.gif)
Infertility Treatment Options for the Female Patient
- Ovulation Medications
- Timing of Normal Intercourse
- Treatment for Blockage of Fallopian Tubes (tubal occlusion)
- Treatment for Endometriosis
- Treatment for Polycystic Ovary Syndrome (PCOS)
- Treatment for Premature Ovarian Failure (Premature Menopause)
- Treatment of Uterine Fibroids and Pelvic Adhesions
- Lifestyle-Related Treatment
- Assisted Reproductive Technologies
Ovulation Medications
If you are infertile due to a problem with ovulation, your doctor may recommend treatment with a fertility drug. These medications are used to regulate or induce ovulation. In general, they are designed to work like your own hormones. Fertility drugs are either used alone or in combinations depending on the reason for your ovulatory problem. Ovulation rates (and subsequent pregnancies) after taking one or more of these medications depend on the reason you are being treated, your age, and the presence of other factors, such as underlying medical problems. Currently used fertility medications may include the following:
- Clomiphene citrate (Clomid, Serophene)
Clomiphene is the most commonly prescribed fertility drug and is used to help you conceive if you have polycystic ovary syndrome or if you ovulate irregularly or not at all. Your doctor may also recommend clomiphene (alone or in combination with other fertility drugs) before you begin an assisted reproductive technology (ART) treatment, such as in vitro fertilization (IVF).
Clomiphene, usually taken as a pill for one five-day cycle each month, causes your pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH prompts your ovaries to produce one or more mature eggs and LH tells your ovaries to release your mature egg or eggs into your fallopian tubes.
Most women who take clomiphene go through three to six cycles of treatment-your chances of getting pregnant do not improve if you take the drug for a longer period of time. You will need to be checked by your doctor on a regular basis to see if ovulation is occurring. If you do not succeed after three cycles, your doctor may recommend a higher dose of clomiphene or another treatment such as a different fertility drug or an assisted reproductive technology (ART).
Clomiphene may cause some side effects: swelling of the ovaries, stomach pain, breast tenderness, insomnia, nausea and vomiting, blurred vision, headaches, fatigue, irritability, depression, and weight gain-these are usually mild and clear after the medication is stopped. Some women also develop a condition called ovarian hyperstimulation syndrome (OHSS), a condition in which your ovaries swell to several times their size and leak fluid into your abdomen causing weight gain, a bloated feeling, and sometimes shortness of breath, dizziness, pelvic pain, nausea, and vomiting. OHSS happens when a woman responds too well to the clomiphene and produces too many eggs. OHSS usually resolves itself without any residual problems, but in some women may be severe. Up to 80 percent of women who take clomiphene will ovulate, usually within the first three months of treatment. Of those women who ovulate, about 40 percent get pregnant. There is also an approximately 10 percent chance that you will conceive twins with clomiphene.
- Gonadotropins
Unlike clomiphene, which stimulates your pituitary gland to produce FSH and LH, gonadotropins directly stimulate your ovaries. Gonadotropins may help you conceive if you tried clomiphene but you did not respond to it. The following gonadotropins are available:
- Human Menopausal Gonadotropin (hMG)
This medication, a mixture of FSH and LH, may be recommended for women who do not menstruate on their own due to the failure of their pituitary gland to stimulate ovulation. This drug is sold as Repronex®. - Urofollitropin or Recombinant FSH
This medication is similar to hMG but without the luteinizing hormone. It works by stimulating your ovaries to mature egg follicles. This drug is sold as Bravelle®, Follistim®, or Gonal F® .
- Human Chorionic Gonadotropin (hCG)
This medication stimulates the mature follicle to release its egg and is used in combination with clomiphene, hMG, and FSH. This drug is sold as Novarel®, Pregnyl® Profasi® or Ovidrel®
Your doctor may also recommend a gonadotropin (alone or in combination with other fertility drugs) before you begin an assisted reproductive technologies (ART) treatment, such as in vitro fertilization since a gonadotropin may help you produce several eggs for the procedure.
Human menopausal gonadotropins (hMG) and urofollitropin or recombinant FSH are given as injections for 7 to 12 days to prompt your ovaries to produce several eggs. This is usually followed with an injection of human chorionic gonadotropin (hCG), which tells your ovaries to release the mature eggs into your fallopian tubes.
You will need to receive shots of the medication (hMG or FSH) for 7 to 12 days each month depending on how long it takes your eggs to mature. Your fertility doctor, or a nurse at the fertility center will train you and your partner to give the shots.
You will also be checked often to see if you are responding to the medication - frequent ultrasounds and blood tests may be necessary. When your doctor determines that your eggs are mature, you will be given an injection of hCG. Most likely you will ovulate within 24 to 36 hours and you will either be sent home to have intercourse, or your doctor will schedule you for intrauterine insemination (IUI).
Most women who use gonadotropins go through a maximum of three to six cycles of treatment-your chance of getting pregnant does not improve if you use the drugs for a longer period of time. You will need to be checked by your doctor on a regular basis to see if ovulation is occurring. If you do not succeed after three or more cycles, your doctor may recommend a higher dose of one of the drugs or suggest another treatment such as an assisted reproductive technology (ART).
Gonadotropins may cause some side effects-pain at the site of the injection, stomach pain or tenderness, breast tenderness, headaches, fatigue, and emotional irritability-these are usually mild and clear after the medication is stopped. Some women also develop a condition called ovarian hyperstimulation syndrome (OHSS), a condition in which your ovaries swell to several times their size and leak fluid into your abdomen causing weight gain, a bloated feeling, and sometimes shortness of breath, dizziness, pelvic pain, nausea, and vomiting. OHSS happens when a woman responds too well to the gonadotropins and produces too many eggs. OHSS usually resolves itself without any residual problems, but in some women may be severe.
Between 20 percent and 60 percent of women who use gonadotropins will conceive. There is also an approximately 10 percent to 40 percent chance that you will conceive twins or more with the use of gonadotropins.
- Human Menopausal Gonadotropin (hMG)
- Bromocriptine (Parlodel®) or Cabergoline (Dostinex®)
Bromocriptine and cabergoline are used to treat women whose ovulation cycles are irregular due to an elevated level of prolactin, the hormone that stimulates milk production in new mothers. This is usually caused by a pituitary adenoma, a benign tumor in your pituitary gland that secretes an excess of prolactin. The resulting condition is known as “hyperprolactinemic amenorrhea” and is a rare cause of fertility problems. Bromocriptine and cabergoline works by inhibiting the production of prolactin.
Bromocriptine is a pill that is available to use by mouth or in your vagina. Once your prolactin level is normal, usually after several months of treatment, you should begin to menstruate and ovulate again. You and your partner may then try to conceive naturally. If conception does not occur after ovulating for a few months, your doctor may recommend additional treatment.
Bromocriptine can be safely used for several years and does not increase your risk of having multiples pregnancies. At the start of therapy some women experience nausea, dizziness, fatigue, diarrhea, and headaches. These symptoms often decrease as the woman's body adjusts to the medication.
About 90 percent of women ovulate for as long as they continue taking bromocriptine. Of those women who ovulate, 65 percent to 85 percent conceive.
Cabergoline is a tablet that is given twice a week with a lower chance of nausea and dizziness. It has not been approved for use in fertility by the FDA, but still offers excellent success in this area.
- Multiple Births and Ovulation Medications
Fertility drugs, on occasion, may be responsible for multiple births. The risk of multiple pregnancies depends on the drug, or combination of drugs being used. For example, clomiphene citrate rarely results in a pregnancy with more than twins, while hMG and FSH are more likely to cause multiple births, including twins, triplets, or more. Multiple pregnancies increase your likelihood of having premature labor. Babies born prematurely are at increased risk of medical and developmental problems.
You should discuss with your fertility doctor if any steps are available to reduce your risk of multiple pregnancies. If you are considering the use of fertility drugs, you and your partner should discuss the issue of multiple pregnancies with your fertility doctor before starting therapy.
Timing of Normal Intercourse
An egg can be fertilized for up to 24 hours after a woman ovulates, and sperm can survive in the woman's reproductive tract for up to 72 hours. Increasing the frequency of intercourse during the appropriate time within a woman's cycle may increase the chances for conception.
Treatment for Blockage of Fallopian Tubes (Tubal Occlusion)
Blockage of the fallopian tubes due to scarring from pelvic inflammatory disease, ectopic pregnancy, or other causes sometimes can be repaired with surgery. New microsurgical techniques permit delicate operations on the fallopian tubes -such repairs may offer a 10 percent to 30 percent chance of pregnancy. In vitro fertilization is probably the most successful option for treating infertility due to blocked fallopian tubes.
Treatment for Endometriosis
Infertility due to endometriosis often is difficult to treat. Many of the medications used to relieve the symptoms of endometriosis may decrease your chances of becoming pregnant. Your doctor may recommend that you have surgical treatment with laparoscopy. During this procedure, your doctor may burn away small areas of endometriosis or use a laser to vaporize them. Your doctor may also remove adhesions or scarred tissues that might be blocking your pelvic organs or twisting them out of their normal position. These procedures may be done during the same laparoscopy session that your doctor performs to diagnose your endometriosis. Your doctor may then treat you with fertility drugs to help induce ovulation or recommend an assisted reproductive technology, such as in vitro fertilization (IVF).
Treatment for Polycystic Ovary Syndrome (PCOS)
PCOS is a common cause of infertility due to infrequency or lack of ovulation. It is most often treated with fertility drugs, especially clomiphene. If you have PCOS, your doctor may also prescribe metformin or another insulin-sensitizing drug that may help you better respond to therapy with fertility drugs. If you do not respond to medication, your doctor may recommend an assisted reproductive technology (ART), such as in vitro fertilization (IVF).
Treatment for Premature Ovarian Failure (Premature Menopause)
Although there is no specific treatment for this condition, your doctor may attempt to induce ovulation with a combination of estrogen replacement therapy followed by fertility drugs. This has resulted in pregnancy in some women. If this treatment is not successful, your doctor may recommend an assisted reproductive technology (ART) using egg donation.
Treatment for Uterine Fibroids and Pelvic Adhesions
Uterine fibroids and pelvic adhesions can sometimes be corrected with surgery. Depending on the location and extent of the problem, your doctor may recommend laparoscopic surgery or a more extensive procedure that requires an incision in your abdomen.
Lifestyle-Related Treatment
It is important to limit, or stop using tobacco, recreational drugs, and alcohol. If you are being treated for a medical condition, it may be necessary to change medications that could be impacting your fertility. Women who have an eating disorder or are involved in very heavy exercise may need to resolve these issues before receiving specific treatment for infertility. Additionally, being overweight has been show to have a significant effect on fertiity. Please see Weight & Fertility Fact Sheet.