Basic treatment is what most patients require. This treatment is simple, less expensive and less comlex than in vitro treatment. Basic treatment can be divided into four groups:
- Ovulation Drugs
- Artificial insemination
- Surgical procedures
- Treatment for Polycystic Ovaries
Ovulation medications are frequently used to treat ovulation disorders. They can also be used with insemination to treat other problems such as endometriosis, male factor and unexplained infertility. These drugs fall into two groups: oral and injectable.
The oral agents are Serophene and Clomid. These are simple, inexpensive agents that give modest results. The pregnancy rates after a few months are 35-40%. Multiple pregnancy rates are 7-10%. Side effects include hot flushes and irritability. Their biggest draw back is that they don't result in pregnancy in two thirds of cases.
The injectable agents are more potent and effective. The most widely recognized drug is Pergonal. Equivalent drugs to Pergonal are Humegon and Repronex. Newer agents are Metrodin, Fertinex, Follistim and Gonal F. These drugs stimulate egg production in the ovary and then hCG or Profasi is given to release the eggs. These agents contain the active agent called Follicle Stimulating Hormone (FSH). There is a less active agent present in some of them. For 95% of patients the agents are interchangeable. These agents give higher pregnancy rates over a few months (50-60%). They are however more expensive and prone to multiples. Multiple pregnancy rates are approx. 15-20%. Most multiple pregnancies are twin.
For a full discussion of these medications, see the page on ovulation drugs.
Intrauterine insemination (IUI) is also known as artificial insemination. This is a procedure where the sperm of the husband or donor is concentrated by a process known as sperm washing. It is then placed in the upper uterus using a small plastic tube or catheter. This is a simple relatively inexpensive office procedure in contrast to the more expensive and involved in vitro technique. The procedure takes a few minutes. The patient then rests for 5 -10 minutes and then returns to daily activity. This is a useful technique in cases where there is poor sperm transport, in unexplained infertility and in endometriosis associated infertility. Insemination is generally used in cycles where ovulation drugs have been utilized. This is because insemination in the natural (unmedicated) cycle produces weak results.
There are two types of surgery: open or large incision surgery and laparoscopic or small incision surgery. Today we try to do as much as possible through laparoscopic surgery because it is easier for the patient and recovery time is a few days. As technology has improved we are able to use laparoscopic surgery to treat more complex problems. We can use ancillary equipment such as lasers to remove endometriosis, and scarring of the tubes. The following is a diagram of a laparoscopic procedure using two incisions:
These are common causes of infertility.
Endometriosis and scarring as depicted above can be very effectively treated with laparoscopy. The fallopian tubes can also be opened using lasers or catheters. We can work inside of the uterus using an instrument called a hysteroscope to remove scarring or fibroids.
Open surgery is still used for reconstruction of the tubes after a tubal ligation procedure. Tubal reversal gives excellent results in many cases. For a full discussion of open microsurgery, please look at the tubal reversal section.
Surgery gives good results if there is mild to moderate disease. If there is severe scarring or endometriosis, in vitro techniques give superior results. Read more about Endometriosis.
The image below shows endometriois of the left ovary.
Read more about In Vitro Fertilization.
Treatment of Polycystic Ovaries (PCOD)
There is an entire section of our web site devoted to PCOD. PCOD is a condition which involves irregular menstrual cycles, infertility, frequently also increased body weight and excessive hair growth. Read more about PCOD.