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Before IVF- More about the fertility drugs

Generally, fertility drugs are used to treat problems with ovulation or recurrent miscarriage. However, this is not always the case, so even if you’re using assisted reproductive techniques such as IVF (in vitro fertilization), fertility drugs are still an important part of treatment. In this case, fertility drugs may increase the number of eggs the women produces. Some are taken orally, and some are injected. What do these wonder pills and injections do? In general, these medications work by causing the release of hormones that either trigger or regulate ovulation. Fertility drugs can also be used in men to treat male factor infertility, but this is less common.

Commonly Prescribed Fertility Drugs

Since the number and names of all of the infertility medications may seem dizzying, here are the basic facts on the drugs most commonly prescribed.

  • Clomiphene
    Clomiphene is usually the first choice for treating infertility, because it is effective. Clomiphene works by stimulating hormones in your brain (hypothalamus and pituitary gland) to release hormones like GnRH (gonadotropin releasing hormone), FSH (follicle stimulating hormone), and LH (luteinizing hormone) – that will stimulate the ovaries to produce egg (or several) each month, while gonadotropins stimulate your ovaries directly to produce an egg (or several). That’s all some women need to get pregnant.
  • Gonadotropins
    Brand names: Pergonal, Repronex, Fertinex, Follistim, Gonal F, Novarel, Ovidrel, Pregnyl, Profasi, and Menogon and Puregon (available only in Europe). These drugs are meant to mimic the LH hormone in the body, LH triggers ovulation. And sometimes they are combined with FSH treatment, also known as human menopausal gonadotropins (hMG), but this may be used in some special cases, not that requently. They are injectables.

But like many other fertility solutions, such as in vitro fertilization, fertility drugs can increase your chance of multiple births — and the more babies you carry, the greater your risk for complications such as miscarriage and premature labor. About 10 percent of women who take Clomid have multiples (mostly twins), as do 10 to 40 percent of women who take gonadotropins.

Risks of Fertility Drugs

As with the use of any drug, risks come with fertility drugs. One risk you’re no doubt familiar with is the risk of a multiple pregnancy. Multiples, either twins, triplets, or higher-order, can occur when using fertility drugs.  The side effects of clomiphene are generally mild. They include hot flashes, blurred vision, nausea, bloating, and headache. Clomid can also cause changes in the cervical mucus, which may make it harder to tell when you’re fertile and may inhibit the sperm from entering the uterus.

Another potential side effect of fertility drug use is ovarian hyperstimulation syndrome, or OHSS. OHSS happens when the ovaries are overly stimulated, becoming dangerously large and filled with too much fluid. This fluid, which is released with ovulation, can lead to serious complications. OHSS is rarely life threatening, but it should be taken seriously.


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Before IVF- What is intrauterine insemination?

What is IUI?

Intrauterine insemination (IUI) involves a laboratory procedure to separate fast moving sperm from more sluggish or non-moving sperm.The fast moving sperm are then placed into the woman’s womb close to the time of ovulation when the egg is released from the ovary in the middle of the monthly cycle.

Is IUI for me?

Your doctor may recommend IUI if:

  • there is unexplained infertility
  • there are ovulation problems
  • the male partner experiences impotence or low sperm count or decreased sperm mobility
  • you do not have any known fertility problems but may not have a male partner and are trying for a baby using donated sperm.
  • Ejaculation dysfunction

 

In sum, IUI is a reasonable therapy for some infertility patients, but should be abandoned for IVF by the end of the third IUI cycle.

It is essential that your fallopian tubes are known to be open and healthy before the IUI process begins, because one of the most common causes of infertility is blockage of the fallopian tubes. A tubal patency test is usually carried out as part of your assessment by the fertility clinic. When the pelvis and tubes are healthy, dye passes freely through both tubes. There should be no adhesions present that might prevent an egg from having access to either tube from the ovaries.

 

The second essential requirement is that there is no significant problem with sperm numbers or sperm quality. If your partner is unable to provide sperm, or if you do not have a male partner, you may want to consider donated sperm.

 

How does IUI work?

For women:

  • If you are not using fertility drugs IUI is done between day 12 and day 16 of your monthly cycle – with day one being the first day of your period. You are given blood or urine tests to identify when you are about to ovulate. Many clinics will provide you with an ovulation predictor kit to detect the hormone surge that signals imminent ovulation.

– or –

If you use fertility drugs to stimulate ovulation, vaginal ultrasound scans are used to track the development of your eggs. As soon as an egg is mature, you are given a hormone injection to stimulate its release.

You should consider the best option for you with your doctor.

 

  •  The sperm are inserted 36 to 40 hours later. To do this, the doctor first  inserts a speculum (a special instrument that keeps your vaginal walls apart) into your vagina.

A small catheter (a soft, flexible tube) is then threaded into your womb via your cervix. The best quality sperm are selected and inserted through the catheter.

The whole process takes just a few minutes and is usually a painless procedure but some women may experience a temporary, menstrual-like cramping.

  • You may want to rest for a short time before leaving the clinic – ask your clinic what they recommend.

 

For men:

  • You will be asked to produce a sperm sample on the day the treatment takes place.
  • The sperm are washed to remove the fluid surrounding them and the rapidly moving sperm separated out.
  • The rapidly moving sperm are placed in a small catheter (tube) to be inserted into the womb.