Simple fertility treatments

At NYC IVF, we aim to use the simplest fertility treatment that offers a reasonable chance of pregnancy first. It’s deeply satisfying, for us and for our patients, to help people conceive with minimal intervention rather than advanced technology whenever possible.

Before you start trying

Preconception counseling is well worth considering before you try to conceive, because it can uncover medical or genetic issues that can be prevented.

Lifestyle changes help too: avoid smoking and excessive coffee. Women should also take a daily prenatal vitamin that contains folic acid.

Timed intercourse

For most couples, timing intercourse is the first step toward conception. Having intercourse three times a week gives the best chance of natural conception without tracking ovulation.

If you’d like to track ovulation, over-the-counter ovulation prediction kits are more accurate than checking cervical mucus or basal body temperature. When a kit detects a hormone surge, ovulation usually follows 1 to 2 days later. Ultrasound can also confirm that a follicle is developing. Start having intercourse the day after the surge and continue for 3 days in a row.

Your chances of natural conception

The chance of conceiving naturally declines as a woman gets older and the longer a couple has been trying without success. It starts to drop at around age 30.

In general, couples have about a 20% chance of pregnancy each cycle during the first 6 months of trying, and about 10 to 15% each cycle in the next 6 months. About 80% of couples conceive by the end of the first year. The monthly chance keeps falling, to 3 to 5% toward the end of the second year (when about another 10% conceive) and about 1% a month in the third year (when fewer than 5% conceive).

Ovarian stimulation and IUI

In many situations, gentle stimulation of the ovaries (or sometimes no stimulation at all) followed by intrauterine insemination (IUI) is a simple, patient-friendly treatment. It can be a reasonable choice for women with mild male factor, an ovulation disorder or unexplained infertility.

Treatment involves:

1. Taking oral medication (clomiphene or an aromatase inhibitor) or injectable medications (gonadotropins).
2. Monitoring follicle growth with ultrasound and estrogen levels. This is the most critical step. Careful monitoring and dose adjustments are needed to avoid developing multiple follicles, which raises the risk of multiple pregnancy.
3. Triggering ovulation with an injection.
4. Preparing the sperm by washing and concentrating it, then placing it in the uterus through the cervix, followed by a few minutes of rest.

In general, the pregnancy rate with this treatment is about 10 to 15% per cycle. It’s reasonable to try it for two to three cycles before moving on to more advanced treatment. For clinic-specific IVF outcomes, see our SART-reported success rates.

The risk of multiple pregnancy

If more than one follicle develops after ovarian stimulation and IUI, a multiple pregnancy can occur, because the number of embryos that reach the uterus after ovulation can’t be controlled. As general figures, the chance of twins is about 8% after clomiphene and up to about 30% after FSH injections. The chance of triplets or more is about 1% after clomiphene and about 3% after FSH injections.

When ovarian stimulation and IUI should be avoided

Some women are likely to respond strongly to fertility medications, especially injections, and develop multiple eggs. For them, the question is whether to go ahead with stimulation and IUI or choose IVF instead, where the number of embryos placed in the uterus can be controlled.

With IVF, you and your doctor decide how many embryos to transfer. A single embryo can be transferred, avoiding multiple pregnancy and its long-term risks to the babies, and any extra embryos are frozen.

When advanced treatment is the better approach

For some women and men, advanced fertility treatment offers a higher chance of success and a safer path to pregnancy. Assisted reproductive technology also opens up options that simple treatments can’t.

Advanced treatment is often recommended for:

• Women with blocked fallopian tubes
• Severe male factor infertility
• Repeated unsuccessful IUI
• Diminished ovarian reserve
• Parents who carry a genetic abnormality
• Women at high risk of multiple pregnancy, such as women with PCOS
• Women who want to freeze their eggs for the future
• Fertility preservation for women diagnosed with cancer
• Treatment involving a gestational carrier

Advanced fertility treatment involves retrieving eggs, fertilizing them in the laboratory and growing the embryos there. Embryos can be genetically tested and frozen for later use. Learn more about IVF and ICSI.

This article is general information, not medical advice. Every situation is different, so talk with your doctor about yours.