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Many
drugs are now available to treat infertility. The first
point is that rarely should any fertility drug be administered
to the female until her partner has had a properly performed
semen analysis. Male
Factor is present in approximately 47% of couples and
must be ruled out early in the evaluation. Unfortunately,
there are few effective medical (drug) treatments for
male infertility with the exception of antibiotics for
reproductive tract infections. Great strides have been
made in the treatment of male infertility through the
use of IVF with micromanipulation procedures such as ICSI.
One
of the first and most widely used fertility drugs is clomiphene citrate or Clomid. Clomid indirectly causes ovulation by stimulating the
hypothalamus (gland at the base of the brain) to release
gonadotropin-releasing hormone (GnRH) which causes the
pituitary gland to release follicle-stimulating hormone
(FSH). FSH stimulates the recruitment and development
of eggs within the ovarian follicles.
Clomid is often used by the generalist as a first line treatment
even though the cause of anovulation (lack of ovulation)
is unknown. It is also widely overused and is rarely
successful if pregnancy has not been achieved within
3-6 ovulatory cycles.
Letrozole-
A new aromatase inhibitor for ovulation induction.
Glucophage
(metformin) is used to induce ovulation in women
with PCOS. It is sometimes used in conjunction with
Clomid or FSH.
Follicle
stimulating hormone (FSH) is used to directly induce
ovulation. FSH is the natural hormone in the body, produced
by the pituitary gland, that stimulates follicular development.
FSH augmentation causes the development of multiple
follicles and is used in in vitro fertilization and
stimulated intrauterine insemination. FSH should only
be used by a reproductive endocrinologist as patients
must be monitored and dosages adjusted based upon each
patient's response.
Human
chorionic gonadotropin (hCG) is produced by the
corpus luteum and once pregnancy is established by the
placenta. It has the same effect as luteinizing hormone
(LH) and is used to trigger ovulation. hCG is administered
during drug stimulated (IVF or IUI ) cycles to time
ovulation. Ovidrel is a new medication recently developed
by Serono through genetic recombinant technology and
it is identical to natural hCG.
Progesterone supports the growth and development of the endometrium
and is usually administered during IVF cycles. It is
administered by injection, oral troches, vaginal suppositories,
gels, or oral micronized capsules.
Lupron (leuprolide acetate) is a gonadotropin releasing hormone
agonist. It causes dramatic reductions in estrogen,
FSH, and LH levels and simulates the menopause. It is
used to treat endometriosis because endometrial cells
are dependent upon estrogen for growth and survival.
It is also used to "down-regulate" patients
undergoing IVF. There are other products, such as Antagon
and Cetrotide that are gonadotropin releasing hormone
antagonists. Their mechanism of action is different
but the end results are the same.
Many
different types of antibiotics can be used to treat
reproductive organ infections in the male and female.
Infective pathogens include Chlamydia, syphilis, gonorrhea,
micoplasm and others. Untreated infections can cause
pelvic inflammatory disease which can damage internal
structures such as the tubes,ovaries, or uterus.
Untreated
infection in the male can cause permanent scarring and
damage to the seminiferous tubules, testes and other
organs. Most infections can be treated effectively if
diagnosed early.
Parlodel
(bromocriptine) is used to treat elevated prolactin
levels or hyperprolactenemia which can cause anovulation.
Prolactin is the hormone responsible for the production
of breast milk in pregnancy. Abnormally high levels
are often accompanied by breast milk production in the
absence of pregnancy. This condition can be caused by
a small benign tumor at the base of the brain and surgery
is sometimes indicated.
Corticosteroids
are powerful anti-inflammatory drugs that work at the
level of the hypothalamic pituitary adrenal axis and
lower the body's immune response. Low dose corticosteroid
therapy may be used in females who have an over production
of male hormones (androgens) such as testosterone. Sometimes
steroid therapy is used when antisperm antibodies are
produced by the female; however, intrauterine insemination
is usually a better alternative. Corticosteriods may
also be used when the male produces antibodies to his
own sperm.
Corticosteroids
are often given to recipients of embryos that have undergone
assisted hatching or ICSI to prevent any potential immune
response caused by the procedures.
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