Review of available infertility treatments.

Treatments for infertility vary in their intensity, invasiveness and associated risks. Treatment can range from medication to induce ovulation to invasive manipulation of eggs and sperm outside of the body. The type of treatment utilized is dependent upon the cause, degree and duration of infertility; the patient's age; the tolerance of side effects; the history of responsiveness and side effects in previous treatments; and the specific treatment preferences of the associated physician and facility. Infertility medications are specifically used for ovulation induction or for controlled ovarian hyperstimulation. In ovulation induction, the goal is to stimulate growth, maturation and ovulation of a single follicle. The single follicle is then fertilized secondary to timed intercourse or artificial insemination, where semen is injected directly into the uterus. Artificial insemination or intrauterine insemination can also be used with either natural or drug-induced ovulation. In controlled ovarian hyperstimulation (COH), multiple follicles are stimulated to grow and mature with medications. COH is necessary for assisted reproductive techniques (ART). The most commonly utilized type of ART is in vitro fertilization. ART are much more complex and invasive than ovulation induction in that they involve techniques to manipulate and fertilize the egg outside of the body. The goal of ART is to cause recruitment and maturation of multiple follicles. After a sufficient number of follicles have grown and matured, they are retrieved and transferred to an incubator for fertilization. The resulting embryos are returned to the uterus for implantation or cryopreserved. Both ovulation induction and ART require medications for the recruitment, development and maturation of eggs. Both techniques utilize similar medications; however, the doses of medication and the specific protocols for their use are varied. This review will discuss the range of available infertility treatments from medications alone to medications in combination with invasive medical procedures. The mechanism of action, side effects, use and effectiveness of the different classes of medications will be discussed. Because there are multiple medications in specific classes, comparisons of their protocols for use, effectiveness and side effect profiles will be detailed. Lastly, new variations of traditional assisted reproductive techniques will be presented.