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Trying to become pregnant but haven’t been successful? It may be heartening to know that 2/3 of couples treated for infertility realize their dream of having a baby is not so easy to achieve.

The treatment that you are offered will be dependent upon your age, your health and the reason for infertility (if one can be determined). The following provides an overview of common fertility treatments available today.

Fertility drugs are often the first-line treatment offered to women unable to conceive. Fertility drugs target ovulation disorders or problems. Fertility drugs can result in the ability to become pregnant in up to 80% of women who experience ovulation disorders.

Sometimes diagnosis of fertility problems is made through a hysterosalpingogram or a laparoscopy. Reproductive technology is the term used to describe the range of medical treatments available to assist couples to conceive, since the majority of people seeking assisted conception technologies are infertile. Current reproductive technologies include IUI (intrauterine insemination), IVF (in vitro fertilization), GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer).

Women now have more choices than ever when it comes to fertility treatments. Whether they choose hormone therapy, surgical options or assisted reproductive technologies, the chances of successfully achieving pregnancy are better than ever.

Drugs as Fertility Treatment

Fertility drugs are often the first-line treatment offered to women unable to conceive. Fertility drugs target ovulation disorders or problems. Fertility drugs can result in the ability to become pregnant in up to 80% of women who experience ovulation disorders.

Clomid (clomiphene citrate, also known as Serephene) is one of the best-known drugs for the treatment of infertility. It is often the first choice used in treatment. Approximately 40% of couples are able to become pregnant within 6 cycles after starting Clomid. Clomid is taken orally rather than by injection, which appeals to users. Clomid is often used in women who have irregular or absent periods, such as may be the case in women who have PCOS (polycystic ovarian syndrome). Clomid is ineffective when there is a blockage of the fallopian tubes for obvious reasons. Clomid is relatively inexpensive. Common side effects (if there are any) may include nausea, moodiness, hot flashes and breast tenderness. Women who take Clomid have a 10% chance of conceiving twins. If pregnancy is not achieved within 6 cycles, another treatment is usually recommended.

Femara (letrozole) is sometimes used as an alternative to Clomid to treat ovulation disorders. Femara is also taken orally. While Clomid can sometimes thin the uterine lining, Femara is less likely to do so. Femara blocks estrogen production and, for this reason, it is also used in breat cancer that is sensitive to estrogen. Femara can be used in women who have endometriosis or PCOS, and also in women who are infertile for no clinically discernable reason. Femara is often used as a second-line treatment in women who have not conceived after 6 cycles of Clomid use. Arimidex (anastrazole) is another drug in the same drug class as Femara and works in a similar fashion by suppressing estrogen production. Side effects of both Femara and Arimidex are similar to those of Clomid.

Gonadotropins are hormonal drugs that are sometimes used when a woman’s pituitary gland does not produce adequate amounts of female hormones, for women who have PCOS, in women who are infertile for unknown reasons and in women undergoing procedures such as IVF to stimulate the production of multiple eggs for fertilization.  Gonadotropins include HCG (human Chorionic gonadotropin), LH (luteinizing hormone) and FSH (follicle stimulating hormone).

Surgical Treatments for Infertility

Sometimes diagnosis of fertility problems is made through a hysterosalpingogram or a laparoscopy.

Hysterosalpingogram (HSG)- HSG is a procedure done to determine whether one or both tubes are blocked and whether there are any problems with the uterine cavity, such as scar tissue or fibroids. The procedure is usually performed in a radiology department and may be done on an outpatient basis. During the procedure a small catheter is inserted through the cervix and into the uterus. Dye is then used to outline the uterus and fallopian tubes as the dye travels. The procedure takes only a few minutes. Women can expect to feel some cramping during the procedure.

Laparoscopy- a laparoscopy is performed through a tiny incision made in the woman’s belly button, through which a small tube with a camera is used to view the uterus, ovaries and tubes. If a problem is found, operative laparoscopy can be performed through making other small incisions to introduce surgical instruments; thus, laparoscopy can both diagnose and treat. Laparoscopy is not performed as often as it used to be, now that other tests are more readily available. Laparoscopy is generally reserved when there is a clear suspicion of endometriosis, fibroids, tumors or scar tissue present that may be the cause of failure to conceive. Women undergoing laparoscopy are generally given a general anesthetic and may have the procedure performed as a day surgery procedure.

Reproductive Technologies for Infertility

IUI (intrauterine insemination)-this procedure, also commonly referred to as artificial insemination, involves inserting semen that has been specially treated (washed) directly into the uterus. IUI is used when the fertility problem is attributed to male factors, when there is an issue with a woman’s cervical mucus, when donor sperm is used and in cases of infertility that cannot be explained. IUI has a 8 to 17% success rate when combined with the use of fertility drugs. IUI, however, is cheaper than other technologies such as IVF.

IVF (in vitro fertilization)- in vitro fertilization occurs in 4 steps: 1) the woman is given fertility drugs to stimulate her ovaries to produce multiple eggs; the women is monitored closely until several eggs of sufficient maturity are present; 2) The eggs are “harvested” by the physician under sedation or general anesthesia; the physician inserts a needle through the vaginal wall to reach the ovaries under ultrasound guidance; follicular fluid is aspirated through the needle and taken to the laboratory, where typically 10 to 30 eggs will be identified; 3) the eggs are prepared and mixed with the fresh sperm provided the male in a culture media for approximately 18 hours, at which time the fertilized eggs are transferred to a growth medium, where they remain until cell division is well under way; and 4) the zygotes (united and growing eggs and sperm) are transported into the woman’s uterus through a catheter.

IVF is expensive. Success rates (meaning pregnancy rates) are estimated to be anywhere between 25 and 40%. IVF is the most commonly used assistive reproductive technique used. Assisted reproductive techniques can be defined as any technique that involves the handling of eggs or embryos.

GIFT (gamete intrafallopian transfer)- GIFT is similar to IVF. The main difference is that, rather than the egg and sperm being united in a petri dish and then being transferred into the uterus, the eggs and sperm in GIFT are placed in the woman’s fallopian tube and are allowed to fertilize naturally within the woman’s body. GIFT may be offered when there is a problem of low sperm count or motility, or when infertility is unexplained.

ZIFT (zygote intrafallopian transfer)- ZIFT is very similar to GIFT, except that the sperm is allowed to fertilize the egg outside of the body, then the zygote is returned to the fallopian tube to continue as nature intended. The ZIFT procedure is used less commonly than the GIFT procedure, and IVF is usually preferred to either of these procedures.

  • Kate Brian. 2010. The Complete Guide to Female Fertility. Piatkus Books.
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