What medications can be used to treat infertility?
- Clomiphene citrate (Clomid®): This drug causes ovulation by acting on the pituitary gland in the brain. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth for a few days each month.
- Human menopausal gonadotropin or hMG (Repronex®, Pergonal®): This drug is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate the development of eggs. It is an injected medicine.
- Follicle-stimulating hormone or FSH (Gonal-F®, Follistim®): FSH works much like hMG. It causes the ovaries to begin the process of developing eggs. These medicines are injected.
- Gonadotropin-releasing hormone (Gn-RH) analogs: Gn-RH analogs act on the pituitary gland to change when the body ovulates; in some cases they can help with ovulation and in other cases they can suppress ovulation. These medicines are usually injected.
- Metformin (Glucophage®): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug sensitizes the body to insulin and can help the body to ovulate more regularly. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth. It often has initial gastrointestinal side effects.
- Bromocriptine (Parlodel®): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.
How does intrauterine insemination work?
Intrauterine insemination is performed in the doctor’s office. The first procedure is to “wash” the semen to produce the healthiest sperm. The sperm are then placed into the uterus using a thin plastic catheter (tube) inserted through the cervix. It is timed as closely as possible to the woman’s normal cycle of ovulation, or with fertility medications.
What is assisted reproductive technology (ART)?
ART occurs when a woman's eggs are harvested and combined with sperm to make embryos that are placed back inside the woman's uterus. The success rate of ART is based on factors including a woman's age and prognosis. Two types of ART are in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
- In vitro fertilization (IVF) means fertilization of an egg with sperm outside of the body. IVF is the most effective form of ART. It is used in a variety of fertility conditions but is not often the first treatment offered. Women undergo one to two weeks of fertility injections which cause the ovaries to produce multiple eggs at a time. Once mature, the eggs are removed from the woman through a short, minimally invasive procedure performed under anesthesia. They are placed in a dish in the embryology lab and combined the man's sperm for fertilization. After 3 to 5 days of growth in the lab, the embryos are implanted in the woman's uterus. A pregnancy test can be performed two weeks later.
- Intracytoplasmic sperm injection (ICSI) is often recommended for couples in which there are problems with the sperm. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs or who have poor quality eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
What other infertility treatments are used?
Gestational carriers are sometimes used by women with medical contraindications to pregnancy or women who have uterine factor infertility. A couple will produce an embryo which will be placed inside the uterus of the gestational carrier. The gestational carrier then carries the fetus to term and gives the baby to the couple (or responsible persons) that produced the embryo.