An Introduction To Fertility Drugs
Every human being is made from an ovum – an egg cell – and a sperm cell. These sex cells are called gametes. Problems with these gametes are a major cause of infertility. Here we will look such problems that can lead to infertility or difficulty conceiving caused by issues with the egg cells of the potential mother. These problems are, generally of three types: firstly periods may have stopped or no eggs are being released during menstruation (periods); second there could be too few eggs or, finally, the eggs released are of poor quality.
Fertility drugs can do little to address these last two issues as, unlike men who produce sperm cells throughout their lifetime, a woman’s ova are formed while she is still in her mother’s womb, and, like each and every other cell in the human body, they too age and die. Conception may still occur using eggs removed and screened for viability or, should these problems prove intractable, using donated egg cells.
Period Problems
A period, menstruation, is the shedding of the lining of the womb (uterus) that builds up each month to allow implantation of an embryo should an egg cell be fertilised by a sperm cell. This is the final stage of a long process stimulated and regulated by protein messengers called hormones. The two crucial hormones in controlling menstruation and, therefore, fertility are oestrogen and progesterone. Some women who are finding it difficult to conceive are surprised to learn that they may not be releasing an egg cell each month as their periods may be regular and seem normal or heavy. For other women, their periods may be infrequent, unpredictable or may have ceased altogether.
One of the first approaches to remedying infertility when it has been established by a sperm count that the semen of the potential father contains sufficient numbers of viable sperm cells, is to use fertility drugs. One such is Clomifene/Clomiphene. This drug is also known as Clomid, Clomifert, Milophene, and Serophene and is often used to treat women who suffer with polycystic ovaries or polycystic ovary syndrome.
How Does Clomifene Work?
The active ingredient in Clomifene is 2-[4-(2-chloro-1,2-diphenylethenyl]phenoxy)-N,N-diethyl-ethanamine a bit of a mouthful usually known generically as Clomifene citrate. To use the technical terminology, Clomifene is a selective oestrogen receptor modifier (SERM). In other words, it signals to receptors that tell the body to stop producing oestrogen passing on this message to the brain so the levels of this hormone which can inhibit menstruation are decreased. This, first leads the pituitary gland in the brain to increase the production of follicle stimulating hormone (FSH) that acts on the ovaries to ripen the eggs ready for release. In turn, this leads to higher levels of a hormone, lutenising hormone (LH) that tells the ovaries to release an egg so stimulating menstruation.
The fertile time during a woman’s cycle only lasts around three days each month and corresponds to the time when the egg cell released from one of her ovaries is travelling down the fallopian tube to the uterus (womb). The point in time at which the egg is released is called ovulation. Bringing a woman’s menstrual cycle into one that is regular and predictable on its own greatly increases the probability of conception. This can take four to six menstrual cycles with Clomifene to become properly established. To enhance the possibility of conception, ovulation tests can be used to detect levels hormone levels that indicate an egg has been released. These tests are non-invasive and simple to use. Ovulation tests comprise little sticks that are urinated on or dipped into collected urine just like a home pregnancy test.
Side Effects of Clomifene
Some of the side effects of taking Clomifene are akin to some of the more troubling symptoms experienced by women during the menopause and include sudden hot flushes, abdominal cramps and bloating, visual disturbances such as blurring or changes in depth perception (though this is highly dose dependent). Sometimes women taking Clomifene will develop ovarian cysts and ultra sound scans can show and enlargement of the ovaries however, this tends to remedy itself on cessation of treatment. More rarely reported side effects include nausea and vomiting, spotting (small amounts of blood releases through the vagina between periods) and alopecia (hair loss).
Clomifene will often cause the ovaries to release more than one egg at a time increasing the chance of conceiving twins tenfold from the usual one percent to ten percent.
Some women or couples may see this as a benefit to the medication meaning that they can complete their family with only one pregnancy but others see the increased chance of twins (or more) as a disincentive to opt for this treatment, particularly if the potential mother has underlying health problems that may make a multiple pregnancy or delivery especially risky. It is worth noting, however, that Clomifene has been used for decades in the treatment of female infertility and has an excellent safety record and that the increased rate of twins and triplets in women who have taken Clomifene to help them conceive is far less than that of treatment with gonadotrophins.
Serious Side Effects of Fertility Medications
It is vital to note that all therapies that modify hormone levels in the body, as Clomifene does, carry with them the risk of the patient developing blood clots which in certain instances can be fatal. Unusual heat, swelling or pain in the calf may indicate a deep vein thrombosis and immediate medical attention should be sought.
Pulmonary embolism is the medical term for a blood clot or clots on the lungs. Any combination of these symptoms warrant emergency medical help: chest pain, thoracic numbness, coughing up blood, palpitations, irregular heartbeat, fainting, breathlessness on even mild exertion, severe dizziness and tremor.
Stroke is another rare but possible consequence of this type of, what is essentially, hormone therapy. The signs to look out for are tremor, slurred speech, numbness or extreme heaviness on one side of the body, drooping of one side of the face, sudden partial or total loss of vision and severe, sudden headache. Call an ambulance immediately if you have any of these symptoms.
Sensible Precautions Reduce The Risk Of Side Effects
Before embarking on fertility treatment one should assess one’s life style – that goes equally for both potential parents. Increasing exercise, keeping weight to within a healthy range, giving up smoking, abstaining from alcohol or reducing intake to fewer than six units per week and no more than two in twenty-four hours will not only increase the chances of conceiving but also reduce the likelihood of minor or serious side effects. Ceasing smoking and bringing your BMI (body mass index) to between twenty and twenty-five are advised before beginning treatment. Taking such measures is a great idea for anyone planning to conceive whether experiencing difficulty or not and will have you in the peak of health if and when you do become a parent.