What Are My Treatment Options?
Ovulatory disorders are involved in about 40% of fertility problems.  Currently, there are two major drugs used to treat ovulatory disorders, namely human menopausal gonadotropins (hMG; Pergonal, Humegon, Metrodin, Fertinex) and clomiphene citrate (CC; Clomid, Serophene), although both of these may be supplanted by an increasing number of other drugs.  A typical cycle of clomiphene citrate costs $50-$100 and has a variety of side effects, including hot flashes, mood swings, headaches, nausea, vomiting and ovarian enlargement or cysts.  A typical cycle of human menopausal gonadotropin costs $800-$1000 and must be administered by injection.

Side effects include mood swings, fatigue, headaches, bloating and weight gain, and possible swelling at the site of injection.  More serious side effects may occur with hMG, such as ovarian hyperstimulation syndrome, and often other drugs must be prescribed along with hMG to ensure it functions properly.  Human chorionic gonadotropin, for example, may be needed to trigger follicle rupture (ovulation).  To support ovulation and pregnancy, progesterone may be prescribed alongside an hMG.


Disorders related to the cervix, which may have a structural or hormonal basis, account for about 15% of couples with fertility
problems.  Cervical problems may be treated with surgery to amend structural problems, or hormonal therapy that would correct problems with cervical mucus.  Problems with the cervix can be bypassed with intruterine insemination (IUI), injecting sperm with a catheter directly through the cervix into the uterus.

 Abnormalities in the uterus or fallopian tubes present another category of female infertility problems.  Some of these abnormalities can be corrected through surgery, or through selective IUI to direct sperm to the patientís fallopian tube.  Approximately 15% of couples with fertility problems have disorders related to tubal or uterine problems.  Pelvic problems, primarily endometriosis and adhesions, may also be treated with surgery.  Problems relating to the pelvic environment account for about 15% of fertility problems.

Many of the problems mentioned above may be treated with assisted reproductive technologies (ARTs).  The major ART
procedures include in vitro fertilization (IVF), embryo cryopreservation, and micromanipulation techniques.  In IVF, after
ovulatory stimulation, oocytes are surgically retrieved from the woman, combined with the partner's (or donor's) sperm in the
laboratory, incubated for one to three days, and then transferred into the woman's uterus, where implantation and development of a healthy baby will hopefully occur.

Less commonly used ARTs include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).  GIFT requires the woman to have a functional fallopian tube and is performed in a single procedure.  The woman's eggs and the sperm are combined in a catheter and immediately inserted into the woman's fallopian tube, rather than mixing oocytes and sperm in the laboratory.  ZIFT has a very poor success rate and is rarely used today.

Embryo cryopreservation is a procedure in which multiple oocytes are removed from a woman, fertilized, and then frozen for
future use.  This technique allows multiple transfers to occur with only one cycle of stimulation and retrieval.  Often times, older
women may require donor oocytes in order to become pregnant.  If none of these procedures prove successful, gestational
surrogacy may be considered in the case of women with healthy eggs who cannot carry a pregnancy to term.

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