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 the treatment.

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 facilitate release.

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.

GONADOTROPIN THERAPY
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.