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FERTILITY DRUGS
Given that all previous tests on both partners proved
satisfactory, it may indicate that the woman is failing to ovulate,
thus suggesting a hormonal problem, and because the ovulation cycle
is so complex it is no wonder why many suffer with this condition.
Bromocriptine (Parlodel) The pituitary hormone 'prolactin' is responsible for stimulating
breast-milk production, and when an excess of this hormone is
present in a non-pregnant woman, it interferes with the normal cycle
of FSH production, thus blocking ovulation and resulting in
infertility. Symptoms of this disorder include, irregular menstrual
cycles, breast-milk secretion, hot flushes and vaginal dryness.
There may be several causes as to this excess production, namely:
certain drug usage, chronic anxiety and (although rare) pituitary
disease. Because anxiety can affect the level of this hormone, it
may be necessary to obtain several measurements of prolactin before
an accurate diagnosis can be made.
Bromocriptine is a drug that is prescribed to treat this condition
by interfering with certain chemicals in the brain, which in turn
suppresses the production of prolactin. Therefore one can see why it
is so commonly used to assist in the termination of breast feeding.
Treatment will be given on a daily basis until such time as
ovulation and pregnancy has occurred. Approximately 80% of those
suffering with this condition will benefit from this treatment and
the incidence of multiple pregnancies is no higher than that in the
normal population.
Clomiphene (Clomid) Having the similar effects as that of oestrogen, Clomiphene causes
the brain to respond as it would in the case of oestrogen levels
being low, and in so doing, releases FSH from the pituitary gland.
This drug is particularly helpful in the following four scenarios:
- those women who have very few menstrual periods
- those women whose periods and ovulation have failed to recommence
after 'stopping' oral contraception
- those with inadequate levels of Progesterone
- and those in whom ovulation stimulus may be necessary, as in the
case of donor sperm treatment.
Clomiphene tablets are usually taken three times a day for five
days, either during the fifth to the ninth or second to seventh day
of the cycle, the first day coinciding with the onset of menstrual
bleeding. After the ovulation response has been achieved, Clomiphene
treatment may be continued for another six months/cycles. Side
effects from the drug have been reported in a small number of
patients, those being, blurred vision, headaches, skin rashes and
mild pain in the lower abdomen. If these symptoms persist and/or are
severe it is suggested that you contact the doctor concerned, as it
may indicate that the dosage is too high. This drug if taken for an
extended period of time can produce ovarian cyst formation, so is
therefore only recommended for those patients in whom ovarian or
pituitary failure is prominent
Human Menopausal Gonadotrophin (HMG)
This treatment would only be appropriate for those women whose
investigations into infertility have shown to have insufficient LH,
FSH and oestrogen response. HMG is purified FSH and LH hormones
extracted from the urine of menopausal women, in the form of
injectable ampoules. Being a fairly complex treatment programme, it
is only offered in specialist clinics and can be expensive. The
woman receives the 'injection' either on a daily basis or a course
of three injections on alternate days. The oestrogen urine output is
then measured via a 24 hour daily collection of urine samples, to
assess whether sufficient HMG is being 'received' to be able to
provoke egg cell production. Ultrasound scanning of the ovary may
also be necessary to assess growth response. Multiple ovulation in
this case is possible, so there is a chance of multiple pregnancy,
this being due to the difficulty in being able to estimate the
'correct' dose and the unpredictability of the ovary's reaction.
Human Chorionic Gonadotrophin (HCG)
HCG's action is very similar to that of LH, in that it stimulates
the release of hormones that would enhance the maturity of the egg
cell. Given in the form of an intramuscular injection at the precise
time of expected ovulation, it aids the mature egg cell by
prolonging the possibility of fertilisation and enhancing the
prospects of implantation. Used in conjunction with Clomiphene there
is approximately an 80% success rate in those receiving this type of
combined treatment, however in the case of there being additional
problems such as cervical mucus abnormalities or a low sperm count
in the partner, this figure would obviously be less.
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