Infertility can feel deeply isolating. Yet at least 6% of women under 44 are unable to get pregnant after a year of trying. You are not alone. Knowing that you are infertile, however, gets you no closer to treating the issue. Infertility is a label, not a diagnosis. Its causes are as diverse as the women who experience this painful experience. The good news is that, with the right diagnosis, a wide range of infertility medications can help you get pregnant and give birth to a healthy baby.
Infertility 101: What You Need to Know Before Trying Medication
So what is infertility anyway? Infertility has many causes. But in diagnosing infertility, doctors typically look to the proximate cause first. This is the factor that is immediately linked to infertility.
Before we get into the nitty-gritty, a brief tutorial on female fertility for those of who you missed, forgot, or slept through high school biology:
To be fertile, a woman’s body must release an egg every month. This is called ovulation, and happens toward the middle of a woman’s cycle. Though textbooks say the average is on the 14th day after a woman’s period, ovulation can happen a little earlier or later. In some women, ovulation happens much later. This delayed ovulation does not in itself cause infertility. But the less frequently a woman ovulates, the fewer chances she has to get pregnant in given year.
After ovulation, if an egg is fertilized, it travels down the fallopian tubes and implants in the uterus. Pregnancy begins at implantation. But if this second phase is too short and a woman menstruates too early, the egg cannot implant. Likewise, if there are problems with a woman’s uterus or fallopian tubes, an egg might fail to implant.
For about 1 in 4 women, there’s a serious problem with the pregnancy--usually an issue with the egg’s chromosomes. This can cause a miscarriage at any stage of the pregnancy, often in the first few weeks.
So most causes of infertility are due to one or more of the following:
- Problems with ovulation, such as not ovulating or ovulating only infrequently
- Problems with implantation, such as the egg not implanting
- Damage to or a problem with the egg
Less frequently, infertility may be because of the way the woman’s body reacts to the pregnancy. Some women have autoimmune disorders that cause their body to treat an early pregnancy as an invader. Others have medical conditions that make it difficult or impossible for the egg to implant in the uterus.
The Critical Importance of an Accurate Diagnosis
Infertility is a syndrome, not a diagnosis. This means that infertility is a label used to describe an inability to get pregnant--not a diagnosis in itself.
To treat infertility, you need to diagnose the reason for the infertility. At minimum, this means identifying the proximate cause of the inability to get pregnant. For instance, are you ovulating? Ovulating but experiencing a too-short luteal period? Or struggling with early miscarriages?
This makes diagnosis a two-step process:
- Identify why a woman isn’t getting pregnant (ovulation, implantation, etc.)
- Identify the underlying cause of this problem.
Once the cause or causes are identified, a doctor will look for an underlying cause. Endometriosis and polycystic ovary syndrome (PCOS) are the leading causes of infertility in women. Endometriosis can damage eggs, interfere with ovulation, make implantation difficult, or cause early miscarriages. PCOS makes it difficult for the body to ovulate. It can also cause chronic health problems that erode the chance of a successful pregnancy.
Armed with information about both the proximate cause and the health issue that is causing it, a doctor can make recommendations about which drugs to try. Sometimes a doctor might also recommend lifestyle remedies. For instance, women with PCOS can decrease their insulin resistance and improve their chances of pregnancy by losing weight. Other women may need to gain weight to improve their chances of regularly ovulating.
By pairing quality drugs with beneficial lifestyle interventions, you can greatly increase your chances of a successful pregnancy. Moreover, a healthy lifestyle can help you deal with the stress of infertility itself, and help you commit to treatment for the long haul.
Drugs Commonly Used to Treat Infertility in Women
Drugs used to treat infertility in women fall into two categories. One group of drugs treats the immediate cause of infertility, and does not necessarily require a diagnosis. Drugs that induce ovulation can treat ovulation disorders even if the reason that a woman is not ovulating is not clear. A second group of drugs is designed to treat specific medical conditions. For example, insulin resistance drugs can correct hormone imbalances that affect ovulation and implantation.
Dozens of drugs can treat infertility, especially in women who have unusual medical conditions such as autoimmune disorders. The most commonly used drugs include:
- Drugs designed to induce ovulation. The most popular such drug is called Clomid. It’s commonly used in women with PCOS, women who don’t ovulate for some other reason, and women who have infrequent ovulation. Less commonly, a doctor might prescribe Femara, another ovulation induction drug.
- Drugs for diabetes and insulin resistance. Conditions that cause insulin resistance, such as PCOS, can make it difficult for a woman to get and stay pregnant. Metformin can improve symptoms of insulin resistance. This makes it more likely that a woman will ovulate. It may also decrease the risk of pregnancy-related complications such as gestational diabetes.
- Dopamine agonists. Sometimes a woman has ovulation problems because her pituitary gland produces too much prolactin, a hormone that induces lactation. Drugs such as Cycloset can help with this.
- Drugs that encourage the ovaries to produce more eggs. Commonly used in women planning IVF or IUI, these injectable drugs cause a woman’s body to produce several eggs in a single cycle.
- Trigger drugs. These drugs trigger an egg to be released from its follicle. They’re most typically used in women planning IVF, but may be used in other women if they have issues with ovulation.
- Drugs for infections and inflammation. Sometimes a chronic infection or an inflammatory disorder damages eggs or makes it difficult for an egg to implant in the uterus. Treating these underlying conditions may help. Often, treatments for serious medical conditions are covered by insurance.
What About Drugs for Unexplained Infertility?
Sometimes a doctor can’t diagnose the cause of infertility. This may be because the woman opts to forego certain tests. Sometimes it happens even after extensive testing. Unexplained infertility, which happens in about 10% of couples seeking treatment, doesn’t mean that there is no cause for the infertility. It just means a doctor can’t diagnose the cause using the available tools.
Using a fertility specialist can reduce the likelihood of getting this frustrating diagnosis. Even then, it’s possible to be diagnosed with unexplained infertility. The good news is that some drugs can treat infertility even without a diagnosis. Drugs that induce ovulation can work well to ensure a woman is releasing eggs and to help with timing intercourse. Some couples opt to pursue IVF, and the right IVF drug cocktail is critical to success in these cases.
Even if a doctor can’t explain why a woman is infertile, they may be able to rule in or out certain causes. So it’s important to get as much information as possible before taking medication for unexplained infertility. Ask also about the odds of success, and whether tracking specific information--such as how frequently you ovulate--might provide the doctor with useful, actionable information.
Infertility Treatment: More Than Just Drugs
Most people pursuing infertility treatment have spent some time online reading about various infertility treatment options. They may know the basics, or have a friend who’s used IVF drugs or taken Clomid.
Infertility treatment, however, is about a lot more than drugs. In fact, some women pursuing infertility treatment don’t need drugs at all. A number of medical procedures can increase the odds of a successful pregnancy. Those include:
- Ovulation testing. Ovulation is critical to fertility. Testing to see if a woman is ovulating regularly is often the first step toward a healthy pregnancy.
- Procedures to clear blockages in the fallopian tubes. Sometimes scar tissue from pelvic inflammatory disease, endometrial tissue due to endometriosis, or injuries block the fallopian tubes, making it more difficult for an egg to travel down the tubes to implant in the uterus.
- Surgery to remove excess endometrial tissue that makes implantation difficult.
- Insemination procedures such as IVF and IUI.
Lifestyle remedies may also help. Various websites are filled with false promises that supplements and other miracle cures can get you pregnant. They can’t and they won’t. However, your overall physical health does affect your body’s ability to release quality eggs and nurture a healthy baby. Moreover, it may help correct hormonal balances or help your body fight disorders that compromise fertility.
Try some of these common sense fertility-boosting lifestyle remedies:
- Maintain a healthy body weight. Women who are too heavy or too thin are less likely to get pregnant.
- Control your stress. Stress can delay ovulation. It can also make it difficult to cope with the challenges of infertility. Therapy, meditation, and support groups may help.
- Eat a balanced, nutrient-dense diet. Vegetables, fruits, and protein should be staples. Limit consumption of simple carbohydrates, sugary snacks, and processed foods. If you are insulin resistant, eat a low glycemic index diet.
- Get plenty of exercise. Exercise on most days of the week. The more exercise, the better.
- Get tested for STDs. Many STDs can undermine fertility or endanger a developing baby.
- Consider charting your monthly cycles. This can provide useful information about your fertility. Your doctor can tell you how to do so.
- Use a fertility-friendly lubricant if you use lube. Traditional lubes can slow or harm sperm. Instead, select a lube like Pre-Seed.
The Myth of Female-Only Infertility: Don’t Forget to Treat the Man!
In spite of so many important gains in women’s rights, gender equality persists in childbearing. Women bear the disproportionate share of the burden. They grow a baby, go through the pain of childbirth, and breastfeed. When a pregnancy fails, it’s the woman who has to deal with the physical pain of a miscarriage. We’re more likely to blame mothers for their children’s shortcomings than fathers. And many women struggle with anxiety and depression after giving birth.
Parenting still has a female face. So even though we’ve known for centuries that it takes two people to make a baby, we have a strong bias toward seeing parenting as women’s work. Maybe that’s why so many couples assume that a problem with fertility must be due to a problem with the woman. The truth is that the man is just as likely to be the cause as the woman. And even when the woman has a diagnosis, there could still be something wrong with the man. In about a third of cases, both the man and the woman have a fertility issue. So treating the woman is never enough. You’ll waste precious time and money, not to mention a lot of grief, if you don’t get your partner tested.
Male factor infertility is easy to test for, and often easy to treat. You and your partner’s bodies work together as a whole, so occasionally the interaction between the two is also an issue. For instance, a woman’s vaginal pH might be such that it kills the man’s sperm. Only by testing both members of the couple can a doctor detect this common but treatable problem.
Infertility: Painful but Treatable
Seeking infertility treatment can feel scary and overwhelming. Treatment is the very best thing you can do for your health, and there’s no time like the present. Fertility declines with age, so don’t waste time waiting for a pregnancy that might never happen. The Center of Reproductive Medicine, with 5 locations in and surrounding Houston, Texas specializes in treating fertility issues in a respectful, safe, supportive environment. You don’t have to do this alone.
Let us help you. With treatment, most women can get pregnant. You can be one of them. Give us a call today!