Treatments for female infertility
If a woman isn't ovulating, her ovaries can nearly always be encouraged to produce good-quality eggs by using fertility drugs. These drug treatments used to produce a large number of multiple pregnancies, but much more is now known about the correct dosage and treatment is very carefully controlled and monitored.
Drug treatments
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Clomiphene drugs
This is the most common fertility drug, taken for five days at the beginning of each menstrual cycle. Clomiphene stimulates the release of follicle-stimulating hormone (FSH) by the pituitary gland. This acts on the ovaries and often triggers the ripening of a follicle and then ovulation, usually around five to ten days after the last tablet is taken. Clomiphene's advantages are that it's free from major side effects and has a low multiple pregnancy rate - only five to ten per cent. There's a possible link with ovarian cancer after 12 cycles, so if conception isn't achieved after about six cycles, you may be advised to try assisted reproduction technology (ART) instead. Increasingly, metformin, taken up to three times a day, is used as an alternative.
Clomiphene-resistant PCOS
If you're suffering from polycystic ovary syndrome (PCOS), but you've failed to ovulate after several months' treatment with clomiphene, you could be given a course of FSH by injection. The success rates of this treatment are quite high. There's an ovulation rate of about 95 per cent per cycle and pregnancy rates of up to 25 per cent after three cycles.
Treatment by pulsatile GnRH
“Hypothalamic” infertility with amenorrhoea is a rare cause of infertility resulting from the absence of a hormone called gonadotrophin releasing factor (GnRH), which is made in the part of the brain called the hypothalamus. The role played by GnRH in fertility is to force another part of the brain, the pituitary gland, to release FSH and LH, which in turn stimulate the ovary to ovulate. Women who are deficient in GnRH can be treated with hormone replacements. These are usually given in subcutaneous “pulses” to mimic normal secretions at 60, 90, and 120 minutes, in an increasing dose per pulse. Ovulation rates as high as 75 per cent and pregnancy rates up to 15 per cent per cycle can be achieved after GnRH replacement treatment.
Bromocriptine
If a woman has high levels of the hormone prolactin in her blood, normal GnRH pulses may be suppressed, so she does not ovulate and cannot conceive. Bromocriptine (or related drugs such as cabergoline or quinagolide) is the best treatment for this condition - it suppresses prolactin production so the ovaries work properly again. After treatment with bromocriptine, ovulation rates can be as high as 75 per cent. If a woman does get pregnant, bromocriptine treatment should be stopped, but there are no known cases of miscarriage, prematurity, fetal abnormalities, or multiple pregnancies as a result of this drug.
Surgical procedures for female infertility
Microsurgical techniques, involving laparoscopy, have greatly improved doctors' ability to repair any damage to the Fallopian tubes. If you have clomiphene-resistant PCOS your doctors may suggest you have surgery such as ovarian drilling. In this operation, holes are drilled in the surface of your ovary with diathermy or laser to stimulate ovulation.
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Posted 16.11.2010
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