Infertility is one of the most common problems in obstetrician-gynecology practice. As we discussed in the previous topics, the causes of sterility are extremely diverse, which is why there are many diagnostic methods and approaches, the main goal of which is to find the cause of impossibility to get pregnant and apply the appropriate treatment. Despite numerous diagnostic methods, sometimes the cause of infertility remains unclear. The treatment of infertility depends on the age of the patient, the duration of the sterility and, of course, the cause leading to its occurrence. One of the main factors for a woman’s fertility is her age – for women up to the age of 25, the probability of getting pregnant within 6 months after the start of trying is 60%, and within a year it is 85%. This percentage decreases by half in women over 35, which is directly related to a decrease in the number of oocytes. The treatment of any woman suffering from infertility should begin with lifestyle changes, as the harmful effects of environmental factors are known. Patients working in an environment with harmful substances such as pesticides, herbicides, dioxins and other chemicals, it is recommended to leave this environment until successful pregnancy and wear of the fetus. In addition to the professional environment, harmful habits such as smoking and the intake of alcohol and caffeine in larger quantities are also important. It is recommended that patients suffering from infertility change their diet if it is incorrect, include physical activities in their daily life and reduce their body mass index (BMI) if they are overweight or obese. A change in lifestyle would only help the main infertility therapy. The actual treatment of sterility includes the following methods: 1. Stimulation of ovulation – in case of established anovulatory cycles, induction of ovulation is recommended in patients, using several groups of medications for this purpose. In case of hypothalamic amenorrhea due to missing secretion of gonadotropin-releasing hormone (GnRH), its synthetic version is administered in the form of injections. The use of exogenous gonadotropins carries the risk of hyperstimulation syndrome and multiple pregnancy. In patients with normogonadotropic amenorrhea (e.g. with PCOS), an anti-estrogen medication is prescribed – e.g. clomiphene citrate. It stimulates the production of GnRH, and hence the gonadotropins – follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Aromatase inhibitors (e.g. letrozole) are also used to stimulate ovulation. Hyperprolactinemia can also be a cause of suppressed ovulation. Dopamine antagonists are prescribed for ovulation induction in these cases – e.g. bromocriptine, cabergoline, etc. 2. Insulin sensitizing medications – metabolic syndrome is common among patients with polycystic ovary syndrome. They often suffer from insulin resistance, which is why they are prescribed insulin-sensitizing drugs such as metformin; 3.Surgical treatment – occupies a central place in the therapy of sterility. The following methods apply to surgical treatment: Ovarian fenestration, the so-called ovarian drilling – with a bipolar needle laparoscopically several holes (fenes) are made on the tunica albuginea; Plastic surgery of the fallopian tubes due to tubal factor – removal of adhesions in the fallopian tubes and restoration of their patency; Myomectomy or polypectomy – surgical removal of fibroids or polyps, which increases the chances of pregnancy. The most frequently applied method is laparoscopic; Operative hysteroscopy to remove uterine adhesions. 4. Assisted reproductive technologies (ART) – clinical and biological methods in which various stages of fertilization and early embryogenesis are carried out outside the body. The most commonly applied such methods are intrauterine insemination (IUI), in vitro fertilization (IVF), fallopian tube gamete transfer (GIFT), intracytoplasmic sperm injection (ICSI), etc. The most commonly used method is in vitro fertilization. In vitro fertilization goes through several main stages. Initially, the ovaries are stimulated and ovulation is induced. This is followed by extraction of the obtained mature eggs and their fertilization with sperms obtained from the ejaculate of the partner. The resulting embryos are cultured and after 2-5 days they are transferred into the fallopian tubes (embryo transfer). Existing infertility treatment options carry their own risks. The most common complications that can occur are multiple pregnancy, ectopic pregnancy and ovarian hyperstimulation syndrome. The treatment of infertility is a complex but not impossible task, for the solution of which you need both the support of the partners and a good team of reproductive specialists, embryologists, endocrinologists, who work together to achieve the dream of a child. Sources: Gynecology under the editorship of Prof. Dr. Angel Dimitrov, MD, PhD. and Prof. Dr. Viktor Zlatkov, MD, 2017 https://www.ncbi.nlm.nih.gov/books/NBK556033/intracytoplasmic sperm injection (ICSI) and others. The most commonly used method is in vitro fertilization. In vitro fertilization goes through several main stages. Initially, the ovaries are stimulated and ovulation is induced. This is followed by extraction of the obtained mature eggs and their fertilization with sperms obtained from the ejaculate of the partner. The resulting embryos are cultured and after 2-5 days they are transferred into the fallopian tubes (embryo transfer). Existing infertility treatment options carry their own risks. The most common complications that can occur are multiple pregnancy, ectopic pregnancy and ovarian hyperstimulation syndrome. The treatment of infertility is a complex but not impossible task, for the solution of which you need both the support of the partners and a good team of reproductive specialists, embryologists, endocrinologists, who work together to achieve the dream of a child. Sources: Gynecology under the editorship of Prof. Dr. Angel Dimitrov, MD, PhD. and Prof. Dr. Viktor Zlatkov, MD, 2017 https://www.ncbi.nlm.nih.gov/books/NBK556033/intracytoplasmic sperm injection (ICSI) and others. The most commonly used method is in vitro fertilization. In vitro fertilization goes through several main stages. Initially, the ovaries are stimulated and ovulation is induced. This is followed by extraction of the obtained mature eggs and their fertilization with sperms obtained from the ejaculate of the partner. The resulting embryos are cultured and after 2-5 days are transferred into the fallopian tubes (embryo transfer). Existing infertility treatment options carry their own risks. The most common complications that can occur are multiple pregnancy, ectopic pregnancy and ovarian hyperstimulation syndrome. The treatment of infertility is a complex but not impossible task, for the solution of which you need both the support of the partners and a good team of reproductive specialists, embryologists, endocrinologists, who work together to achieve the dream of a child. Sources: Gynecology under the editorship of Prof. Dr. Angel Dimitrov, MD, PhD. and Prof. Dr. Viktor Zlatkov, MD, 2017 https://www.ncbi.nlm.nih.gov/books/NBK556033/