There are several so-called treatment plans in current use for
infertile couples. They vary in detail from one clinic to
the next, but most include some means of enhancing egg numbers
or quality (clomiphene or gonadotropins) as described below.
In many instances intrauterine inseminations are added to
OVULATION INDUCTION (O.I.)
There are a number of different regimens used to treat
infertility. Some are medical, some are surgical and
some are combinations of both. Each has its unique
advantages and disadvantages.
Remember, in women with a tubal factor, it is often necessary to resort
to tubal surgery or in-vitro fertilization. And in men with significantly
lowered sperm counts or sperm motility, IVF, again, is usually the only hope.
The following treatment plans are those frequently utilized by the Center
for Reproductive Health for couples not suffering from a tubal or
severe male factor.
OVULATION INDUCTION WITH CLOMIPHENE CITRATE
Clomiphene may be used to induce ovulation in women not ovulating
on their own. Under these circumstances, IUI’s may not be used
right away. The most common use for Clomid is in patients with
polycystic ovarian disease – a condition in which eggs are
abundant – but are not being released. Clomid helps
INTRAUTERINE INSEMINATIONS – I.U.I.’S
This is the most common procedure done in most infertility clinics.
It should not be confused with in-vitro fertilization (IVF).
IUI’s are relatively simple, office procedure used as treatment
for a variety of reasons, usually in conjunction with superovulation
with Clomid or gonadotropins.
Inseminations allow us to take any sperm sample that is borderline
or better and prepare it in such a way that the most motile sperm
are concentrated in a small pellet.
This pellet is then dissolved and inserted – in a procedure much
like a Pap smear – into the uterus near the opening of the fallopian
tubes. Experience has shown that this high concentration of very motile
sperm placed at the very opening to the tubes will result in an increased
chance of pregnancy.
Insemination, like superovulation, is of no value in patients
with tubal factor or severe male factor.
SUPEROVULATION WITH CLOMIPHENE AND IUI’S
This is often the first line of treatment for patients whose
cause for infertility is uncertain. Unexplained infertility
is often the result of a number of subtle factors in both
the egg and the sperm. Clomiphene increases the number of
eggs released each cycle – in turn increasing the opportunity
for fertilization. Inseminations enhance the concentration and
quality of the sperm, again, increasing the chance of fertilization.
“Clomid with IUI’s” as it is commonly called, has given excellent
results in the treatment of unexplained infertility, borderline
ovulation disorders and in couples whose male partner has low
normal sperm counts. Generally, we will continue this protocol
for 3 to 6 months (cycles) if pregnancy does not occur.
Gonadotropins (some of the “brand” names include Follistim,
Gonal-f, and Repronex) are powerful medications used for
ovulation induction and, more commonly, superovulation.
They may be used in patients who fail to ovulate on Clomid
with other less aggressive means.
More often there used is limited to unexplained infertility patients who
have not conceived by less aggressive approaches, or to older infertility
patients whose decreasing ovarian reserve limits the benefits of Clomid.
Gonadotropins are a mainstay of IVF.
In general, gonadotropins are more likely to produce a pregnancy than Clomid.
However, because gonadotropins will produce significantly more eggs, the risk
of multiple pregnancies outweighs the benefits in many patients.
Another downside to their use is that they must be give by injection.
Because of their expense and their use as a “last line” of treatment
prior to surgery or IVF, gonadotropins are almost always used in
conjunction with IUI’s.