Fertility treatments come in three levels of rising complexity: clinical and medication optimization, low-complexity assisted reproduction (timed intercourse and IUI) and high-complexity assisted reproduction (IVF, ICSI, gamete donation and PGT). Responsible reproductive medicine starts with the least invasive option and moves up only as needed.
Indicated for most cases with a defined diagnosis. It takes 3 to 6 months to evaluate the results.
| Level | Treatment | What it is |
|---|---|---|
| 2 | Timed intercourse | Ovulation induction, monitoring and guidance on having sex at the ideal moment |
| 2 | Intrauterine insemination (IUI) | Sperm processed in a lab and placed directly into the uterus at the moment of ovulation |
| 3 | IVF | Ovaries stimulated, eggs collected and fertilized in the lab, embryos transferred to the uterus |
| 3 | ICSI | A variation of IVF: a single sperm injected directly into each egg |
| 3 | Gamete donation | The use of donor eggs or sperm |
| 3 | PGT | Genetic analysis of the embryos before the transfer |
Each level has its own indications. IUI, for example, is indicated for mild male factor, cervical factor, unexplained infertility, lesbian couples and single women, while the classic indication for ICSI is severe male factor.
Gamete donation is indicated in premature ovarian failure, severely reduced ovarian reserve with advanced age, azoospermia with no possibility of extraction, or serious genetic conditions. PGT is indicated in advanced maternal age (35+), recurrent miscarriage, implantation failure in IVF, or a family history of genetic conditions.
As a general rule, the book lays out the treatment ladder like this:
Skipping rungs can be justified in specific cases, such as advanced age or severe diagnoses. The book's diagnosis chapter gives examples: in tubal factor, IVF is frequently the most direct path, and in some cases of endometriosis IVF comes directly. Where you start is a decision to make with your specialist.
The treatment ladder is Chapter 34 of Map to the Positive, in Station IV (Signs). Before it, the station helps you reach the right diagnosis: when to see a specialist, the red flags, how to choose a doctor, the advanced tests and the 8 most common diagnoses. After it, Chapter 35 walks you through IVF phase by phase and Chapter 36 covers your mental health along the way.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: NICE Clinical Guideline CG156. Fertility problems: assessment and treatment.