At Shady Grove Fertility (SGF), we believe in a stepped-care approach to treatment, starting with the simplest, most affordable low-tech fertility treatment options first and moving up to more advanced treatments only if needed.
More than half of all the treatment cycles we do are considered low-tech and many patients find success with this route. Oftentimes, it makes sense to start with the low-tech treatment, but when fertility treatment doesn’t initially work, it becomes a question of when to consider moving forward to advanced fertility treatment to increase the chances of conception?
While IVF is one of the most successful fertility treatments ever created and has the highest per cycle success rate, many patients who pursue treatment at SGF will be able to achieve a pregnancy with less intensive treatment option.
Dr. John R. Crochet Jr., M.D., an SGF Houston physician, who sees patients at SGF’s Houston’s Beaumont and Clear Lake offices, shares insights of when to take the next steps in your fertility treatment plan.
“Many individuals and couples delay seeking fertility treatment because they are intimidated by advanced fertility treatments,” shares Dr. Crochet. “We want patients to know that low-tech fertility treatment options can be an affordable and effective first step for those trying to conceive.”
When to seek help from a fertility specialist
The first question most couples ask if they are having trouble conceiving is: When should we seek help from fertility specialist? The easiest way to answer this question is to look at the accepted guidelines based on the age of the female partner, in instances of opposite-sex couples.
SGF recommends seeing a fertility specialist if a woman is:
- Under 35 with regular cycles, unprotected intercourse and no pregnancy after 1 year
- 35 to 39 with regular cycles, unprotected intercourse and no pregnancy after 6 months
- 40 or over with regular cycles, unprotected intercourse and no pregnancy, more immediate evaluation and treatment are warranted
If there are other known conditions or you are experiencing irregular periods, you should seek help from a fertility specialist sooner. LGBTQIA+ individuals and couples and those interested in pursuing single parenthood are encouraged to seek help from a fertility specialist when they are ready to learn more about their family-building options.
Some patients will start by talking with their OB/GYN, but it’s also perfectly fine to schedule a consult with a fertility specialist.
“When you start your fertility journey, we’ll begin with a basic fertility workup that includes testing for both partners,” shares Dr. Crochet. “From there, we’ll be able to chart a path for your fertility treatment that will optimize your chances of success and could likely begin by exploring low-tech fertility treatment options.”
When to get started with Clomid or Letrozole
Most patients have the option of starting with low-tech forms of fertility treatment. In fact, many patients start with oral medications (i.e. Clomid or letrozole) while still under the care of their OB/GYN. These treatments don’t have the high success rates associated with in vitro fertilization (IVF) but they are simpler and much more affordable.
When oral medications are not working, though, it could be time to take another step in your fertility treatment journey.
“If we look at the data, we see that after 3 to 4 cycles of oral medications, the success rates drop off dramatically, even if the woman is ovulating. If she is over 35 or the couple’s infertility is unexplained, the data show that they should move on even sooner,” shares Dr. Crochet. “In fact, it’s actually been shown that it is more cost-effective to switch to more advanced treatments like IVF rather than continuing with Clomid.”
When to take the next step in your fertility treatment plan
After oral medications or speaking with their OB/GYN, the next step is visiting a fertility specialist, but that doesn’t mean jumping right into IVF. Depending on the patients’ diagnoses and age, there are still several steps a fertility specialist might recommend before IVF.
For example, patients might continue oral medications and intrauterine insemination (IUI) but add injectable medications. One thing that will change when you work with a fertility specialist is that you will be monitored with ultrasound and bloodwork throughout the stimulation phase of whichever treatment you do. That way, you and your physician will know if the medications are having the desired effect.
If a treatment cycle does not result in a pregnancy, the patient will meet with their physician to review how the cycle went and how to proceed.
In addition to one-to-one conversations with physicians, patients are also provided opportunities to speak with their nurse, professional counseling staff, and make use of SGF’s resource library and free, fertility events.
When to move forward to IVF
“Ultimately patients will make the decision on what to do moving forward with their treatment. I always provide the patient information on their cycle, the success rates, and data that we have which helps them to make the most informed decision,” offers Dr. Crochet. “If a pregnancy is not achieved within a few cycles of oral medication or IUI, we can review those cycles together and decide when to move on to IVF.”
IVF is the most successful treatment a couple can do using their own eggs and sperm. IVF is also one of the few treatment options where success rates have gone up over time due to technological advances. Women under the age of 35 have a 50% chance of getting pregnant on their first cycle. However, about 59% of women undergoing IVF will have remaining high-quality embryo(s) to freeze for a subsequent frozen embryo transfer (FET).
SGF also offers innovative financial plans to help make fertility treatment more affordable, including the Shared Risk 100% Refund Program.
When to move forward to donor egg treatment
Some patients, especially those who are over 40 or have other medical conditions that reduce the quality of their eggs, go straight to donor egg treatment. For most patients, however, the move is a result of not having success with IVF.
For these patients, it can be a hard transition, especially if they are younger,” says Dr. Crochet, “but the upside is that their chances of success can jump to over 50% when they move to donor eggs.”
For women unable to conceive using their own eggs, donor eggs allow for a woman to carry a child that is genetically linked to the male partner. Donor egg treatment also offers the highest pregnancy and delivery rates of any fertility treatment because the donated eggs come from women between the ages of 21 and 32 which coincides with these women’s peak fertility. Patients using donor eggs at Shady Grove Fertility have a 51% live birth rate with each transfer.
Extensive personal and medical histories are provided on every donor. Once a donor is chosen, the cycle is quite simple for the donor egg recipient. You will take medications that prepare your uterine lining for pregnancy. The male partner will provide a semen sample that will be used to fertilize the donor eggs. Once the embryos are ready, an embryo transfer will take place.
Bringing home a baby
When mapping out a treatment plan, it helps to focus on the end goal — bringing home a baby.
Along the way, your physician will guide you with evidence-based recommendations for the needs of your family, and the SGF community will be there to support you in whatever decisions you make.
“For people struggling to conceive, we encourage you to reach out to a fertility specialist at SGF so we can help build the family of your dreams,” shares Dr. Crochet. “We’ll take our patient-centered approach of stepped-care treatment to optimize your chances of success.”
Medical contribution by John R. Crochet Jr., M.D.
John R. Crochet, Jr., M.D., is board certified in obstetrics and gynecology (OB/GYN) as well as reproductive endocrinology and infertility (REI). Dr. Crochet received his medical degree from the University of Texas Medical Branch in Galveston. He then completed his residency in OB/GYN at the University of Texas Southwestern Medical Center in Dallas where he received commendations for his teaching and was recognized for excellence in laparoscopic and endoscopic surgery and ultrasonography.
Editor’s Note: This article was originally published in April 2021, and has been updated for content accuracy and comprehensiveness as of July 2022.
