Infertility Treatments
Fortunately, there are many fertility treatments available for the female. Unfortunately, there are no truly effective male infertility medications. Products currently marketed for male infertility have not been shown to increase pregnancy rates or offer any “real additional value”.
A high percentage of infertile women present with ovulatory problems. Ovulatory irregularity is a symptom of many conditions including PCOS, hormone deficiencies or excesses, poor ovarian function, ovarian failure, too much exercise and/or stress, elevated prolactin levels, and others.
Clomid Treatment
The physician may presumptively start the patient on a 3-6 month trial of Clomid. In some cases, IUI may be combined with Clomid. The length of the trial depends upon many factors including patient age, her FSH level, response to Clomid, etc. Clomid is most likely to be effective in the first three cycles and treatment after that point is not recommended. As mentioned early, sometimes specialists will prescribe Clomid for six months.
One a woman is ovulating on Clomid there is no value to further increasing her dose. If she does not ovulate on 50mg of Clomid, the dose may be increased to 100mg or 150mg until ovulation resumes. Unlike FSH, Clomid does not stimulate the ovaries directly. Rather, it works at the hypothalamus to compete with estrogen receptors.
Oftentimes, we ask couples to monitor their cycles using the LH test kits and to plan intercourse around the most fertile times.
If 3-6 months of Clomid therapy fails, follicle stimulating hormone (FSH) may be administered in conjunction with an IUI cycle.
Follicle Stimulating Hormone (FSH) Treatment
Dr. Shaykh may elect to treat the patient with FSH usually administered by injection daily and intrauterine insemination (IUI). FSH directly stimulates the ovaries to produce many eggs. She may also receive Lupron, Antagon, or Cetrotide to control the timing of ovulation.
FSH should only be administered by a board certified fertility specialist, like Dr. Shaykh, who has extensive clinical experience using these drugs.
FSH can produce the serious side effect known as ovarian hyperstimulation syndrome so patients must be closely monitored by ultrasound and blood estradiol measurement.
Most of the high order multiple births seen in the media are a result of an FSH IUI cycle where “too many” eggs fertilized and formed viable embryos. Specialists know how to monitor and control the cycle thus greatly reducing the chance of >2 babies. High order multiples are rarely seen in IVF cycles because the physician limits the number of embryos replaced into the uterus.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) results in highly elevated male hormones (testosterone, etc.) known as androgens. Elevated androgens in the female often result in ovaries covered with cysts, thinning of the hair on the head, dark increased body hair, lowering of the voice, irregular or failed ovulation, and long term health risks mainly from cardiovascular disease.
When PCOS is diagnosed it is often treated with Glucophage (metformin) which lowers insulin levels. PCOS patients are hyperinsulinemic due to the overproduction of insulin which ultimately leads to overproduction of androgens. When insulin levels are reduced with drugs like metformin, normal ovulation will often resume.
PCOS patients are often treated using IVF. These patients must be closely monitored by the reproductive endocrinologist as they can have exaggerated and unpredictable responses to follicle stimulating hormone.
Most often, the mass media focuses on IVF, when producing news reports about infertility treatments. This is true even though a relatively small number of women (% varies by practice) will ever require the procedure. We have a separate page on our Web site for IVF.
IVF may be the “first line” treatment in some cases such as male infertility, older females, tubal disease, specific cause of the couple’s infertility and treatment history, etc.
In the IVF procedure the eggs are retrieved after the female undergoes ovulation induction with FSH. Once retrieved they are combined with the sperm and fertilization occurs.The fertilized eggs, now embryos, are transferred to incubators until ready for transfer to the mother, usually 3-5 days.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is used in many IVF cycles when male infertility is present, the female is older, there have been IVF cycle failures, etc. Using ICSI, a sperm is inserted directly into an egg using a microscopic needle. ICSI is particularly useful in cases of severe male infertility where only a few, or one, sperm may be available. ICSI is the only treatment option for these couples unless they use a sperm donor. (See our ICSI page)
Surgical Treatments
Most surgical procedures are now performed using laparoscopy. (See the detailed discussion under “Fertility Tests”). Small surgical openings are made in the abdomen, usually at the pubic hair line and belly button making scars barely noticeable.
The laparoscope, a telescope like device, is inserted in one opening and allows the surgeon to visualize the ovaries, tubes, uterus, and other internal structures.
Endometriosis is a common cause of infertility and can often be removed by the reproductive endocrinologist during the diagnostic laparoscopy. Laparoscopy can also be used to “reconnect” the Fallopian tubes depending on how the tubes were severed and patient specific factors.
Most fibroids and polyps can be removed laparoscopically. Additionally, many “large surgeries” such as a hysterectomy can be performed laparoscopically.
The major advantages of laparoscopy over “open surgery” are: less pain, shorter recovery time, laparoscopy is usually an outpatient surgery, less expense, and less scarring.