Treatment for Infertility
Infertility is usually treated with clomiphene citrate, human chorionic gonadotropin, and/or intrauterine insemination. Less than 5 percent of all infertility cases are treated with in vitro fertilization or other so-called assisted reproductive technologies.
Current research also shows that the inclusion of acupuncture and certain herbal remedies can improve fertility and increase pregnancy outcomes. However, herbs should not be taken unless they are prescribed by a board-certified herbalist.
Clomiphene Citrate (CC) to Treat Infertility
CC is a drug that induces ovulation and is used as a frontline fertility treatment for both anovulatory and ovulatory women. It can be damaging to the cervical mucus, however, and should be combined with intrauterine insemination (IUI) so as to maximize the chances for conception. This drug often is contraindicated in women over the age of 35 who do not present with PCOS, as it can permanently reduce estrogen levels and cause thinning of the endometrium.
The typical initial dose is 50 mg per day from days 3-5 through days 7-9 of the menstrual cycle. Patients should use an LH kit (a kit that predicts when ovulation will occur based on the level of LH in the woman's urine) and time intercourse to maximize the chances of conception.
If ovulation occurs as a result of CC treatment, the 50 mg/day regimen should be maintained for 3 to 4 cycles. If ovulation doesn't occur, the dose can be increased by 50 mg increments. If even as much as 150 mg per day doesn't induce ovulation, then a transvaginal ultrasound should be performed to allow the physician to get a close-up view of the development of the follicle (the follicle is a cluster of cells in the ovary that change in color and shape during the different phases of the menstrual cycle).
Transvaginal Ultrasound & Infertility
Transvaginal ultrasound involves inserting an ultrasound probe into the vagina. Ultrasound waves emitted from the probe pass through the vaginal wall and bounce off the ovaries, producing an image or photograph of the ovaries. If follicular development appears normal, the next step usually involves an injection of the hormone HCG (human chorionic gonadotropin) to trigger ovulation, followed by intrauterine insemination.
Intrauterine Insemination (IUI) & Infertility
During ovulation, the cervical mucus should be abundant, clear, and slippery to facilitate the sperm's passage up through the cervical canal. If it's not, which may be the case for women on CC infertility therapy, IUI is an effective medical alternative. IUI involves separating the sperm from the seminal fluid and resuspending it in a small amount of fluid that's then placed directly inside the uterus.
Human Chorionic Gonadotropin (HCG) to Treat Infertility
Human chorionic gonadotropin (HCG) is a hormone that stimulates the ovaries and triggers ovulation. It's often used in women for whom CC medication doesn't work but in whom follicular development appears normal. HCG is a very potent fertility drug that should only be used under the guidance of a fertility specialist.
Assisted Reproductive Technology (ART) & Infertility
Even though the success of assisted reproduction has increased substantially over the past 10 years, it makes up less than 5 percent of all infertility treatments. ART is a good treatment option for couples who are infertile as a result of male infertility factors, unexplained infertility (which accounts for about 20 percent of all infertility cases), tubal factors (blockage or abnormalities in the fallopian tubes), or endometriosis. It is important that patients who might benefit from these high-tech treatments consult fertility specialists who are knowledgeable about all of the options.
In Vitro Fertilization (IVF)
The most popular ART technique is in vitro fertilization. In vitro is a Latin term meaning "in glass." In IVF, the woman's eggs are surgically removed and mixed with sperm in a glass dish. After the eggs have been fertilized (a couple of days), they are placed in the woman's uterus where they continue to develop.
IVF is an expensive, delicate procedure that requires sophisticated equipment and expertise. The average pregnancy rate for IVF patients is about the same as that for fertile couples who conceive and carry the infant to term.
Smoking cigarettes has been shown to reduce the number of eggs available for fertilization and increase the risk for a woman's eggs to have genetic abnormalities. Cessation of smoking for at least 2 months before attempting IVF significantly improves the chances for conception.
Other than taking care of oneself by eating healthfully, not smoking, and limiting alcohol and drug consumption, there really aren't any preventive measures that either men or women can take to guard against infertility. Patients who are significantly overweight are strongly urged to lose weight, because being overweight is not only a risk factor for infertility, it also reduces the likelihood that treatment will be successful.
Infertility Support Services
For most couples and single women who are trying to become pregnant, infertility causes considerable stress and anxiety. And even though infertility is medically defined as the inability to conceive or become pregnant after at least a year of trying, many women become anxious and worried before 12 months have passed.
Patients who are having a difficult time coping with emotional issues associated with infertility should seek professional counseling and/or find a support group for people sharing the same challenges and frustrations. RESOLVE and the American Fertility Association are national self-help groups that have been established for patients by patients. The American Society for Reproductive Medicine is a good resource for patient information.