Female infertility is caused by poor ovulation (egg production), damaged fallopian tubes or problems with the womb (uterus) where the pregnancy grows. After infertility testing, women can be treated with medications, surgery, intrauterine inseminations (IUI) or In Vitro Fertilization (IVF)
Clomid Pills for Infertility
Clomid (Clomiphene Citrate, 50 mg oral pills) is prescribed to improve egg ovulation and it takes 2-3 months on Clomid therapy to conceive pregnancy. Clomid is one of the oldest prescriptive fertility medications, most often used for patients with PCOS (Polycystic Ovary Syndrome) to treat infrequent or absent ovulation and irregular menses. Clomid helps to restore ovulation and many of patients get pregnant. Although designated to improve ovulation, Clomid is prescribed for all-type infertility patients. Therapy is monitored for effectiveness (ovulation blood test) and for side effects; ovarian cyst, hyperstimulation, mood swings, hot flashes, abdominal pain and visual disturbances. Women naively believe in ‘magic Clomid pills’ that after years of unsuccessful attempts to conceive, Clomid will perform a miracle. When not pregnant after months on Clomid, patient refuses to stop medication, changes doctor to get new prescriptions, risking disappointment and side effects
Damaged Fallopian Tubes (Tubal Factor)
Healthy fallopian tubes pick up eggs produced by women ovary. Pelvic infection (PID) and tubal inflammation is the most common cause for tubal damage, loss of tubal function and tubal infertility. Infection, especially one caused by chlamydia, may spread from vagina or cervix to the upper pelvis and damage fallopian tubes. Chlamydia PID is implicated in tubal disease, ectopic pregnancy, tubal blockage and tubal infertility. Following PID fallopian tubes are frequently closed and swollen at the end, forming hydrosalpinx. Hydrosalpinx lowers chances for successful IVF and should be removed before IVF treatment
Ectopic Pregnancy
Ectopic Pregnancy located in the fallopian tube, happens when fertilized egg get stuck in the tube unable to reach uterus. Tubal pregnancy may rupture and bleed heavily necessitating surgery to remove ectopic or a tube. Unruptured ectopic is often treated with medication (Methotrexate injections). Fallopian tubes may remain open after ectopic giving patient chance for pregnancy, but after failure to conceive for six months or longer, hysterosalpingogram (HSG test) will determine tubal condition and patency. History of tubal repair; tuboplasty or reconstruction and many non- tubal surgical procedures including appendectomy may increase risk for ectopic pregnancy. Tubal infertility, including tubal ligation, is best treated with IVF
Infertility after Pelvic Surgery
Myomectomy is surgery to remove fibroids (myomas), uterus non- cancerous growths. Fibroids change shape and characteristics of the uterine tissue, causing pain, heavy periods and bleeding, pressure on the bladder with frequent urination and other symptoms. Large fibroids are often removed to relief symptoms and to allow pregnancy to grow. Surgery benefits outweigh surgical risks. Patient with small fibroids may have successful pregnancy without surgery or to have less invasive hysteroscopy. Myomas are the most common indication for hysterectomy (removal of the uterus). Many women never conceive after myomectomy after post- surgery scarring precludes pregnancy implantation and growth. Extensive scarring may damage fallopian tubes and lower chances for pregnancy, especially in older patients. Oocyte or embryo freezing before myomectomy is a valid consideration. Uterine Artery Embolization, another treatment for fibroids, carries risk of permanent loss of menses (amenorrhea), with no periods and no chances for pregnancy
Surgery for Endometriosis
Surgical treatment for pelvic endometriosis frequently involve multiple procedures and in severe cases surgery potentiates endometriosis-damaging effect on ovaries with loss of follicles and eggs. For women with advanced endometriosis, especially these who lost one ovary and at risk for early menopause, egg freezing is of great value. Endometriosis is a medical condition common in infertile women, known to produce inflammation and hostile environment for implantation and pregnancy, increased risk for miscarriage and tubal damage from the scar tissue. Patients with endometriosis often undergo IVF to conceive. Several cycles of IVF treatment are often needed, but at the end, more than 50% woman with minimal to mild endometriosis, and 30∼40% of women with severe disease have a baby
