Treatments for Diseases That Cause Infertility

Specific treatments for diseases that sometimes cause infertility can sometimes also improve fertility. This section focuses on three specific conditions; visit What are the treatments for uterine fibroids? for more information on how treatments for uterine fibroids might also affect fertility. Treatments for other diseases, such as thyroid disorders, may also improve fertility in women who have them.

There are specific treatments for PCOS that may help a woman get pregnant. A more detailed description of PCOS and its symptoms is available from the NICHD PCOS topic page.

Treatments for infertility in women with PCOS include1:

  • Weight loss. Women with PCOS who lose weight are more likely to have restored ovulation and improved pregnancy rates.2
  • Medication to promote ovulation. Clomiphene is the most common treatment for infertility in women with PCOS. Studies have shown that in women with PCOS, those who took clomiphene were six times more likely to get pregnant than those who did not. However, a recent study found that a newer drug, letrozole, also known as Femara, improves the receptivity of the uterus lining in women with PCOS.3
  • Insulin-sensitizing medication. A medication called metformin treats diabetes and can also help improve menstrual cycles and ovulation in women with PCOS. Use of metformin may help regulate the hormones that affect the menstrual cycle, but so far there is no evidence that metformin treatment increases the rate of pregnancy in women with PCOS.
  • A combination of clomiphene and metformin. In women with PCOS who do not respond to clomiphene by itself, adding metformin may slightly increase the rate of pregnancy.
  • Hormone therapy. Gonadotropins and hCG are types of hormones used to treat women who do not respond to clomiphene and/or metformin.4,5
  • Fertility treatments. ART, such as IVF, also may help women with PCOS get pregnant.
  • Surgery. Ovarian drilling is a surgical treatment that can stimulate ovulation in women with PCOS. The procedure is usually done through a small incision near the belly button, with the woman under general anesthesia. A laser or electrocautery (a process that destroys tissue using heat current) is used to destroy parts of the ovaries. This surgery is not commonly used. But it can be an option for women who are still not ovulating after losing weight and trying fertility medicines. Studies of women with PCOS have shown that ovarian drilling results in an 80% ovulation rate and a 50% pregnancy rate.6

There are specific treatments for endometriosis. A more detailed description of this topic can be found on the NICHD topic page on endometriosis.

Treatments for the infertility that can occur with endometriosis include:7,8

  • Surgery to remove the patches of tissue caused by endometriosis can improve a woman's chances of getting pregnant. Some studies suggest that surgical treatment of endometriosis can double the pregnancy rate.
  • ART, which can improve the chances for getting pregnant among women with endometriosis.

There are currently no treatments that increase fertility among women with POI.6 However, women with POI can use ART and become pregnant with the help of an egg donor.9 More information about this condition is available on the NICHD POI topic page, which includes a discussion of treatments for POI symptoms and associated conditions.

Citations

  1. American College of Obstetricians and Gynecologists. (2015). FAQ: Polycystic ovary syndrome. Retrieved January 11, 2016, from http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS external link
  2. Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2011). Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews, 2, CD007506.
  3. Wallace, K. L., Johnson, V., Sopelak, V., & Hines, R. (2011). Clomiphene citrate versus letrozole: Molecular analysis of the endometrium in women with polycystic ovary syndrome. Fertility and Sterility, 96(4), 1051–1056. Retrieved January 6, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/21851939 [top]
  4. Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: Etiology, pathogenesis, and diagnosis. Nature Reviews.Endocrinology, 7, 219–231.
  5. Vause, T. D., Cheung, A. P., Sierra, S., Claman, P., Graham, J., Guillemin, J. A., et al.; Society of Obstetricians and Gynecologists of Canada. (2010). Ovulation induction in polycystic ovary syndrome. Journal of Obstetrics and Gynaecology Canada, 32, 495–502.
  6. American College of Obstetricians and Gynecologists (2002, reaffirmed 2008). Management of infertility caused by ovulatory dysfunction. ACOG Practice Bulletin No. 34. Obstetrics and Gynecology, 99(2), 347–358.
  7. Practice Committee of the American Society for Reproductive Medicine. (2012). Endometriosis and infertility: A committee opinion. Fertility and Sterility, 98(3), 591–598.
  8. Jacobson, T. Z., Duffy, J. M., Barlow, D., Farquhar, C., Koninckx, P. R. & Olive, D. (2010). Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database of Systematic Reviews, 20(1), CD001398.
  9. National Library of Medicine. (2014). Premature ovarian failure. Retrieved January 13, 2016, from http://www.nlm.nih.gov/medlineplus/prematureovarianfailure.html
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