F
Infertility is defined as unsuccessful conception after 12 months of attempting to conceive, as opposed to sterility, the inability to reproduce. Infertility may be due to reproduction dysfunction of the male, female, or both.
Female infertility can be due to disruption of any phase of the reproductive process. The most critical phases include follicular maturation, ovulation, transport of the ovum through the fallopian tubes, fertilization of the ovum, nidation, and growth/development of the conceptus. Causes of infertility include the following:
Anovulation, failure of follicular maturation: Absence of adequate hormonal stimulation; ovarian follicles do not ripen, and ovulation will not occur.
Unfavorable cervical mucus: Normally the cervical glands secrete large volumes of thin, watery mucus, but if the mucus is unfavorable (scant, thick, or sticky), sperm is unable to pass through to the uterus.
Hyperprolactinemia: Excessive prolactin secretion may cause amenorrhea, galactorrhea, and infertility.
Luteal phase defect: Progesterone secretion by the corpus luteum is insufficient to maintain endometrial integrity.
Endometriosis: Endometrial tissue is implanted in abnormal locations (e.g., uterine wall, ovary, extragenital sites).
Androgen excess: May decrease fertility (most common condition is polycystic ovary).
Male infertility is due to decreased density or motility of sperm or semen of abnormal volume or quality. The most obvious manifestation of male infertility is impotence (inability to achieve erection). Whereas in female infertility an identifiable endocrine disorder can be found, most cases of male infertility are not associated with an identifiable endocrine disorder.
Antiestrogens: Nonsteroidal estrogen antagonist that increases follicle-stimulating hormone (FSH) and leutinizing hormone (LH) levels by blocking estrogen-negative feedback at the hypothalamus.
Gonadotropins: Produce ovulation induction in women with hypogonadotropic hypogonadism and polycystic ovary syndrome (PCOS). Ovaries must be able to respond normally to FSH and LH stimulation.
Gonadotropin-releasing hormone (GnRH) agonists: Causes down-regulation of endogenous FSH and LH levels. GnRH agonists stimulate release of pituitary gonadotropins. Suppression of endogenous LH can decrease number of oocytes released prematurely, improve oocyte quality, and increase pregnancy rates.
Gonadotropin-releasing hormone (GnRH) antagonists: Suppresses endogenous LH surges during ovarian stimulation. GnRH antagonists avoid initial flare-up seen with GnRH agonists, shortening the number of days needed for LH suppression and allowing ovarian stimulation to begin within the spontaneous cycle.
Medications to induce ovulation
| Name | Category | Availability | Uses | Side Effects |
| Cetrorelix (Cetrotide) | GnRH antagonist | I: 0.25 mg, 3 mg | Inhibition of premature LH surges in women undergoing ovarian hyperstimulation | OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, peripheral/dependent edema; headaches, pain/redness at injection site, mood swings, hot flashes, insomnia, vaginal dryness |
| Chorionic gonadotropin (Novarel, Ovidrel, Pregnyl) | Gonadotropin | I: 5,000 units, 10,000 units, 20,000 unitsOvidrel: 250 mcg/0.5 ml | In conjunction with clomiphene, human menotropins or urofolitropin to stimulate ovulation | OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, peripheral/dependent edema; ovarian enlargement, ovarian cyst formation, headache, pain at injection site |
| Clomiphene (Clomid, Milophene, Serophene) | Antiestrogen | T: 50 mg | Anovulation, oligo-ovulation with intact pituitary/ovarian response and endogenous estrogen | Ovarian cyst formation, ovarian enlargement, visual disturbances, premenstrual syndrome, hot flashes, headaches, blurred vision, nausea, breast tenderness |
| Follitropin alpha (Gonal-F) | Gonadotropin | Injection, powder: 75 units, 450 units, 1,050 unitsInjection, solution: 300 units/0.5 ml, 450 units/0.75 ml, 900 units/15 ml | In conjunction with human chorionic gonadotropin to stimulate ovarian follicular development in pts with ovulatory dysfunction not due to primary ovarian failure (e.g., anovulation, oligo-ovulation) | OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, peripheral/dependent edema; flu-like symptoms, upper respiratory tract infections, bleeding between menstrual periods, nausea, ovarian enlargement, ovarian cysts, acne, breast pain/tenderness, mood swings |
| Follitropin beta (Follistim AQ) | Gonadotropin | I: 75, 350, 650, 975 international units FSH | In conjunction with human chorionic gonadotropin to stimulate ovarian follicular development in patients with ovulatory dysfunction not due to primary ovarian failure (e.g., anovulation, oligo-ovulation) | OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, shortness of breath, peripheral/dependent edema; flu-like symptoms, breast tenderness, dry skin, rash, dizziness, fever, headaches, nausea, fatigue, mood swings |
| Goserelin (p. 558) (Zoladex) | GnRH agonist | Implant: 3.6 mg, 10.8 mg | Endometriosis, adjunct to menotropins for ovulation induction | Hot flashes, amenorrhea, blurred vision, edema, headaches, nausea, vomiting, breast tenderness, weight gain, mood swings, insomnia, vaginal dryness |
| Leuprolide (p. 684) (Eligard, Lupron) | GnRH agonist | Injection, Solution: 5 mg/ml for subcutaneous injectionInjection, powder: 3.75 mg, 7.5 mg, 11.25 mg, 15 mg, 22.5 mg, 30 mg | Endometriosis, adjunct to menotropins/human chorionic gonadotropin for ovulation induction | Hot flashes, amenorrhea, blurred vision, edema, headaches, nausea, vomiting, breast tenderness, weight gain, mood swings, insomnia, vaginal dryness |
| Menotropins (Menopur, Repronex) | Gonadotropin | 75 units FSH, 75 units LH activity | In conjunction with chorionic gonadotropin for ovulation stimulation in pts with ovulatory dysfunction due to primary ovarian failure | OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, dyspnea, edema of lower extremities; ovarian enlargement, ovarian cyst formation, breast tenderness, mood swings |
| Nafarelin (Synarel) | GnRH | 2 mg/ml nasal spray (200 mcg/spray) | Endometriosis, adjunct to menotropins/human chorionic gonadotropin for ovulation induction | Loss of bone mineral density, breast enlargement, bleeding between regular menstrual periods, acne, mood swings, seborrhea, hot flashes, headache, insomnia, vaginal dryness |
| Urofollitropin (Bravelle) | Gonadotropin | 75 units FSH activity | In conjunction with human chorionic gonadotropin for ovulation stimulation in pts with polycystic ovary syndrome who have elevated LH:FSH ratio and have failed clomiphene therapy | OHSS (ovarian hyperstimulation syndrome): Abdominal pain, indigestion, bloating, decreased urinary output, nausea, vomiting, diarrhea, rapid weight gain, shortness of breath, edema of lower extremities; ovarian enlargement, ovarian cyst formation, pain/redness at injection site, breast tenderness, nausea, vomiting, diarrhea, mood swings |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
