Posts

11
Sep

Clomiphene Citrate

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Clomiphene Citrate (Clomid)

pills
Clomid citrate is commonly the first medication that is pre­scribed for patients who are unable to ovulate on their own with unspecified infertility in combination with insemina­tion. Women who have normal fallopian tubes, regular 28 day cycles, and partners with a normal sperm count, but are still experiencing infertility, are termed as having ‘unspecified’ infertility. The pituitary gland regulates the amount of FSH (follicle stimulating hormone) and LH (leutenizing hormone) in the system. These two hormones play a key role in ovulation. The levels of these hormones determine when and how many eggs are developed and re­leased. LH is responsible for the further maturation and re­lease of the egg(s).

Clomid citrate is an anti-estrogen medication. This means that it tricks the pituitary gland into thinking that the levels of estrogen in the body are low, causing the pituitary gland to secrete additional FSH and LH. This increase of FSH and LH stimulates the development of the follicles which contain the egg(s). Clomid citrate is taken as a pill, and is generally pre­scribed as one (50mg) pill each day for 5 days in the beginning of the menstrual cycle (days 3-7). A mature follicle is usually found around day 12 of the cycle. If ovulation does not occur, the medication can be changed to reflect the patient’s needs. Ultrasound is the best way to determine the number and maturity of the follicles. Ovulation predictor kits can be used to measure if there has been a surge of LH mid-cycle, indicating ovulation has occurred. Ovula­tion occurs about 24-28 hours after the detection of the LH surge in the urine. Once ovulation has occurred, natural or artificial insemination is performed in an attempt to fertilize the egg(s) that have been produced.

25
May

Ovarian Drilling

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Ovarian drilling with laparoscopy is a technique which may help women who have Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovaries (PCO) to ovulate normally, thus increasing their chances of pregnancy. Ovarian drilling is typically considered after several attempts at ovulation induction using clomid, or an insulin-sensitizing medication, such as metformin. Polycystic ovaries are generally smooth and pearl colored, and have many small immature follicles along the outside lining of the ovary. Women with either condition may have higher levels of testosterone in their bodies, which inhibits ovulation.
Ovarian drilling cauterizes the stromal theca cells in the ovary. The reduction of this testosterone-producing tissue leads to reduced testosterone levels in the body. Studies have reported that approximately 80% of women who underwent this surgery began ovulating regularly. Post surgery, women who did not regain ovulation, and were previously resistant to clomid citrate, were then more receptive to medical protocols. Pregnancy rates after ovarian drilling are reported as around 50%.
Ovarian drilling with laparoscopy is an out-patient surgery. Anesthesia is administered to the patient, and three small incisions are placed in the abdomen. The abdomen is inflated with gas to allow the physician to view the ovaries using a laparoscope. The drilling is done by cauterizing different parts of the ovary, and removing the unwanted tissue. The physician is able to explore the reproductive system during the laparoscopy, to determine if any additional issues may be present. When the procedure is done, a super glue-like adhesive is administered to the incisions, and the patient is able to go home to heal, after recovering from anesthesia.

25
May

All About Injectables

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Injectable medications are used for IVF or IUI cycles. One of the main processes in an IVF or IUI treatment cycle is the controlled stimulation of the ovaries, to produce eggs. The medications used in ovulation induction are called gonadotropins. Brand names include Follistim, Gonal-F, Menopur, Bravelle, and Repronex. Gonadotropins are primarily used to treat two types of women: 1) those who do not ovulate, ovulate irregularly, or have failed to conceive using Clomiphene citrate (Clomid) and 2) women who ovulate on their own, but may need help in producing multiple eggs, and whose bodies would benefit from the enhanced hormonal environment.
How do they work?
Gonadotropins are natural hormones that trigger the ovaries to make eggs. They are generally safe to use, but do require experience and careful monitoring.In a natural menstrual cycle without any medications, a woman produces one or two follicles, which are fluid filled sacs that contain an egg. The growth of the eggs and their release from the follicles are influenced by the secretion of two hormones from the pituitary gland: Follicle Stimulating Hormone (FSH); and Luteinizing Hormone (LH), both known as gonadotropins.When a woman becomes menopausal, her pituitary gland secretes large amounts of these hormones in an attempt to stimulate the ovaries, which no longer function. Gonadotropins (other than Follistim and Gonal F) are manufactured by extracting FSH and LH from the urine of post-menopausal women. Menopur contains both FSH and LH, while Bravelle contains only FSH.For a woman going through infertility treatments, these extracts must be injected and cannot be taken orally, because they would be digested by the stomach.Recently, gonadotropins (Gonal-F, Follistim) have been manufactured in the laboratory using recombinant technology, which allows a pure form of FSH to be produced. This is not a human tissue or urinary by-product, it is a recombinant FSH. Since it is more pure, it may be self-injected, using a small needle just under the skin.