Medical Fertility Treatment

FOLLICULAR MONITORING Cycle tracking: Serial ultrasound scans to monitor egg development in the ovary and to assess how the womb lining thickens during one typical month of a womans’ cycle, can be very useful in identifying potential problems, and in pinpointing exactly when ovulation occurs. The 2 to 3 ultrasound scans are often combined with blood tests, mucus assessment and urine ovulation test sticks to provide a complete picture.

OVULATION INDUCTION:

Tablets or injections may be recommended to regulate or boost ovulation and improve the chance of pregnancy. These treatments are only useful if the fallopian tubes are open and the sperm test is normal. These treatments may be combined with other techniques including intrauterine insemination (IUI), which boost chances further. I always recommend IUI when injections are used.

• Clomiphene : Clomiphene has been used to induce ovulation in women who do not naturally produce an egg once a month. It is routinely given from the second full day of the period for 5 days, and the dose may vary . Some women are resistant to the action of the drug and require larger doses, but most women start on 50mg daily. A different means of treatment is used if no ovulation occurs after increasing the dose over several months, or if no pregnancy results after 6-9 months when ovulation is happening monthly. The drug should not be used continually for over 12 months as there is some evidence that prolonged use may increase the risk of ovarian cancer. A shorter duration of use is not associated with any risk. Like all fertility drugs, Clomiphene can be associated with the possibility of multiple egg development. It is for this reason that all women on the medication should have an ultrasound scan during at least one of their treatment cycles, to ensure that the treatment is working, and that too many eggs are not developing in any one month, which would in turn increase the risk of conceiving twins, triplets or even more babies at the same time.
• Some women experience headaches or hot flushes whilst taking the tablets, and they can be associated with feeling a little depressed, but most patients have no side effects at all. Rare side effects include alopecia and blurred vision. The medication should be stopped immediately if these symptoms occur.
• There is no increased risk of miscarriage or birth defects after taking Clomiphene.
• Tamoxifen : Tamoxifen is similar to Clomiphene in the effects on the ovary, but it tends to cause less side effects. Most people recognise it as the drug routinely used in women with breast cancer but it works very well when it comes to promoting egg growth. It is given the same way as Clomiphene. it is advised to take between 20-60mg daily for five days, starting on the second full day of the period. A scan is performed between day 10 and 12 to monitor egg growth and to predict when ovulation will occur.
• FSH Injections : Injections are often used when Clomiphene or Tamoxifen have not worked, or in some women who ovulate normally but need ‘superovulation’ to help conception. It is my routine practice to combine the use of these injections with intra-uterine insemination each month. The injections themselves start between day 2 and 3 of the period, and are usually recommended daily, or less commonly on alternate days. They sound frightening I know, but they are easy to do! A total of 10 to 12 daily injections are normally needed to ‘grow’ one or two eggs every month. A scan will confirm when the egg(s) is ripe. At this stage a different injection will be given to help the egg(s) release and the IUI treatment arranged thereafter.
• Pregnancy should result within 6 months when the injections are used during each cycle. In vitro fertilisation is the next step if there is no news at that stage, and may be recommended earlier if the response to the treatment is not optimal.