Because many women with fertility problems do not ovulate, several medications and procedures have been developed to induce ovulation.
Sold under the brand names Clomid® and Serophene®, clomiphine is the most commonly prescribed fertility drug. Taken orally, clomiphene “tricks” the ovaries into producing a mature egg, sometimes several. Clomiphene is usually given as a sole fertility treatment or as a prelude to intrauterine insemination (IUI).
When in vitro fertilization (IVF) or sometimes when IUI is planned, you will be given injectable gonadotropins — a drug containing follicle-stimulating hormone (FSH). Gonadotropins are sold as Metrodin®, Fertinex®, Follistim® and Gonal-F®. Drug preparations containing LH and FSH, such as Pergonal®, are also available. Injections are given for several days during the first half of your menstrual cycle. Most women who take these drugs produce three to 10 or more egg follicles in a single cycle. Periodic blood tests and pelvic ultrasound scans should be done throughout drug treatment to prevent overstimulating the ovaries. So-called “hyperstimulation syndrome” is a painful enlargement of the ovaries that may require hospitalization.
Human chorionic gonadotropin (hCG)
After you have finished your course of treatment to stimulate follicle growth, you will probably receive an injection of hCG to trigger ovulation — the release of eggs from their follicles. Ovulation generally occurs 24 to 48 hours after taking hCG.
Intrauterine insemination (IUI)
Couples with mild-to-moderate male factor infertility and those with unexplained infertility are top candidates for IUI. Because of its relative simplicity and low cost, many couples choose IUI before trying IVF and other high-tech procedures.
Before insemination, the woman takes fertility drugs to stimulate egg production and trigger ovulation. Twenty four to 48 hours later, the male partner produces a semen sample, which is then “washed” in a centrifuge. Sperm washing concentrates the sperm and removes a hormone-like substance called prostaglandin, which normally is filtered out by the cervical mucus. Prostaglandin would cause severe cramping if allowed to enter the uterus. The washed sperm is then delivered through a catheter through the cervix into the uterus. The procedure is painless, and if it works, you will have a positive pregnancy test about 14 days later.
As with other assisted reproductive procedures, IUI can be done with sperm from a donor who has been screened for communicable diseases such as AIDS, and for genetic diseases. Most donors have unusually high sperm counts and donate anonymously. Sperm banks ordinarily provide couples with descriptions of available donors, including the donor’s height, weight, build, hair and eye color, education level, ethnic and religious background, and hobbies. Donor sperm is frozen until it is needed. Some couples recruit a friend or relative to donate sperm, but even in these cases, the known donor must pass a medical screening.
Assisted reproductive technology (ART)
Almost 100,000 ART procedures performed in 2000 were reported to Centers for Disease Control and Prevention. The largest number of ART procedures occurred among patients who used their own freshly fertilized embryos, which was 76 percent. Of the 100,000 procedures started, 82 percent progressed to embryo transfer. The highest rates were among ART procedures using donor eggs and freshly fertilized embryos, which was 44 percent resulting in a live birth. The lowest rates were among procedures using the patient’s eggs and thawed embryos, which was 20 percent live-birth rate).
In vitro fertilization (IVF)
IVF involves surgically removing eggs from the woman or a donor who has taken fertility drugs, fertilizing the eggs in a laboratory dish with sperm from the husband or a donor, letting the embryo grow for a few days, and then placing two to four embryos (also known as zygotes) into the uterus of the wife or a surrogate. Any remaining embryos can be frozen for future use. IVF accounts for more than 90 percent of ART cycles performed in the United States
Gamete intrafallopian transfer (GIFT)
GIFT involves removing eggs from the wife or donor and then placing several eggs, along with the husband’s sperm or donor sperm, directly into the fallopian tube of the woman or a surrogate.
Zygote intrafallopian transfer (ZIFT)
FFor ZIFT, eggs and sperm are united in a laboratory dish and allowed to develop to the zygote stage. Several zygotes are then placed directly into the fallopian tube of the woman or a surrogate.
Intracytoplasmic sperm injection (ICSI)
This new treatment for severe male-factor infertility uses microscopic laboratory instruments to insert a single sperm directly into an egg. If the egg fertilizes, it is transferred to the woman’s womb. ICSI is an alternative to using donor sperm.