A closer look at the data suggest that the benefit of letrozole over clomid depended on the BMI of the participants. For patients with a BMI of less than 30 kg/m2, the cumulative live birth rate was approximately 30% for each group. However, for patients with a BMI over 30 kg/m2, twice as many patients had a live birth in the letrozole group than the clomid group.

IVF may be used to overcome female infertility when it is due to problems with the fallopian tubes, making in vivo fertilisation difficult. It can also assist in male infertility, in those cases where there is a defect in sperm quality; in such situations intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg. In these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.


The AMIGOS study suggested that clomid provided the best balance of a high pregnancy rate with a reasonably low multiple rate among couples with unexplained infertility. However, the authors of the Huang study concluded that on balance letrozole was better. From our vantage point, given that clomid more commonly causes multiple eggs to be ovulated, it seems like the slightly better option between the two because the whole point of treatment in unexplained infertility patients is to increase the odds of delivery by increasing the number of eggs ovulated.
I had a wonderful experience at CHA Fertility Clinic and got pregnant on my first cycle.  My son will turn two this year and I immediately contacted them when we were thinking of having a second child.  The doctors and staff are so kind, informative, and helpful, and they really put my mind at ease.  We had looked at other fertility clinics … Read More
Those fearful of conceiving with multiples should strongly consider IVF and only transferring one embryo at a time. In these circumstances, just 1% of pregnancies lead to twins, and triplets are even more rare. Alternatively, 8 - 30% of medicated IUI pregnancies lead to twins. Finally, the least preferable circumstance is do to IVF with multiple embryo transfer, where in women under 38 years of age, 30% of pregnancies culminate in a multiple birth.

Treatment with Clomid tablets plus IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. This pregnancy rate holds up for about 3 tries and the success rate is considerably lower after that. More about success rates with IUIs is on the insemination page and on the Clomid for unexplained infertility page. The insemination component boosts fertility more than the Clomid does - but success rates are higher when both are used together.
A 2013 review and meta analysis of randomised controlled trials of acupuncture as an adjuvant therapy in IVF found no overall benefit, and concluded that an apparent benefit detected in a subset of published trials where the control group (those not using acupuncture) experienced a lower than average rate of pregnancy requires further study, due to the possibility of publication bias and other factors.[34]
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle into the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.
Wondering if it’s time to seek fertility help from a specialist? Your age can help clue you in to the answer. If you’re younger than 35, it’s perfectly normal for it to take six months to a year to conceive. If, after a year, you haven’t accomplished your conception goal, you’ll want to talk with your practitioner and/or get a referral to a fertility specialist. If you’re older than 35, experts recommend that you seek help from a fertility specialist after six months of regularly trying to conceive without birth control — and you may even want to go after three months. If you’re over 40, you’ll probably want to start off your quest for a second pregnancy with a fertility evaluation from your doctor. Ditto if your partner is over 40, since 35 to 40 percent of fertility problems can be traced back to the man, and a guy’s age affects the quality of his sperm.

PCOS: Polycystic ovarian syndrome (PCOS) is an ovarian issue that can cause irregular menstrual cycles and make it difficult for women to ovulate — a crucial part of the conception and pregnancy process. Women with PCOS do not release eggs regularly, and their ovaries often have many small cysts within. IVF is a strong option for women with PCOS, since it can help their bodies ovulate to achieve pregnancy.
Talk it out. Once you realize you’re entitled to your emotions, find an outlet for them. Talking about your feelings and your struggles can be a huge release and allow you to receive the support you need. If your family or friends don’t understand your sadness (or you find it hard to contain your baby envy around friends with more than one child), seek out people in your same situation. Find a support group for people with secondary infertility — online or in your area. And consider joining WTE's Trying to Conceive group to find moms who are also coping with secondary infertility.
Dr. Gorka Barrenetxea provides us with a practical case of secondary infertility that occurs more commonly than one may think. A couple, throughout their lifetime, can have children with 20, 25, 30 and 35 years, but when they decide to have a second or third child, they may encounter trouble conceiving due to the passage of time itself, Dr. Barrenetxea states.

Many women spend much of their early adult lives trying not to get pregnant. But when you finally do want to start a family and it doesn’t happen right away, it can leave you feeling frustrated. Not to mention, trying to get pregnant month after month unsuccessfully can be emotionally taxing. You should know that you are not alone, and that unexplained infertility is exactly that– unexplained– so no finger pointing as to who is at fault!


The diagnosis is one of exclusion — that is, one which is made only after all the existing tests have been performed and their results found to be normal. This is why the frequency of this diagnosis will depend upon how many tests are done by the clinic — the fewer the tests, the more frequent this diagnosis. And the better the tests, the more likely you are getting a diagnosis instead of being told it's "unexplained."
First, consider where the information about the success rates is coming from. Generally speaking, IVF success rates in the United States comes from the clinics themselves or from the Center for Disease Control and Prevention. The Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine both contribute to the CDC data.
Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.
Obviously, if the same couple decides to have more children at age 38, the chances won't be 25% anymore; it is likely that they are about 10%, which translates into a reduced pregnancy chance. This does not mean the couple has become infertile. Since they weren't absolutely fertile at age 32, it is only logical that their pregnancy chances at 38 are so low.
Step on the scale. Have you put on some extra pounds since your last baby was on board? Or maybe you’ve lost a lot of weight (because after all, who has time to eat when you’re running after a little one)? Your weight can impact your fertility, so getting as close as possible to a healthy BMI can also help get you closer to that second pregnancy you’re hoping for.
^ Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM (2013). "The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis". Human Reproduction Update. 19 (6): 696–713. doi:10.1093/humupd/dmt026. PMC 3796945. PMID 23814102.

Stay positive. Search for success stories — there are so many out there. Look within your personal network or support groups to find other women who have similar experiences with infertility. Connect with them and share your stories. Learn what they have done, what doctors they have worked with, and what contributed to their successful pregnancies.
I used to have a neighbour I would do almost anything to avoid. An elderly lady, she was given to jam-making, church-going and patrolling the local streets. If I saw her coming, I would dive back inside my front door or seize my son's hand and gallop to our car. I once twisted my ankle in an effort to escape her. Whenever she saw me she would utter the words, "If you don't get your skates on and give that child a brother or sister he's going to be a lonely only." Even now, it's hard to say what was more loathsome. Was it the boisterous intrusion of her tone, the inexcusability of the phrase "lonely only", or the idea of strapping on skates as a euphemism for – what exactly? Unprotected sex?
It’s not because you just ate a whole lot of greasy food (myth!). Sudden, out-of-control acne could be blamed on fluctuating hormones (from your period or menopause), a whole lot of stress, or a medication side effect. It may also be a sign of polycystic ovarian syndrome. That’s because in women with PCOS, ovaries make more androgen—the “male hormone”—than normal. Elevated levels may lead to adult acne flare-ups, as well as excessive facial or body hair, and even male-patterned baldness. These natural acne remedies may help your skin.
Male infertility may be caused by trouble with sperm delivery due to structural difficulties like testicle blockage or damage to the reproductive organs, sexual function concerns such as premature ejaculation, or genetic conditions including cystic fibrosis. Another root of male infertility may be abnormal sperm function or production, often due to genetic defects or health problems including diabetes or certain sexually transmitted diseases. Other risk factors include overexposure to certain environmental factors, such as alcohol, cigarette or marijuana smoke, chemicals, and pesticides, as well as frequent exposure to high temperatures (hot tubs and saunas). Specific cancers and their treatments can also be harmful to male fertility.
Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.
The stress of secondary infertility on an individual's life and relationships can be significant. It can be hard to find support from family and friends, especially when a woman or couple already has/have children. Sentiments such as, "you should be grateful for what you have," or, "just keep trying," almost never serve as useful advice or support. Couples and single parents can even experience resentment from other couples with infertility who are unable to even have their first child.
IVF has many steps, and it takes several months to complete the whole process. It sometimes works on the first try, but many people need more than 1 round of IVF to get pregnant. IVF definitely increases your chances of pregnancy if you’re having fertility problems, but there’s no guarantee — everyone’s body is different and IVF won’t work for everyone.
The likelihood of a diagnosis of unexplained infertility is increased substantially in women 35 and over - and greatly increased in women over 38. The reason for this is that there are more likely to be egg quantity and quality problems as women age. Since we do not have a "standard category" called egg factor infertility, these couples sometimes get lumped in to the "unexplained" infertility category.
The ultrasound is to check the size of your ovaries. Your doctor will also look for ovarian cysts. If there are cysts, your doctor will decide how to deal with them. Sometimes your doctor will just delay treatment for a week. Most cysts resolve on their own with time. In other cases, your doctor may aspirate the cyst (suck out the fluid) with a needle.
Women who switch from IUI to IVF sooner or begin with IVF get pregnant quicker than those who stick or start with IUI. One study found that undergoing immediate IVF resulted in superior pregnancy rates with fewer treatment cycles compared to those who did two rounds of IUI before switching to IVF.  While the immediate IVF group got pregnant quicker, the overall success after up to 6 IVF cycles was similar.
The eggs are retrieved in a simple process which takes about 15-20 minutes and is carried out in the doctor’s office under light sedation. The ovaries are accessed through the vaginal cavity and each of the follicles containing an egg is punctured. The fluid containing the eggs is aspirated through a very fine needle. The patient rests for a brief time and can then go home with an escort. Usually, the patient feels back to normal the day after.
Risk of ectopic pregnancy. Women who have difficulty getting pregnant have an increased risk for ectopic pregnancy, regardless of how they conceive. And all assisted reproductive technology treatments, including IVF, also make an ectopic pregnancy more likely. An ectopic pregnancy occurs when an embryo implants in a fallopian tube or the abdominal cavity rather than in the uterus. It's treated with the medication methotrexate or by surgically removing the embryo to prevent it from severely injuring the mother by continuing to grow.
Additionally, couples may turn to assisted reproductive technology, the most common of which is in vitro fertilization (IVF). Other techniques may include special injections or using a donor's eggs or sperm. Complications can sometimes occur, the most common being bleeding or infection; ovarian hyperstimulation syndrome, in which the ovaries become swollen and painful; and multiple pregnancies.

For couples who have no difficulty achieving a pregnancy, the natural chance of pregnancy per month of ovulation is largely dependent on the age of the woman. For women in their early 30s or younger, the natural pregnancy rate is about 20 to 25 percent per cycle. This drops off significantly through her mid-to late-30s; by her early 40s, the chance of pregnancy is about 5 percent per cycle. This age-related decrease is primarily due to a decline in the quality of the eggs within the ovaries.


Women who switch from IUI to IVF sooner or begin with IVF get pregnant quicker than those who stick or start with IUI. One study found that undergoing immediate IVF resulted in superior pregnancy rates with fewer treatment cycles compared to those who did two rounds of IUI before switching to IVF.  While the immediate IVF group got pregnant quicker, the overall success after up to 6 IVF cycles was similar.
While it’s always recommended to consult with a medical provider before making any treatment decisions, this article serves as a great jumping point for those looking to get pregnant using assisted reproductive technologies (ART). In it, we discuss everything you need to know about IUI and IVF.  We start things off with a high-level overview, then jump into the different types of each treatment, discuss treatment details, key decisions within each treatment, success rates, cost comparisons, risks, and who each treatment might be a good fit for.

Laboratories have developed grading methods to judge ovocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos.[72] Since 2009 where the first time-lapse microscopy system for IVF was approved for clinical use,[73] morphokinetic scoring systems has shown to improve to pregnancy rates further.[74] However, when all different types of time-lapse embryo imaging devices, with or without morphokinetic scoring systems, are compared against conventional embryo assessment for IVF, there is insufficient evidence of a difference in live-birth, pregnancy, stillbirth or miscarriage to choose between them.[75] Active efforts to develop a more accurate embryo selection analysis based on Artificial Intelligence and Deep Learning are underway. Embryo Ranking Intelligent Classification Assistant (ERICA),[76] is a clear example. This Deep Learning software substitutes manual classifications with a ranking system based on an individual embryo's predicted genetic status in a non-invasive fashion.[77] Studies on this area are still pending and current feasibility studies support its potential.[78]


Low weight: Obesity is not the only way in which weight can impact fertility. Men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. For women, being underweight and having extremely low amounts of body fat are associated with ovarian dysfunction and infertility and they have a higher risk for preterm birth. Eating disorders such as anorexia nervosa are also associated with extremely low BMI. Although relatively uncommon, eating disorders can negatively affect menstruation, fertility, and maternal and fetal well-being.
The goal of this treatment is to increase the number of sperm that reach the Fallopian tube and subsequently increase the chance of fertilization. IUI provides the sperm an advantage by giving it a head start, but still requires the sperm to reach and fertilize the egg on its own. Depending on your fertility diagnosis, IUI can be coordinated with your normal cycle or with fertility medications.
Obesity: The obesity epidemic has recently become is a serious issue, particularly in industrialized nations. The rising number of obese individuals may be due in part to an energy-rich diet as well as insufficient physical exercise.  In addition to other potential health risks, obesity can have a significant impact on male and female fertility. BMI (body mass index) may be a significant factor in fertility, as an increase in BMI in the male by as little as three units can be associated with infertility. Several studies have demonstrated that an increase in BMI is correlated with a decrease in sperm concentration, a decrease in motility and an increase DNA damage in sperm. A relationship also exists between obesity and erectile dysfunction (ED). ED may be the consequence of the conversion of androgens to estradiol. The enzyme aromatase is responsible for this conversion, and is found primarily in adipose tissue. As the amount of adipose tissue increases, there is more aromatase available to convert androgens, and serum estradiol levels increase. Other hormones including inhibin B and leptin, may also be affected by obesity. Inhibin B levels have been reported to decrease with increasing weight, which results in decreased Sertoli cells and sperm production. Leptin is a hormone associated with numerous effects including appetite control, inflammation, and decreased insulin secretion, according to many studies. Obese women have a higher rate of recurrent, early miscarriage compared to non-obese women.
Risk of multiples. IUI with fertility medication carries a significant risk of multiple pregnancies, including higher-order multiples (triplets or more). A good clinic will carefully monitor your follicles to make sure that only a safe number are mature before the IUI, but they cannot entirely eliminate the risk. Recent advances in IVF (including blastocyst transfer) mean that most modern fertility clinics now transfer only one or two embryos per IVF cycle. As a result, the risk of multiple pregnancies for IVF patients is much lower than it used to be.
3. Painful Periods: We’re not talking about normal cramping here. But, severe pain that stops you in your tracks and even causes nausea or vomiting. Alone this may not be a sign of infertility, but combined with other symptoms like pain during intercourse, blood in the urine or during bowel movements, or irregular periods, can be signs of endometriosis–a condition that accounts for 20-40% of female infertility cases.
In general, the cost of IVF is higher than for IUI, but IVF confers the highest pregnancy rates per cycle. It is impossible to put a precise figure on the two treatments for comparison as much will depend on your personal treatment program. You can see some ballpark figures on the website of the Society for Assisted Reproductive Technology. It also contains an overview of the differences between IUI and IVF.
After your body releases an egg, the hormone progesterone kicks in to build and maintain the lining of the uterus. It makes your body temperature go up slightly. So taking your temperature with a basal thermometer every morning before you get out of bed can help you figure out if you ovulated. You can buy these thermometers at the drugstore. They're inexpensive, but they aren't as accurate as other ways of tracking ovulation.
Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta
With egg donation and IVF, women who are past their reproductive years, have infertile male partners, have idiopathic female-fertility issues, or have reached menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. After the IVF treatment some couples are able to get pregnant without any fertility treatments.[3] In 2018 it was estimated that eight million children had been born worldwide using IVF and other assisted reproduction techniques.[4]

Only 30 percent of patients who receive 100 mg of Clomiphene a day will produce more than three follicles. Patients that produce less than than three follicles have about half the chance of getting pregnant than those that produce greater than three follicles. Patients that receive fertility medications but do not do an insemination have only half the success rates compared to those who do.

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