A Capitol 4th of July

As I worked my way to downtown D.C. for the 4th of July Parade on Constitution Avenue, I consulted several maps in both the Metro stations and on the train itself. Once at the Federal Triangle stop there were several very helpful Metro employees directing pedestrian traffic and answering questions. The combination of the maps and the personalized attention made my trip less stressful and more efficient as I made the trip from my office (after 1 IVF retrieval and 3 embryo transfers) in much less time than I anticipated.

The journey that patients are taking as they pursue fertility treatments is a lot more involved than the one that I took this morning (and it costs a lot more than a Metro Farecard). However, both maps and personalized attention can make for a better trip. My hope is that this blog and the forthcoming book “100 Questions and Answers about Infertility” are the maps that may help…but the personalized guide is up to you to find (more about that in a future post).



49. How would I know when to pursue more advanced fertility treatments?


The decision to seek out more advanced fertility treatments is a complex question, and multiple factors must be considered when making it. For most couples undergoing treatment with IUI (either alone or with fertility drugs), the best chances for success usually occur within the first four treatment cycles. After that, the likelihood for pregnancy decreases. In many of our patients, we recommend only one or two IUI treatments. If these efforts are unsuccessful, we suggest that the couple proceed with other more aggressive treatments including both natural cycle IVF and traditional IVF using injectible fertility medications.


For some patients, IUI should rarely be utilized. For example, those couples with severe tubal disease, pelvic adhesions, or severe male factor infertility may do best by directly proceeding with IVF as their first treatment option. If an age factor must be considered or if the couple has prolonged infertility (infertility lasting more than 5 years), we may recommend IVF first or attempt just a few treatments with IUI before moving to IVF.