Once the probable causes of infertility have been identified, treatments can begin. If irregular ovulation or lack of ovulation is the problem, ovulation may be induced with medication. These medications are the well-known fertility drugs. It is important to remember that these fertility drugs are helpful only if the infertility is caused by a problem with ovulation, but cannot help at all if the infertility is caused by something else.
The most commonly used medication to induce ovulation is called Clomid (clomiphene citrate). Through its effect on the hypothalamus, clomiphene citrate stimulates a release of FSH and LH from the pituitary. FSH and LH are the hormones that act on the ovary to cause the ripening and release of eggs. The medication is taken in the form of a pill for five days during the month. Minor side effects include hot flashes and lower abdominal discomfort. Clomiphene citrate substantially increases the chances of having twins by stimulating two eggs to ripen instead of one. It increases the chances of having triplets and quadruplets only minimally.
In the cases when Clomid doesn't work, a second type of fertility medication must be used. This medication is called Pergonal (or human menopausal gonadotropin) and must be given by injection every day until ovulation occurs. This treatment is both costly and time-consuming and a woman must be closely watched for any adverse side effects. By causing several eggs to ripen at one time, the use of this medication can result in triplets or quadruplets. Ultrasound monitoring and hormone testing have helped lower the numbers of unwanted multiple births. Serious side effects of Pergonal include large ovarian cysts and massive shifts in body fluids.
Problems with the fallopian tubes may be treated surgically. The fallopian tubes may have been blocked as a result of a congenital abnormality, scarring subsequent to a previous pelvic infection or to endometriosis, or previous pelvic surgery. Sometimes the fallopian tubes themselves are normal, but adhesions surrounding them prevent the egg and sperm from meeting.
There is a reasonable chance that the surgical removal of the adhesions will improve fertility. Unfortunately, when repairing the fallopian tube requires major reconstructive surgery (tuboplasty), the success rate is much lower. Even when it is possible to open the fallopian tubes, tubal function does not always return to normal and the infertility may persist. Frequently operating microscopes, very fine instruments and lasers are used to improve the success rate of tubal surgery.
An experimental procedure that may eliminate the need for surgery in some cases of blocked fallopian tubes has been adapted from a technique used to unclog coronary arteries. A catheter carrying a small balloon is threaded through the uterus into the blocked tube. When the balloon is inflated, the fallopian tube is stretched and the obstructive tissue is washed out.
Other treatments are available for other specific causes of infertility. For example, treatment of a genital infection may correct the infertility, especially if the partner is treated simultaneously. Sometimes problems with the cervical mucus may be treated by the administration of low doses of estrogen.
