PART I: WHAT TREATMENTS ARE AVAILABLE FOR INFERTILITY? MEDICAL THERAPY

There are a variety of treatment options available for infertility.  Medical therapy is among the most common treatments for infertility and is used to correct various infertility problems such as ovulatory dysfunction or unexplained infertility.

This is Part I in a series of available Infertility Treatments in recognition of National Infertility Awareness Week.

Infertility in Women

The first line of treatment when there is no determined cause for infertility or for disorders of ovulation is medication, and a fertility clinic can help with this treatment.  The drugs are designed to make an egg or multiple eggs grow on the ovary.  For woman who ovulate on a regular basis, the goal is to develop more than one egg (often referred to as superovulation) and for women with irregular cycles (typically due to lack of ovulation) to develop one egg to ovulate.

Fertility Medical therapy comes as oral medication and injectable medication. For most patients fertility therapy starts with oral medication. Most often either Clomiphene Citrate or letrozole is used. When oral medication fails to provide favorable results, or when conception does not occur within three cycles of ovulation, other treatment options should be considered.

The next line of fertility medical therapy used to treat infertility is gonadotropin therapy.  This form of treatment is used when other oral agents fail to provide successful results.  Gonadotropin therapy is highly effective in ovulation induction but due to its high multiple pregnancy rate, especially in woman who do not ovulate,  this therapy is often not used.

Gonadotropin therapy can be used with intercourse or inseminations when there is no explanation for the infertility, lack of ovulation or when all fertility  issues have been corrected but pregnancy has still not been achieved.  This form of therapy enhances fertility by stimulating multiple eggs to be produced.  It improves pregnancy rates because with more eggs produced there are more chances for those eggs to be fertilized and hence higher chance of pregnancy. But rmemeber when more eggs are produced there is a higher chance of multiple pregnancy. The multiple pregnancy rate with gonadotropins is about 15%.

Gonadotropin is administered daily as an injection, similar to an insulin shot.  The shots are given daily for about 12 days on average.  During the treatment cycle, the patient is carefully monitored to ensure that the medication is working properly.  Blood tests and ultrasounds are performed to optimize dosing of the medication and prevent the risk of over stimulating the ovaries (making too many eggs).  Since there is a risk of a multiple pregnancy with gonadotropin therapy, it is important for the patient to be monitored carefully.

Other medications used to treat infertility include thyroid medications (for thyroid dysfunction), parlodel (for elevated prolactin levels) and  antibiotics.

Infertility in Men

When sperm production is low or sperm motility is a problem, urologists or fertility specialists use medication to increase sperm produced. Sometimes men have low hormone levels that need to be adjusted with medication and hormone therapy is required to help produce sperm.  Sometimes Clomiphene can improve sperm production in males, but HCG injections have also been utilized.

Medical therapy in men can also include the identification of sexual problems such as the need for behavioral therapy or medicines to improve premature ejaculation or impotence.