Fertility Drugs: Are they worth it?

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Biology 103
2001 Third Web Report
On Serendip

Fertility Drugs: Are they worth it?

Margaret Pendzich

Over the past few years there seems to have been an increase in the amount of couples that have used fertility drugs and ended up having nine or more children. The couples' stories have been aired on the news, and when interviewed, many of the couples stated that they only wanted one child, but because one of the spouses was infertile, they were unable to get pregnant. At the advice of their doctor, the couple took fertility drugs, and the result was the rapid expansion of their family. The effectiveness of fertility drugs such as Clomiphene and Bromocriptine are overshadowed by their many, and often very harmful, side effects. Are infertility drugs worth the cost that possible side effects have?

Causes and Solutions to Infertility

Infertility affects 7.1 percent, or 2.8 million couples, of married people in the United States. It is difficult to assess the overall percentage of infertility that exists in the United States, as many individuals do not know that they are infertile until they attempt to have children. In addition, information on the web is confined to addressing infertility among married couples, thus this web paper discusses studies conducted among married couples. Less than a third of married couples seek help from their doctors, even though almost 90 percent of all cases of infertility have one or more causes than can be treated. Infertility's most common causes include egg quality/production, blocked tubes, and the male-factor. (1).

Problems in egg quality/production are the result of poor egg quality, irregular ovulation or failure to ovulate because of hormonal deficiencies or imbalances. A fourth case is polycystic ovarian syndrome, which is a condition in which a hormonal imbalance prevents the egg-containing follicles on the ovaries from maturing and releasing an egg, instead forming sometimes painful ovarian cysts. These problems, especially deteriorating egg quality, are often age-related, and apply most often to women 37 and older. Possible solutions to poor egg quality/production include use of a donor egg, fertility drugs such as Clomiphene and Bromocriptine, and in vitro fertilization (IVF). (1).

Blocked fallopian tubes are often the result of scar tissue, adhesions, and damaged tube ends (fibria). Another common cause is endometriosis, which is the growth of endometrial cells (the tissue that lines the uterus) outside the uterus, most often on the ovaries, Fallopian tubes, or the exterior of the uterus. About 10 to 15 percent of women of childbearing age have this condition, many of them without symptoms. Even if a woman ovulates regularly, blocked tubes make pregnancy next to impossible, since the egg is unable to reach the uterus. The primary treatment for blocked fallopian tubes is laparoscopic surgery that is used to open the tubes. If surgery is not an option or is unsuccessful, other possible solutions include donor eggs and in vitro fertilization (IVF). (1).

In men, infertility can be the result of a blocked vas deferens, or epididymis, poor sperm quality, low sperm motility (the sperm's ability to move) a semen deficiency, or not having enough, or any sperm to begin with. The most common solution is to undergo an operation to clear the blocked tubes. However, if the operation is unable to cure a man's infertility, fertility drugs may boost sperm production, or a man's sperm can be used to artificially inseminate his partner. Other options include using donor sperm or a procedure called intracytoplasmic sperm injection, which is injecting sperm directly into the egg. (1).

Assisted Reproductive Technologies

Assisted reproductive technologies, or ARTs, refer to IVF and several variations tailored to individual parents' unique conditions. IVF is a process that begins with the woman taking a fertility drug (usually Clomiphene or Bromocriptine) to stimulate her ovaries to develop several mature eggs for fertilization. By the monitoring of blood hormone levels, the woman's doctor can detect when her eggs are mature; an ultrasound confirms that the eggs are ready to be retrieved. Shortly after, the woman will be given a local anesthetic, and her doctor will remove the eggs using a needle inserted through her vaginal wall. Her partner's sperm is then combined with her eggs in a dish in a laboratory. Two days later, her fertilized eggs each become a ball of cells called an embryo. Usually, two to four embryos are inserted into the woman's uterus through her cervix with a thin catheter. (Extra embryos, if there are any, may be frozen in case this cycle doesn't succeed.) In a successful cycle, an embryo will implant in the woman's uterine wall and continue to grow. (In 20 to 30 percent of IVF pregnancies, more than one embryo implants, depending on the number of embryos inserted.) (1).

Other ART procedures include GIFT, ZIFT, ICSI, donor eggs or embryo, and surrogacy. GIFT refers to gamete intrafallopian transfer, which is where a woman's eggs are removed, mixed together with her partner's sperm in a dish in a laboratory, then surgically injected into her Fallopian Tubes. Fertilization happens naturally inside her body and the embryo implants naturally. ZIFT refers to zygote intrafallopian transfer, where collected eggs are fertilized with her partner's sperm in a dish in a laboratory and then surgically placed in her fallopian tubes using a fiber-thin tube called a laparoscope. ICSI refers to intracytyoplasmic sperm injection, where a single sperm is injected into a single egg and the resulting embryo is transplanted into a woman's uterus. With the donor egg or embryo, if a woman is unable to conceive using her own eggs, a donated egg is mixed with her partner's sperm and the resulting embryo is implanted in her uterus. This procedure can also be done with a donated embryo. Surrogacy refers to a procedure where another woman carries the parent's embryo, or a donor embryo, to term and gives the baby to the original couple at birth. (1).

ART procedures are invasive and expensive. Unlike fertility drugs, these techniques aren't rigorously tested before they are introduced to the public. Though no long-term health effects have been linked to children born using ART procedures, or to mother who have had a procedure done (except in the case where fertility drugs were used), most doctors recommend reserving ART as a last resort for having a baby due to the stress placed on the woman's body. Also, many ART procedures, such as IVF, increase a woman's chance of multiple births. (1).

Fertility Drugs

Fertility drugs work by promoting ovulation by stimulating hormones in a woman's brain to get an egg (or several) ready and release it from her ovaries each month. Many fertility drugs have been used safely and successfully for more than 30 years. Unlike many other infertility solutions, such as in vitro fertilization, fertility drugs won't increase the chance of multiple births beyond 5 to 15 percent. The most common fertility drugs include Clomiphene, Human Menopausal Gonadotrophin, and Bromocriptine.

Clomiphene, taken in pill form daily, stimulates the pituitary gland to produce follicle-stimulating hormones, which are the hormones that trigger ovulation. It prompts the ovaries to prepare a number of eggs for ovulation. Once the drug cycle is finished, the hypothalamus gland releases a lutenizing hormone, which instructs the ovaries to release a mature egg from its follicle to the Fallopian Tubes. Women who ovulate irregularly or not at all commonly use Clomiphene. Clomiphene can cause a wide range of side effects, including mood swings, dry cervical mucus, mild ovarian enlargement, stomach pain, breast and ovarian cancer. About 70 to 90 percent of women who take Clomiphene will ovulate, and of those who ovulate, 20 to 60 percent will get pregnant. (1, 2).

Human Menopausal Gonadotropin (hMG) consists of purified follicle stimulating hormone (FSH). When injected into the body, FSH causes a woman to develop egg follicles. After seven to twelve days of shots, the woman receives an injection of human chorionic gonadotropin that stimulates the ovaries to release the egg or eggs that it has just developed. HMG is most often given to women with low estrogen levels who have not responded to Clomiphene. Possible side effects from hMG include abdominal tenderness and weight gain. In rare cases, less than 5 percent of the time, women develop hyperstimulated ovaries, a potentially fatal condition signaled by sudden onset of severe pelvic pain, nausea, vomiting, or weight gain. Due to an excessive number of eggs, the ovaries rapidly swell to several times their size and may leak fluid into the abdominal cavity. Even with careful monitoring, multiple pregnancies and ovarian hyperstimulation can occur. The rate of multiple births is close to 20 percent. About 70 to 90 percent of women who take hGM will ovulate, and of those who ovulate, 20 to 60 percent will get pregnant. (1).

Bromocriptine, which can be taken orally or as a vaginal pill, reduces the pituitary gland's production of the hormone prolactin. Excess prolactin reduces estrogen levels and inhibits ovulation. Women who take Bromocriptine suffer from hyperprolactinemic amenorrhea, which is a condition where ovulation problems are caused by a pituitary adenoma (a benign tumor). Side effects from Bromocriptine include nausea, dizziness, low blood pressure, and headaches. Patients who take the drug vaginally often report fewer side effects. 90 percent of the women who take Bromocriptine will ovulate as long as they continue taking the drug. Of the women who ovulate, 65 to 85 percent will get pregnant. (1).

Are Fertility Drugs Safe?

One major concern surrounding fertility drugs are the instances of multiple births that arise from their use. Multiple births occur in about 50 percent of cases, especially among women in their early 30s or younger. In most cases, risks can be lowered through careful monitoring and controlling dosages of medications. For IVF, if a high number of eggs are seen developing on the ultrasound, doctors are able to remove them and place back two or three embryos. However, as Dr. Valerie Baker states, "in the case of normal or artificial insemination, we have no control. So if we see too many eggs, we may advise the couple to not attempt to get pregnant. But couples sometimes are hesitant to cancel the cycle because they have so much invested in it, both financially and emotionally". In addition, if the couple does not cancel the cycle and four or more embryos implant, the newborn babies have a high risk of neurological complications if they survive. (3).

Multiple births are also risky because they can result in the birth of sickly, premature babies. Premature babies face serious complications, including lung problems and bleeding the head, which can cause long-term physical and mental impairment. (4).

Fertility drugs are often fingered as a risk factor for ovarian cancer. There are several factors that may increase a woman's risk of ovarian cancer. One factor is that an increased number of uninterrupted ovulations in a woman's lifetime increases her chance of developing ovarian cancer. This may explain why events that interrupt the constant cycle of ovulations, such as pregnancy, breastfeeding, and oral contraceptive use, are associated with a decreased risk of ovarian cancer. Another factor is that increased levels of certain hormones associated with ovulation, such as human chorionic gonadotropin, increase the risk of ovarian cancer. Fertility drugs can increase both the number of ovulations and the levels of hormones associated with ovulation. (5, 6).

A conflicting study states that women who take ovulation-inducing drugs in conjunction with IVF are not are increased risk of developing breast, ovarian, or uterine cancer. However, women who seek treatment but do not take fertility drugs have more than twice the expected incidence of uterine cancer, and women with unexplained infertility have elevated rates of uterine an ovarian cancer. This study was based on date on 29, 700 women who registered for treatment at 10 IVF clinics in Australia. This study, however, only refers to increasing the risk of cancers when fertility drugs are taken in conjuncture with IVF, and not the risk of cancer when drugs are taken by themselves. (7).

While multiple children may seem like a good alternative to remaining childless for many couples, each couple must weigh the risks and benefits of using fertility drugs or ARTs to have these children. Fertility drugs and ARTs may cause serious physical damage and have long-term effects on the mother and the child. Consequently, each couple must consult their doctor and follow his/her recommendations to ensure that the use of a fertility drug is safe for the parents and the child. Childlessness can also be resolved by a method that is physically safe for all parties: adoption.

The use of fertility drugs also has many social and ethical implications. It implies that parents are interested in having offspring that are genetically related to them. There are many options available to infertile couples, and fertility drugs are one solution. Fertility drugs often have severe physical side effects, and are often ineffective. Adoption is a choice open to infertile parents, yet adoption has many social stigmas attached to it that often prevents many couple from choosing adoption over fertility drugs. In addition, due to the cost of fertility drugs, it is often upper and middle class parents that are able to choose this option. This has similar social implications as done genetic engineering. Overall, fertility drugs are an effective solution to infertility for many couples, yet it comes with physical and social costs.

 

WWW Sources

1) The Baby Center, Provides information pertaining to all aspects of childcare and childrearing

2) Site of the International Council on Infertility Information Dissemination

3) Site of Health Beat

4) Site of The Reproductive Health and Rights Center

5) Site of the National Cancer Institute

6) Site of Science Ministries Incorporated

7) Site of International Family Perspectives

 

 

Comments made prior to 2007

This was a GREAT article (Fertility Drugs: Are they worth it?) I have been considering trying for another child at 46 and doing a lot of online research. This article's description of the 3 main fertility drugs, their method of working, side effects and percentages of success, was by far the most direct and informative of anything I have found. Thank you for such a fine resource ... Heidi Newman, 4 April 2006

Comments

Serendip Visitor's picture

Think... before you comment

I am on fertility medicine. I hate it. It burns. It hurts. I have gained weight and am always tired. Yet I really want children. I am so tired of being told to take the natural route!!! My father, a complete believer in the natural route would be horrified if he had to see how many injections I have to administer in a month. Not to mention the costs, and we live in a third world country (South Africa).

I have watched every friend have a child and some have had two. I have had to support family with too many kids yet all we want is our own child. Some of us honestly have a problem and need some assistance.

I urge any person who comments holds their richeous view of 'natural is better' to sit, and try for kids for 5 years, and go through a menstrual cycle every month for five years. It kills you. You stop caring about the risks.

Lastly - if one more person tells me to adopt - I actually wont talk to them again. If you have tried for kids (honestly) and been unsuccessful, people, we have considered this option. Always the mamas with the babies that are full of 'good advice'. Especially the ones that have tried for 'two months'.

Serendip Visitor's picture

I feel for you and understand fully

I totally get you. I totally understand the feeling of wanting kids soo bad, your own kids. I also understand how everyone has advice for you, and if you don't tell people what your going thru (which was my case), I wanted to strangle every person who asked or told me, when or that I should have kids "Back off". Do what you need to do, to feel you have tried all avenue's you are willing/wanting to take to have and hold those precious little being's, miricales. True miricles no matter how they were conseived. The roller coast ride a woman goes thru every month to try and get pregnant is very very hard emotionally and physically. I cry right now thinking about it. Yes, you stop caring about the risks. I have a few health issues now from my infertility days and shots dugs, I wouldnt change a thing. All the best, hang in there, there are many of us women out there, unfortuneately we don't talk about these things when we are going thru it and do it alone. We need to support each other.

Serendip Visitor's picture

heartache

I agree with you! Hang in there and keep trying! We have one daughter through IUI and have been trying for a second for over a year now. I took various fertility meds for 6 cycles, with 6 failed IUIs. I am baffled as to why I can't get pregnant again. Age? God? Stress? If I hear one more person say, "if it's me a by to be..." I'll scream!

Serendip Visitor's picture

That word would be

That word would be "righteous"...

Serendip Visitor's picture

Sorry Righteous

Haha - sorry about that.

I think I was so angry that I did not even read my post before I updated. I had just come out of hospital with OHSS (another unmentioned side effect) ... so this was the wrong topic to comment on.

Good news is - we have decided we are not trying anymore and will have a wonderful life without kids. We will focus our energy on other things now. To all the trying couples out there... good news is you are not alone! There are many things life has to offer and I now see life in a different angle, thanks to a fantastic husband and a different type of doctor :).

Good luck!

Serendip Visitor's picture

Fertility treatments

I have been married almost 6 years now. I have Polycystic Ovarian Syndrome and also having problems ovulating. I have been on clomed. I dont have a right ovary due to a cyst and also endometriosis. Needing help please. On what I need to now.

Betty's picture

Fertility

I want to get pregnant but am trying to conceive and am not conceiving. I was using Femiplan pills but i left them 4 months ago now i want a baby

Bergitta's picture

Any infertility tips?

My husband and I have been trying for about 18 months now and we still have no baby. I don't want to do IVF or anything like that. I'd like to stay natural if I can.

Does anyone one know how you can increase your fertility or chances of conceiving?

Ann Dixon's picture

Additional resources on the web

Thanks to Kelly's Biology class for these additional links:

Male Infertility - causes, which is part of a Stanford class Overview of Infertility Treatment

Female Infertility - from the Harvard Mental Health Newsletter, May 2009

Melissa's picture

Effects of fertility drugs on a fertile woman - HELP

Hi,

I went through IVF 1.5 years ago... I am fertile but carry a rare chromosome disorder so we decided to try IVF to utilise the PGD option... the IVF worked very well I produced a whopping 17 eggs, 14 of which fertilised... Heartbreaking though all 14 were tested and were all effected by the chromosome disorder. Since then we decided to try naturally (the IVF experience was heart breaking so we felt we could deal with the natural process). However, we have been trying VERY HARD, for the past year and a half.. and I am just not getting pregnant - its weird (We already have one other child).

My question is - could the fertility drugs have messed up my natural fertility.. hence the trouble we are having now?

Any ideas... cheers :)

Serendip Visitor's picture

chromosome disorder

I also have a rare chromosome disorder and I am on round 2 of ivf and Pgd. I was recently just given the statistics of having an embryo without the chromosome disorder is less than 2% by my genetic counselor. So basically 98% of the time our embryos are not viable. I was heart broken but still hoping to find one in the 2%. Good luck!

Serendip Visitor's picture

fertility/foster/adopt

i agree w a lot of you. First off clomid is the most prescribed, it really isnt all that expensive. but will it work is the question, im gettin ready to do a second round after, two surgs, and an ectopic. as for adoption id love to but its expensive, we are considering fostering, and hope to have one of our own, it can be very confusing and hard. hope this helps.

Serendip Visitor's picture

fertility drugs

I know of someone who is taking fertility drugs in order to
lose weight and i think that the side affects to that can be very dangerous i believe that she her emotions are in conflict and causing her to become very confused and i am trying to find out what the side affects to doing this to your body would be.

kekelove's picture

Just tryin

Well i justed takein some fertilty pill so heres hopein i have been tryin for 09 years.they were cheap thou

Serendip Visitor's picture

im trying i need answers

I have a 2 yr old girl and about a year ago i was pregnant with another one i lost the baby due to an ectopic pregnancy which i had one of my tubes removed. i have taken the home tests to even see if i can still conceive they all say yes i have bought some fertilty drugs and have been taking them for about 3 weeks. Do you think that this will work or it will just cause problems.. Also, do you think i can even really get pregnant with only one fallopian tube??

Anonymous student's picture

Answer

I am a student in a very educational Human Sexuality class, where one of the topics is infertility. One of the discussions we had was a woman with one ovary and one fallopian tube...one on each side. She still got pregnant. Somehow the egg from her left ovary made it over to her right fallopian tube, and she became pregnant (after a couple miscarriages due to drugs-the drugs messed up one falloian tube and one ovary). Another woman had an egg implant itself on her liver, and since the liver is a serious source of blood, and the infant had all it really needed in the egg...it survived. So yes, you can still conceive with only one fallopian tube :)

Kfb's picture

Ivf over adoption

This blog implies that people chose ivf over adoption for a need to have their own biological offspring. However, the rising cost of adoption and horrible red tape have couples with insurance turning to ivf for financial and practical reasons!!

Anna Short's picture

Decreasing Need for Drugs

Some interesting advancements in ART may mean there will be less need for stimulation drugs during an IVF protocol. There is a technique that matures follicles after they have been harvested from a woman's body. I believe this science is primarily targeted to women with PCOS and women who have undergone cancer treatments, but it could become more widespread.

Anonymous's picture

OHSS - a terrible and dangerous side effect of fertility drugs

I had a cycle of ICSI to try and concieve, unfortunately i suffered from severe OHSS which could have killed me. I did concieve but had to terminate the pregnancy after the first trimester because the OHSS did not resolve - I was carrying 22kg of ascites (fluid) on my abdomen and in terrible pain. Even after termination, three months in and out of hospital, unable to work or look after my son i am still suffering with persistant ascites and abdominal pain. My ovaries are huge and full of cysts. I was perfectly healthy before my icsi, had no history of pcos and all my hormone and blood tests were normal. No one told me I would go through hell, loose my baby and quite possibly have died. I would never do this again. Clinics have a lot to answer for. They take your money and then when things go wrong they don't want to know they just let the local NHS hospital pickup the pieces.

Anonymous's picture

I m doing a class study on

I m doing a class study on the use of fertility drugs for my nursing class and it sounds to me like good or bad the use of fertility drugs should be something that is really thought about before use. Also I would like to comment on the expenses of adoption. I think that is so sad that we have all of these children in our country and others that need a good home yet most will never see one because of the high costs of adoption. I myself would love to adopt. I have two wonderful boys of my own, but now am unable to have children. The outragious costs of adoption are the only thing holding me back. I wish that children who need love and a good home did not have to be bought to be shown the happiness of a good family!! Thank you and I enjoyed reading all of your comments. I learned a great deal and will share it all with my class tomorrow.

Serendip Visitor's picture

adoption

Adoption is available and it is free thru the foster system! there is no excuse for not having children unless you dont want any! I have asdopted my 3 beautiful daughters that r healthy happy and just like me! I love my daughters and remember God is the creature of all!

Ricki's picture

agreeing

I think it is b/s also for the cost of adopting i can understand a small fee for the fact that foster centers and homes need money to support these kids but isnt that what taxes go to I don't know I really want to adopt one day but i know it will be hard finacially.

Anonymous's picture

Dealing with Infertility

I would like to say,fertility drugs give couples a chance of conceiving their own child,which they wouldn't be able to do,left to their own devices.Unless you experience infertility firsthand you have no idea what to expect.In my opinion, this article made it sound like fertility drugs are a bad thing and that they aren't effective which simply isn't true.

link7881's picture

For an infertile woman

For an infertile woman trying to get pregnant, the desire for a baby often overwhelms everything else. At the same time, the No. 1 fear of many Americans is cancer. So when a recent study in The New England Journal of Medicine reported that taking clomiphene -- one of the most commonly prescribed fertility drugs in the United States-may dramatically increase the risk of ovarian cancer, thousands of women were thrown into conflict. Clomiphene, like several other fertility drugs, is prescribed to stimulate ovulation; pregnancies and birth-control pills both suppress it, lowering the odds. Other studies have suggested an association between clomiphene and ovarian cancer without demonstrating a firm causal relationship. Clomiphene is still being prescribed, sometimes with new caution. I found a website that may agree with this, California Oncologists. It is a website of oncologists and you may want to ask this question and find some good answers.

Anonymous's picture

DRUGS

I want 2 know the cost of the drugs and what is the average amount of time u have 2 take them before u concieve

Anonymous's picture

what is the cost of fertility drugs

I also want to know the cost of fertility drugs coz i seriously need a baby of my own.

Anonymous's picture

amount of time

Sorry I forgot to tell you the average amount of time to take the meds is about 4-6weeks depending on the meds the DR has you on and if your body is reacting. If you become pregnant you may have to continue estrogen and progesterone up until you are 12 weeks. But again that depends on the DR.

Anonymous's picture

IVF

It really depends on your location, I'm in cali and I did IVF with ICSI meds were about $2600, and the IVF was around $8500 only because they gave military discounts and the ICSI was an extra $1200. It was our first time and they transfered 2 embryos which resulted in triplets that I lost at 22 weeks and 6 days. I had 11 frozen and just recently did a frozen cycle that cost $1500. and meds were about $1900 because I didn't need as many. Thank God insurance paid for all meds,and visits and ultrasounds but they did not cover the actual procedure. They gave us a discount because of the previous lost. Only one was transfered this time and I am 2 months pregnant with one baby. I hope this helped you. I have read some people pay upwards of $1200 or more. Just check around and do your homework. Any other questions I will be more than happy to answer.

yetunde's picture

conceiving on time

what is the reason for us not conceivng on time? is it that we dont have sex when am ovulating or am not producing enough eggs?

Pensacola Fertility Clinic's picture

Other Factors

More factors come into play as well such as your male partner cell phone usage and especially what Dr. Cove mentioned. We have seen on the news of new Mothers in their 60's but there is doing what's sensible and not being selfish just because you can.

Dr. Robert Cove phd's picture

My views on Fertility drugs

My views on Fertility drugs are mixed, as with any drug they have minor side affects, but does the good fertlilty drugs do really outway the the problems that can arise in the future? There is always the chance of multiple births but as this arcticle says the parents DO often become phisically and emotionaly attached to there unborn children, they have every right so, but there is also the slight chance all the children won't make it. If they do make it then there might be abdominal injuries and scarring. But again it is up to the parents to make the executive decision.

Anonymous's picture

Fertility drugs are definitely worth the money

Fertility drugs cost a lot less than any type of adoption (domestic/international) so, to suggest that only middle to upper class individuals are using these drugs to avoid adoption would be incorrect. A lot of people don't want to adopt because they can't afford it. The side effects of the drugs are minimal when administered properly.

Anonymous's picture

exactly! My husband I chose

exactly! My husband I chose adoption international because ivf was are only option we were told domestic adoptions are years waiting and fifty percent failure rate. Ten thousand dollars almost two years later our country closed with our money. Adoption in many countries come with strict restrictions weight age income divorces health problem assests college ed etc I am so tried of people saying so carelessly "you can always adopt" atleast with ivf you don't jump through hoops and red tape

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