HealthSquare: Overcoming Infertility page 3 Treatments

A number of fertility drugs are available today. The choice depends on the specific cause or causes of a couple's problem. Drugs used to stimulate ovulation in women who don't ovulate naturally include clomiphene (Clomid, Serophene), bromocriptine (Parlodel), human menopausal gonadotropin (HMG), follicle­stimulating hormone (FSH), and gonadotropin­releasing hormone (GnRH).

Clomiphene is used most often. The drug can induce ovulation in 80 to 85 percent of women who take it; the resulting pregnancy rate is 40 to 50 percent, with slightly increased chance of multiple births (twins, triplets, or more).

Bromocriptine is reserved for women whose bodies generate too much of the hormone prolactin. Excessive levels of prolactin can disrupt the reproductive hormonal cycle by blocking FSH and LH, the two key hormones that promote growth and release of an egg (for more information, see chapter 17, “How the Reproductive System Works”). By restoring a normal hormonal balance, bromocriptine can induce ovulation in 80 percent of infertile women who take it.

Treatment with other hormones such as HMG and GnRH is still being explored, but they might be tried if the other drugs aren't working.

Surgery

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If HSG or laparoscopy reveals an abnormality that can be repaired mechanically, your doctor may recommend surgery. This approach is usually best if you have adhesions (scar tissue), endometriosis, uterine fibroid tumors, or a physically abnormal uterus. Operations to correct these problems usually require hospitalization for several days and recovery at home for several weeks.

Assisted Reproductive Techniques

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Modern technology has made pregnancies possible that would never have happened a few decades ago. Here's an overview of available techniques.

Artificial Insemination

Artificial insemination can be performed with your partner's sperm (Husband Insemination) or an unknown donor's sperm (Donor Insemination). The physician inserts a syringe containing a prepared sperm sample into the vagina and releases the solution into the cervical opening. The technique is used mostly for sperm problems but is also helpful when intercourse can't take place often enough to conceive.

WHEN THE PROBLEM IS FAILURE TO OVULATE

The growth and release of a mature egg from the ovary depends on a precisely orchestrated—and easily interrupted—series of hormonal signals. For most infertile women, drugs that boost or supplement these signals are sufficient to trigger ovulation. Clomiphene citrate (Clomid, Serophene) works by coaxing an increased output of reproductive hormones from the pituitary gland. A more direct approach supplies the necessary hormones by injection. First a follicle stimulating hormone such as Metrodin or Pergonal is administered for 7 to 12 days. Then a single shot of the hormonal medication Profasi jump-starts release of the egg.

Intrauterine Insemination

If the cause of infertility is suspected to be the quality of the cervical mucus or an inability of the sperm to move toward the egg fast enough, intrauterine insemination can be tried. Bypassing the cervix, sperm are deposited directly into the uterus, from which they swim into the fallopian tubes. Conception rates for this technique range from 30 to 42 percent when cervical mucus is the problem and 14 to 43 percent when inadequate sperm are responsible. As in artificial insemination, sperm can be taken from your partner or a donor.

In Vitro Fertilization

July 25, 1978, marked the birth of the first “test­tube” baby. That landmark child was conceived outside the human body and implanted in her mother's uterus with a technique called in vitro fertilization (IVF). Today thousands of children conceived in vitro are leading healthy lives.

IVF, which requires a team of experts and takes several days, consists of four basic steps.

(1) The woman takes drugs that stimulate ovulation. A day and a half later, the doctor removes the eggs from her body. The eggs, which used to be “harvested” with laparoscopy in the hospital, can now be removed in the doctor's office.

(2) Meanwhile sperm are obtained form the partner or donor, usually on the same day the eggs are harvested.

(3) In a laboratory, eggs and sperm are combined in a special solution (culture medium) and the egg is fertilized.

(4) A solution containing the fertilized egg (embryo) is inserted through the cervical canal into the uterus. This transfer procedure usually takes place at least 48 hours after fertilization. The woman rests for at least 3 hours before going home.

While the success of IVF varies widely among doctors and institutions, the pregnancy rate is about 20 percent. Approximately three­fourths of these pregnancies continue to a successful delivery.

Gamete intrafallopian transfer (GIFT), another in vitro technique, is identical to IVF except that fertilization occurs in the woman's fallopian tube rather than in a test tube. The harvested eggs and prepared sperm are inserted into the fallopian tube at the same time. From there, the fertilized egg travels to the uterus, as it would under ordinary circumstances. Success rates for GIFT are slightly higher than for IVF. Because IVF is less costly, it's worth trying before the more expensive GIFT techniques. Researchers continue to explore new methods.

Key Points

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Remember: timing and time are both critical factors in successful conception. Because the window of opportunity closes just 12 hours after ovulation, even the most fertile of couples has only a 20 percent chance of conceiving a child each month.

However, you have another 1 in 5 chance the following month—and the month after that—steadily increasing your cumulative odds of success. That's why time is so important. The majority of couples whose fertility evaluations turn up no identifiable problems will conceive a child unassisted within 2 years.

Patience, indeed, is among the most important of infertility therapies. Still, when you've been waiting 1 year, or 2 years, or more, hope founded on statistical odds can be little consolation. If you find your patience running out, remember that there are support groups to turn to across the nation. Ask your doctor or the nursing department of a local hospital for the organizations in your area