HORMONAL INFERTILITY TREATMENTS
Gonadotrophic hormones
In some cases clomiphene does not work. Very rarely a group of drugs called gonadotrophic hormones, which bypass the hypothalamus and pituitary gland and act directly on the ovaries, may be offered as a next resort. However, probably only about one woman in 10,000 will ever come across them.
Gonadotrophins are expensive to produce (most are derived from the urine of menopausal or pregnant women) and the dose needs careful monitoring if a multiple pregnancy is to be avoided because they act directly on the ovary. For this reason they are drugs of last resort. Success rates when they are used are about sixty per cent. More than twenty per cent of these will be multiple pregnancies.
Bromocriptine This is a relatively new drug, introduced into the UK in the mid 1970s. It may help the very small minority of women whose pituitary gland produces excess levels of a hormone called prolactin, which stops the production of gonadotrophic hormones. Prolactin is the hormone which causes lactation (production of breast milk) and is one of nature's natural contraceptives.
Bromocriptine's side effects can include vomiting, nausea, constipation and, possibly, hallucinations, psychotic symptons and peptic ulcers. In rare cases where a woman suffers from a pituitary tumour which has given rise to visual impairment, it can cause further enlargement of the tumour and increase problems of seeing. There is also some suggestion that it may cause later complications in pregnancy including miscarriage and prematurity. In an attempt to avoid this, treatment is usually stopped once ovulation has returned to normal so that the levels of bromocriptine in a woman's blood are relatively low when and if she conceives.
Hormone analogues
A new and still experimental development at St Mary's Hospital, Paddington in London, involves the use of tiny doses of LHRH, a gonadotrophin-releasing hormone, to induce ovulation. If current experiments continue successfully, this could be one of the most exciting and least worrying developments in infertility treatment for a long time. It was recently discovered that the human body produces LHRH in short bursts, in other words not constantly secreting it at a uniform rate. Previously, attempts to induce ovulation by using LHRH as an injection have failed because the natural physiological mechanism involved was far more subtle. Since this discovery, attempts have been made to give LHRH at regular intervals that mimic the natural bodily process. In twenty women who failed to ovulate following other available treatments, all have ovulated and six out of seventeen have become pregnant.
Because this treatment so closely mimics the natural bodily process, in theory it is less likely than most to have powerful side effects. Even more reassuring, it only induces one egg at a time.
Male hormone treatment Hormone treatment for men is largely unsuccessful. Thyroid extract, oestrogen and testosterone have all been tried as methods of raising the sperm count but with little positive benefit and occasionally unfortunate side effects. More recently clomiphene and gonadotrophic hormones have also been tried but with markedly less success than in women.
In summary
Properly administered and monitored drug treatment for female infertility can be extremely successful. However, as with all medical technology some doctors are better at using it than others. If you are thinking about drug therapy you should be aware of the potential complications and side effects and be prepared to stop if these get too serious. Drug treatment is something of a balancing act in which you need to weigh the desire to have a baby against the possible costs. Only you can decide where to draw the line.
*29\343\2*
|
