Obstetrics & Gynaecology – Dr kelly loi
Medication may help boost chances of having babies.
For many couples struggling with fertility problems, drugs are the first step in treatment. However, the effectiveness of treatment with medication alone depends on the underlying cause or causes of infertility, which may be due to problems in either the female or the male reproductive system. Female infertility reasons can be broadly divided into ovulation disorders, gynaecological conditions such as endometriosis, and tubal disease which prevent the sperm and egg from meeting.
If ovulation alone is the problem, medication may be helpful. However, if there are other factors involved, medication alone will not be sufficient. For example, a patient with endometriosis or blocked tubes may need surgery first. A couple with male factor problems such as poor sperm count will need to address this issue concurrently.
Fertility medication refers to drugs which enhance reproductive potential. For men, there are currently very few effective fertility medication options. For women, however, fertility medication is available to promote ovulation.
Ovulation refers to the release of an egg from the ovary. This usually occurs once a month in women with regular menstrual cycles. Drugs like clomiphene work by stimulating hormones in your brain to get an egg to be released from the ovary each month. If clomiphene does not work, injections with gonadotropins may be given to stimulate your ovaries directly to produce eggs. That may be all some women need to get pregnant.
Such drugs have been used safely and successfully for many years. Clomiphene is generally a very effective drug for most women suffering from ovulatory dysfunction. Between 70% and 90% of women taking clomiphene begin to ovulate within the first three cycles. Additionally, 40% of couples will become pregnant. But like many other fertility solutions, such as in vitro fertilisation, fertility drugs can increase your chance of multiple births — and the more babies you carry, the greater your risk for complications such as miscarriage and premature labour. About 10% of women who take clomiphene have multiple pregnancies (mostly twins). There is also a possible association between prolonged use of such medication and ovarian cancer. Therefore, prior to starting ovulation induction treatment, fertility investigations such as semen evaluation and testing for tubal patency, will be suggested to lessen the chances that other factors may be limiting the success of the medication. Once treatment is started, patients will be monitored to ensure that the medication has maximal effect and her risks are minimised.
Ideally, a couple should be having regular sexual intercourse two to three times a week in order to improve their chances of conceiving. Regular intercourse may also help to improve the sperm quality.
To increase the chances of conception further, the exact timing of ovulation can be tracked so that the timing of intercourse can be planned more precisely. For couples keen to determine the time of ovulation, urine kits may be used to detect the urinary hormone surge which occurs just before ovulation. Ultrasound scanning can also be performed by a gynaecologist for ‘follicle tracking’ purposes, i.e. to determine the size and growth of the egg before ovulation occurs.
Fertility falls with age; a couple should ideally plan to start a family as early as possible. Women are born with a fixed number of eggs. With increasing age, there is a fall in ovarian reserve — this is the number of functioning follicles or eggs left in the ovaries. With increasing age, our general health also tends to decline. Existing conditions may worsen or new illnesses may develop, which can have an impact on fertility too. Furthermore, if problems are encountered, they should not delay seeking treatment. Early diagnosis and treatment is especially important in older couples, particularly in the case of women over the age of 35, who should make an appointment after six months of trying to get pregnant.
Dr Kelly Loi
BA (1st Class Hons, Oxford), MA (Oxford), BM BCh (Oxford),
DFFP (London), MRCOG (London), FAMS (Singapore)