Editing Infertility (section)

==Treatment==<!-- This section is linked from [[Pro-choice]] -->
Treatment depends on the cause of infertility, but may include counselling, fertility treatments, which include in vitro fertilization. According to [[ESHRE]] recommendations, couples with an estimated [[live birth rate]] of 40% or higher per year are encouraged to continue aiming for a spontaneous pregnancy.<ref>{{cite journal | title = Failures (with some successes) of assisted reproduction and gamete donation programs | journal = Human Reproduction Update | volume = 19 | issue = 4 | pages = 354–365 | year = 2013 | pmid = 23459992 | doi = 10.1093/humupd/dmt007 | doi-access = free | vauthors = Baird D, Bhattacharya S, Devroey P, Diedrich K, Evers J, Fauser B, etal | collaboration = ESHRE Capri Workshop Group }}</ref> Drugs used include [[clomiphene citrate]], [[human menopausal gonadotropin]] (hMG), [[follicle-stimulating hormone]] (FSH), [[human chorionic gonadotropin]] (hCG), [[gonadotropin-releasing hormone]] (GnRH) [[gonadotropin-releasing hormone analogue|analogue]]s, and [[aromatase inhibitor]]s.<ref name="Jr.2010">{{cite book| vauthors = Sabanegh Jr ES |title=Male Infertility: Problems and Solutions|url=https://books.google.com/books?id=YthJpK5clTMC&pg=PA82|date=20 October 2010|publisher=Springer Science & Business Media|isbn=978-1-60761-193-6|pages=82–83}}</ref>

=== Medical treatments ===
Clomiphene is a [[selective estrogen receptor modulator]] used to induce ovulation. It works by blocking the negative feedback from estrogen, creating a [[gonadotropin releasing hormone]] (GnRH) increase, which causes release of [[luteinizing hormone]] (LH) and [[follicle-stimulating hormone]] (FSH) from the anterior pituitary. FSH and LH act on the ovaries to increase follicle growth and lead to ovulation.<ref name="Carson 2021" /> [[Letrozole]] is an [[aromatase inhibitor]] which reduces estradiol levels and increases levels of FSH and LH, which can stimulate ovarian follicle maturation and ovulation. Letrozole is the preferred treatment in those with infertility due to PCOS and is associated with a higher pregnancy rate than other treatments.<ref name="Carson 2021" /> Both clomiphene and letrozole have a risk of a multiple gestation pregnancy, with the risk being less than 10%.<ref name="Carson 2021" /> Those with hypogonadotropic hypogonadism require pulsatile GnRH therapy, which is associated with a 93-100% pregnancy rate after 6 months of therapy.<ref name="Carson 2021" /> The risk of a multiple gestation pregnancy with gonadotropins is 36%.<ref name="Carson 2021" /> Ovarian stimulation with clomiphene, aromatase inhibitors, or gonadotropins (especially when combined with intrauterine insemination) have a risk of [[ovarian hyperstimulation syndrome]] which may occur in 1-5% of cycles and presents as [[ascites]], electrolyte abnormalities and blood clots.<ref name="Carson 2021" />

Fertility treatments or medications do not increase the risk of breast, ovarian, or endometrial cancers.<ref name="Carson 2021" />

[[Metformin]] does not increase the rate of live births in those with infertility (including in those with [[Polycystic ovary syndrome|PCOS]]), and its use is not recommended.<ref name="Carson 2021" />

In some cases, in vitro fertilization (IVF) is used, in which induced ovarian follicle stimulation is followed by the extraction of oocytes from the ovaries. The oocytes are then fertilized in vitro by sperm using [[Intracytoplasmic sperm injection]] (ICSI) and the fertilized eggs are re-introduced into the uterus in a procedure called [[embryo transfer]].<ref name="Carson 2021" /> ICSI was first developed in 1978 by [[Robert Edwards (physiologist)|Robert Edwards]] and [[Patrick Steptoe]].<ref>{{cite journal |last1=Steptoe |first1=P. C. |last2=Edwards |first2=R. G. |date=12 August 1978 |title=Birth after the reimplantation of a human embryo |url=https://pubmed.ncbi.nlm.nih.gov/79723/ |journal=[[The Lancet]] |volume=2 |issue=8085 |pages=366 |doi=10.1016/s0140-6736(78)92957-4 |pmid=79723 |access-date=27 June 2024}}</ref>

Ovarian stimulation (such as with clomiphene) combined with in-vitro fertilization or intra-uterine insemination has lower success rates with increasing age.<ref name="Carson 2021" />

Sperm or oocyte donors with in vitro fertilization and gestational carriers are sometimes used for gay couples, those with severe medical conditions that make pregnancy dangerous or preclude pregnancy, those with severe infertility, or females with a non-functioning uterus.<ref name="Carson 2021" />

[[File:IVF.jpg|thumb|263x263px|A depiction of the procedure of in-vitro fertilization]]

===Tourism===
{{Main|Fertility tourism}}
''Fertility tourism'' is the practice of traveling to another country for fertility treatments.<ref>{{cite journal | vauthors = Bergmann S | title = Fertility tourism: circumventive routes that enable access to reproductive technologies and substances | journal = Signs | volume = 36 | issue = 2 | pages = 280–288 | date = 2011 | pmid = 21114072 | doi = 10.1086/655978 | url = https://pubmed.ncbi.nlm.nih.gov/21114072/ | access-date = 27 July 2021 | url-status = live | s2cid = 22730138 | archive-url = https://web.archive.org/web/20210727144424/https://pubmed.ncbi.nlm.nih.gov/21114072/ | archive-date = 27 July 2021 }}</ref>

===Stem cell therapy===
Several experimental treatments related to [[stem cell]] therapy are not yet routinely used in reproductive medicine. These treatments may provide the opportunity for a live birth for people who lack gametes and also for same-sex couples and single people who want to have offspring. Theoretically, with this therapy, artificial gametes can be produced ''in vitro''.<ref>{{cite journal | vauthors = Vassena R, Eguizabal C, Heindryckx B, Sermon K, Simon C, van Pelt AM, Veiga A, Zambelli F | display-authors = 6 | title = Stem cells in reproductive medicine: ready for the patient? | journal = Human Reproduction | volume = 30 | issue = 9 | pages = 2014–2021 | date = September 2015 | pmid = 26202914 | doi = 10.1093/humrep/dev181 | doi-access = free }}</ref>
* Spermatogonial stem cells transplant takes place in the seminiferous tubule, with the patient experiencing spermatogenesis. This therapy is sometimes used in cancer patients, whose sperm have been destroyed due to the gonadotoxic treatment.<ref>{{cite journal | vauthors = Hermann BP, Sukhwani M, Winkler F, Pascarella JN, Peters KA, Sheng Y, Valli H, Rodriguez M, Ezzelarab M, Dargo G, Peterson K, Masterson K, Ramsey C, Ward T, Lienesch M, Volk A, Cooper DK, Thomson AW, Kiss JE, Penedo MC, Schatten GP, Mitalipov S, Orwig KE | display-authors = 6 | title = Spermatogonial stem cell transplantation into rhesus testes regenerates spermatogenesis producing functional sperm | journal = Cell Stem Cell | volume = 11 | issue = 5 | pages = 715–726 | date = November 2012 | pmid = 23122294 | pmc = 3580057 | doi = 10.1016/j.stem.2012.07.017 }}</ref>
* Ovarian stem cells may be used to generate new oocytes, which can then be implanted in the uterus after in vitro fertilization. This therapy is still in the experimental phase.<ref name="Kim 2024">{{cite journal |last1=Kim |first1=Hye Kyeong |last2=Kim |first2=Tae Jin |title=Current Status and Future Prospects of Stem Cell Therapy for Infertile Patients with Premature Ovarian Insufficiency |journal=Biomolecules |date=19 February 2024 |volume=14 |issue=2 |pages=242 |doi=10.3390/biom14020242|doi-access=free |pmid=38397479 |pmc=10887045 }}</ref>