Fortunately, there are numerous fertility drugs available to treat many of the causes of female infertility. Unfortunately, there are very few medications shown effective for the treatment of male infertility resulting in improved pregnancy rates. Male conditions that do respond are rare, such as hypothalamic hypogonadism. However, there are “non drug” male treatments, such as IVF with ICSI, that have proven very effective.
Many female fertility drugs are “ovulation inducing agents” meaning that they regulate or stimulate ovulation. The best known drug in this class is Clomid, which has enjoyed widespread clinical use for over three decades. Other ovulation inducing agents include FSH which is marketed as Gonal-F, Follistim, Bravelle, Menopur, and others.
The Assisted Fertility Program's main infertility clinic office, located in North Florida, was the first fertility program established in 1985. Our offices are conveniently located across from the Lewis-Gale medical center, so infertile couples in Southwest Virginia may no longer need to travel outside of the area for specialized services. In addition, patients from Virginia who need IVF included in their package are flown to our office in Florida where they will stay at the luxurious Castillo Real hotel. There, they can undergo IVF treatment and relax during a five-day stay. When done with treatment, patients will be flown back to Virginia, all at no cost to them. That is just one of the ways Dr. Shaykh ensures his patients' utmost comfort and satisfaction!
Clomid works at the hypothalamus to “occupy or compete for” estrogen binding sites. The hypothalamus can be thought of as the “hormone regulator” reading the levels of various hormones and adjusting production accordingly. In a normal ovulatory cycle, estrogen levels rise as the follicles mature leading to a decrease in FSH production. FSH is the hormone responsible for the recruitment and development of the ovarian follicles each containing an egg. Since Clomid binds estrogen sites, the hypothalamus reads lower estrogen levels and signals the pituitary to continue production of FSH thus leading to follicular recruitment.
Once ovulation is occurring on Clomid (evidenced by increased progesterone levels and ultrasound), there is no advantage to increasing the dosage. Pregnancy is most likely to occur during the first three ovulatory cycles and therapy beyond 3-6 cycles is not recommended. Continued use of Clomid is highly unlikely to succeed, is expensive, and can cause significant side effects. Unfortunately, we sometimes see women who have been on Clomid for a year or more, prescribed by her OB/GYN.
Women 35 and older should seek infertility specialist care immediately and should not “waste” valuable time trying Clomid without a definitive diagnosis. Fertility can decline very rapidly in this age group.