Fortunately, there are many fertility drugs now available to help infertile women. Most of these drugs stimulate, or facilitate, ovulation. Unfortunately, there are few medical (drug) treatment options available for men.
Sperm require three months to develop and sperm seen today are a product of the conditions three months ago. Many companies promoting “natural products” tout “sperm enhancers” that promise to increase sperm count or improve sperms survivability. Unfortunately, none of these products have good controlled clinical studies to backup their claims.
Rarely, some men are born with a severe deficiency of FSH and LH, a condition known as hypogonadotropic hypogonadism. These men can often be effectively treated with FSH but must take the medication for several months and the therapy is very expensive. Most opt for IVF with ICSI where a single sperm is inserted directly into the egg.
Clomid is widely used as an ovulation induction agent and should only be used for three ovulatory cycles unless the patient in under the care of a fertility specialist. Studies demonstrate that therapy beyond this period is rarely effective and can increase the chances of side effects.
Follicle stimulating hormone (FSH) is a naturally occurring hormone that directly stimulates the ovaries causing recruitment and development of eggs within the ovarian follicles. Commercial FSH preparations come in two categories; 1) hMG or natural FSH products that are derived from the urine of postmenopausal women and 2) pure FSH manufactured using genetic recombinant technologies.
FSH is employed in in vitro fertilization cycles where it stimulates the development of numerous eggs needed for the various ART procedures. It is also used by fertility specialists in stimulated IUI cycles.
Lupron is commonly used to treat endometriosis and it works by lowering estrogen levels, a hormone which endometrial cells require to survive. Lupron is also used in assisted reproductive cycles to prevent premature ovulation, which could cause loss of the eggs before they can be retrieved. A new product Ganirelix produces the same clinical effect, down regulation, albeit by a different mechanism.
Sometimes a woman’s body may produce excess amounts of the hormone prolactin which can lead to irregular or no ovulation. Prolactin is known as the “pregnancy hormone” because it stimulates breast milk production. High prolactin levels, a condition known as hyperprolactinemia, are sometimes due to a benign tumor located on the pituitary gland.
Metformin (Glucophage) has recently been studied for the treatment of PCOS and is receiving wide clinical use. PCOS produces abnormally elevated androgen levels (male hormones) and metformin lowers these levels by increasing the cells sensitivity to insulin. Once androgen levels normalize, ovulation will often resume. We discuss metformin’s mechanism of action, its place in the treatment of infertility, side effects, and dosing.
Progesterone is initially produced by the leftover follicles (corpus luteum) and later by the placenta. Progesterone stimulates the development of the endometrium which must thicken and become more vascular to support an implanting embryo. If progesterone levels are too low it can lead to a condition known as a “luteal phase defect” where the endometrium fails to develop normally. Progesterone is supplied in many different forms including injections, gels, troches, and creams.
Once the ovarian follicles mature, the pituitary under the influence of the hypothalamus, releases a surge of luteinizing hormone (LH) which initiates the final stages of follicular maturation and ovulation. The body reacts to hCG in the same manner as LH. Therefore, an injection of hCG is often given to cause ovulation in an IUI cycle and to prepare the follicles for retrieval in an IVF cycle.