After the initial assessment has been completed, a consultation between the couple and physician is usually the next step before deciding on a treatment plan. Individual considerations such as insurance coverage, time, age of the patient and underlying cause of infertility are then considered in order to decide on the best course of action.
In general, the following treatment scheme(s) can be followed.
- If the uterine cavity is normal, at least one fallopian tube is open and the semen parameters are normal enough–Clomid with or without intrauterine insemination (IUI) is attempted over 3-4 cycles. Injectible fertility medications (Follistim, Gonal-F, Repronex, Menopur, Bravelle) can then be considered with or without IUI, if clomid fails. Ultimately, if both the initial treatments fail then one canproceed with IVF. In some couples, either or both of the initial treatments may be eliminated before proceeding to IVF.
- If both tubes are badly damaged or sterilized then one can consider reconstructive surgery or IVF.
- Hysteroscopic surgery is performed in case there are any intracavitary defects such as endometrial polyps, submucosal fibroids, intrauterine adhesions or uterine septums.
- Hyperprolactinemia and thyroid dysfunction are usually treated with hormonal treatment.
- Laparoscopy- is rarely required unless there is reason to believe that there are conditions that need to be treated surgically such as tubal disease, endometriosis, etc. that a patient may benefit from to enhance her fertility.
- Depending upon the exact circumstances a combination of the above treatments may be necessary.