Fertility Drugs

I chose to do my science paper on fertility drugs. I was interested in researching fertility drugs because it is a very important issue for couples seeking to become parents. It's very good information to know and may also even help someone that is looking into using fertility drugs. In researching this topic I came across a massive amount of information and was glad to see that so much information was being provided for such a delicate matter.

Most men and women are raised thinking that eventually they will marry and have children. What happens when a couple gets married and wants to have a child and finds out that after several times of having unprotected sex there is no pregnancy? The finger is usually pointed at the woman but in some cases it can be due to the man. In a woman's case, the problem is usually that she is not ovulating normally and in a man's case he might have low sperm count. These are the problems that are most heard of but there are other factors that can cause infertility. An anxious couple quickly turns to science to try and find a solution to their problem. Although taking fertility drugs is the "solution", it can be quite strenuous for the couple. The couple has to submit to an emotional roller coaster , possible financial hardship, and a love life that sounds more like supply and demand. Some couples get so tied up with conceiving a child that they do not enjoy what they're doing but rather do it on demand. "Their marriages are sometimes threatened to the point of divorce."(p.16, Carr) "there is a definite relationship between infertility and stability and happiness in marriagemore than one-half of the couples who seek divorce are childless and the majority of infertile couples eventually apply for divorce."(p.16, Carr) When a couple is trying to conceive they will often have feelings of frustration and discouragement. As we see, making the decision of seeking help using fertility drugs requires that both parties be supportive of each other and really work together to achieve their goal.

"Between 15 and 25 percent of all couples in the United States are infertile. If you've had unprotected sex for more than 12 months (if you're over 35, it's six months) and are still not pregnant, you could be one of them."(www.babycenter.com) Once a couple suspects infertility and becomes a reality they begin a new emotional stage of their life. It is said that women are usually the ones that suffer the most when dealing with infertility. For some women, motherhood is a large part of their image of themselves as females. Men tend not to be pressured the same way to become fathers. "Most men are able to deal with this matter better because they are brought up to repress their feelings."(www.babycenter.com) If it is known that the fertility problem is his then a man's image of himself will begin to suffer. Infertile couples end up on an emotional roller coaster because they begin "to live their life in month to month cycles of hope and disappointment that revolve around ovulation calendars and menstruation."(www.babycenter.com) They also begin to deal with financial issues because the treatment is expensive and requires holding off on extra expenses in order to save money.

What are the causes of infertility? All of the cause that will be named were taken from the Major Causes of Infertility Chart from www.babycenter.com . In the following I will only mention the condition and the definition but they also provide symptom and solution information. Women: Condition: Endometriosis- This condition, in which endometrial tissue (the uterine lining that sheds with each monthly period) grows outside the uterus. Condition: Ovulation problems- Any condition (usually hormonal) that prevents the release of a mature egg from an ovary. Condition: Poor egg quality- Eggs that become damaged or develop chromosomal abnormalities can't sustain a pregnancy. This problem is usually age-related-egg quality declines significantly in the late 30's and early 40's. Condition: Polycystic ovarian syndrome- Patients whose ovaries contain many small cysts have hormone imbalances and do not predictably ovulate. Condition: Female tube blockages- Blocked or damaged fallopian tubes prevent eggs from getting to the uterus, and sperm from getting to the egg. Leading causes include pelvic inflammatory disease, sexually transmitted diseases such as chlamydia, and previous sterilization surgery. Male: accounts for 35 to 40 percent of all fertility problems. Condition: Male tube blockages- Any obstructions in the vas deferens or epididymis (the tubes that transport fertile sperm). Varicoceles (varicose veins) in the testicles are the most common cause of male tube blockages. Sexually transmitted diseases such as chlamydia or gonorrhea are also linked to tube blockage problems. Condition: Sperm problems- Low or no sperm counts, poor sperm motility (the ability to move), and abnormally shaped sperm can all cause infertility. Condition: Sperm allergy- Fewer that 10 percent of infertile women and men have immune reactions to sperm, which cause them to produce antibodies that kill sperm cells. In men, this is most common after a vasectomy. This diagnosis is controversial. Unexplained and Combination: accounts for 20 to 35 percent of problems. Condition: Unexplained infertility- This catch-all term is used when doctors can't find a cause for infertility after a full workup. Some experts think that being significantly over-or underweight, exercising excessively, and even environmental toxins may be contributing factors, but no direct links have been confirmed. Condition: Combination infertility- The term used to describe couples who have both male and female infertility problems, or when one partner has more than one fertility problem.

What are the treatment options? The first resort is fertility drugs or surgery. "The newer and more high tech treatments known as Assisted Reproductive Technologies (ART), such as in vitro fertilization, are considered a last resort, largely because of their cost and complexity." (www.babycenter.com) Treatment options: Fertility drugs, Artificial Insemination, Surgery, (ART). There are several different pills or shots you can choose from but the most popular ones are Clomiphene Citrate that is sold as Clomid or Serophene, and Human Menopausal Gonadotropins (hMG) sold as Pergonal, Humegon, or Repronex. Both of these treatments can be used for men and women. Doctors use this treatment to stimulate ovulation and sperm production. Fertility drugs for use in men have not yet been approved by the FDA (Food and Drug Administration) and there have not been enough studies done on the effects of fertility drugs on men. But studies do show that these drugs can only help men that have specific hormonal imbalances that originate in the pituitary gland. "Both Clomiphene, taken daily as a pill, and hMG, injected two to three times a week, prompt the pituitary gland or hypothalamus (the part of the brain that regulates basic functions such as temperature) to make more luteinizing hormone and follicle-stimutating hormone." (www.babycenter.com)

The drug therapy generally lasts for about three to four months. If your partner has still not became pregnant, the doctor may increase your dosage or change the treatment. Fertility drugs are used on men to help them "jump-start" their sperm production. If fertility drugs don't work, a man may have to undergo a testicle biopsy to see what else is wrong with his sperm.

Both Clomiphene and hMG have temporary side effects. They include blurred vision, weight gain, temporary breast enlargement and tenderness and in some cases clomiphene can even cause liver damage. The cost can vary from $30 dollars for five days worth of pills (1 cycle) to more than $2,000 dollars for a cycle of two to three hMG injection a week.

When a woman takes fertility drugs the chance of multiple births will not increase more than 5 to 15 percent. The most popular fertility drug taken by women is Clomid and is taken in pill form everyday. This pill produces more hormones that trigger ovulation. Women who can take this pill include women who ovulate irregularly or not at all, and women who have polycystic ovarian syndrome.

This pill needs to be taken about five days a month and takes about three to six drug cycles to start ovulating regularly. "Success rates do not improve if you take the drugs longer, if you are not getting any results, you may have your dosage increased or switched to another medication or procedure.

The side effects you might experience include mood swings, dry cervical mucus, mild ovarian enlargement (swelling), stomach pain, breast tenderness, insomnia, nausea and vomiting, blurred vision, headaches, fatigue, irritability, depression, weight gain, and in rarer cases ovarian cysts.

Success rates: 70 to 90 percent of women ovulate within the first three months of treatment. Of those who ovulate, 20 to 60 percent get pregnant. The cost is a little over thirty dollars for one cycle of Clomid. Women's treatment is always relatively more expensive than men's.

Besides having to deal with expensive treatments, couples also need to worry about having multiple births. "All multiple pregnancies are high risk" and those risks increase with the number of infants in a given pregnancy. There is an inherent higher frequency of pre-term labor and low birth weight for all multiples and with that comes a host of raised chance for health problems." (www.infertility.about.com) Sometimes the thought of having multiple children is enough to change the minds of some parents. U.S. stats for 1996 from www.infertility.about.com stated the following: Live births in twin deliveries: 100,750 (about 50,375 sets of twins). Live births in triplet deliveries: 5,298. Live births in quadruplet deliveries: 560 and live births in quintuplets and other higher order multiples: 81. According to the website of Parents of Multiple Births Association of Canada, it is estimated that "Overall 15-17 percent of multiple births result from infertility treatments, however, it is estimated that 60 percent of triplets, 90 percent of quadruplets, and 99 percent of quintuplets result from these treatments. Multiple births vary with the procedure used. Clomid itself has a low multiple rate, around three to six percent are usually twins. Researchers believed that the more eggs or embryos meant better chances of getting pregnant, but, recently researchers found that transplanting fewer embryos can result in fewer multiples without decreasing pregnancy chances.

Long term effects. Some studies have found that the most prescribed fertility drug has an increased risk of ovarian tumors. There is some doubt because infertile women have always had a greater risk of developing ovarian growths regardless whether they took fertility drugs or not. Scientists believe that the repeated ovary stimulation is what leads to ovarian cancer. It is known that a woman whose close maternal or paternal relatives have breast or gynecological cancer is three times more likely to develop ovarian cancer. It ultimately comes down to the woman making the decision of whether or not to use fertility drugs. There are opposing views tat suggest that ovarian cancer risk is not increased with fertility drugs but still require further exploration.

As I mentioned before, using fertility drugs or any other treatment is expensive. There are some organizations and ways that can assist you with the cost. "Only about one-quarter of U.S. employer health plans cover infertility treatments." (www.babycenter.com) There are several ways that you can use tax time to your advantage. You can use Flexible Spending Accounts, there are some companies that have flexible spending accounts for health expenses. The tax advantage is that the money accrues in the account pre-tax so it's tax free income. Another way is if an expense is "deductible" then you can factor it into your income tax returns. You can also file itemized tax returns, and there is also a company called The Fertility Foundation, Inc. that helps couples if they are unable to afford the treatments. "The Fertility Foundation, Inc. can help with up to 80 percent of the first cycle, and if necessary, up to 50 percent of the second and third. (While couples must use a Reproductive Endocrinologist). (www.infertility.about.com) For an application, list of requirements, or basic information about the organization you can visit http://www.fertilityfoundation.org

Although this paper is long it does not provide nearly all the information available about infertility. This paper can be seen as tool. There's no doubt in my mind that taking fertility drugs is a very big decision. What I learned from this research is that many eager parents put their own health at risk in order to have a baby. Overall, success depends on each case individually and on the severity of your condition and age.

Bibliography

About, The Human Internet. http://www.infertility.about.com . (17 May 2001)

Baby Center, Cradle and all. http://www.babycenter.com . (17 May 2001)

Carr, Delta Genevieve. Fertile and Infertile Marriages. Xerox University Microfilms: USA, 1975.