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Female Infertility - Treatment

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Improved ovulation through fertility drugs

The primary treatment for women who are infertile due to ovulation disorders is with fertility drugs. These medications control or stimulate ovulation. In general, they work like natural hormones to initiate ovulation. Some of the most common fertility drugs include:

• Clomiphene citrate (Clomid, Serophene). For women who have PCOS or other ovulatory disorders, this drug is taken orally and helps initiate ovulation. It causes the pituitary gland to release more natural like hormones, which stimulate the growth of an ovarian follicle containing an egg.

• Human menopausal gonadotropin, or hMG (Repronex). For women who will not ovulate on their own because the pituitary gland fails to stimulate ovulation, this injected medication is prescribed.

• Follicle-stimulating hormone, or FSH (Gonal-F, Follistim, Bravelle). This medication helps stimulate the ovaries to mature egg follicles.

• Human chorionic gonadotropin, or HCG (Ovidrel, Pregnyl). This drug stimulates the follicle to release its egg (ovulate). Typically used in combination with clomiphene, hMG and FSH

• Gonadotropin - releasing hormone (Gn-RH) analogs. For women with erratic ovulatory cycles or who ovulate too early this medication is prescribed. Gn-RH analogs transport constant Gn-RH to the pituitary gland, which changes hormone production, so that a doctor can start follicle growth with FSH.

Fertility drugs that are injected raise the chance of multiple births. Fertility drugs taken orally also add to the chance of multiple births but at a much lower rate. Careful monitoring must accompany the use of these drugs, i.e., blood tests, hormone tests and ultrasound measurement of ovarian follicle size may be required. In general, with greater number of fetuses comes higher risk of premature labor. Premature babies are at an elevated risk of health and developmental problems.

Surgery

Depending on the cause, surgery may be a treatment option for infertility. Obstructions or other problems in the fallopian tubes may be surgically repaired. Laparoscopic techniques are used to perform slight operations on the fallopian tubes.

Endometriosis caused infertility is usually difficult to treat. Your doctor may treat you with ovulation therapy, where medication is used to activate or control ovulation. In vitro fertilization may also be used, in which the egg and sperm are joined in the laboratory and moved to the uterus.

Assisted reproductive technology (ART)

The treatment of infertility has been revolutionized by this technology. In the United States each year thousands of babies are born as a result of ART. Physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals work together as a team to help infertile couples achieve pregnancy.

The most common forms of ART include:

• In vitro fertilization (IVF). This is the most successful ART technique. With IVF mature eggs from a woman are collected and then fertilized with a man's sperm in a laboratory dish, the embryos are implanted in the uterus three to five days after fertilization. IVF is an option when both fallopian tubes are obstructed, or in cases of endometriosis, ovulations disorders and unexplained infertility. Your chances of having more than one baby at a time are increased with IVF because often multiple fertilized eggs are implanted. Frequent blood tests and daily hormone injections are required.

• Intracytoplasmic sperm injection (ICSI). A technique in which a single sperm is injected directly into an egg to achieve fertilization concurrent with the standard IVF procedure. ICSI is particularly helpful in couples that have experienced past failures to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilization.

• Assisted hatching. A technique that involves the assisted implantation of the embryo into the lining of the uterus.

Optimal conditions for ART include a woman with a healthy uterus and natural ovulation and with healthy sperm. After age 32, the achievement rate of ART gradually diminishes.

Common Treatment Barriers

Some problems exist with the treatment of infertility. These include:

• Multiple births. The top complication of ART is multiple births. In cases where too many babies are conceived, one or more fetuses may be removed to improve survival odds for the other fetuses.

• Ovarian hyperstimulation syndrome (OHSS). A woman may experience enlarged ovaries, pain and bloating if too much stimulation occurs. Symptoms that are mild to moderate often resolve with no treatment, although pregnancy may delay recovery. In rare cases, fluid accumulates in the abdominal cavity and chest, leading to abdominal swelling and shortness of breath. This fluid accumulation can deplete blood volume and lower blood pressure. Some cases may require emergency treatment.

• Bleeding or infection. There is a risk of bleeding or infection with ART.

• Low birth weight. This risk is mainly seen when multiple births occur.

• Birth defects. There is some concern regarding correlation between ART and birth defects. Additional research is needed to confirm this possible connection.

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