“You have been married for 3 years already and still no baby ah?
My daughter married for 2 years already have 2 children,
1 boy and 1 girl.
Hurry up lah, you are not getting any younger you know.”
There is no escape from that busybody gossiping aunty which is present in every household and hovers around you especially during family gatherings. You ask yourself after each gathering Why can’t I get pregnant? What’s wrong with me?
In this article, I would like to talk about how hormone therapy can benefit Infertility or subfertility. Before we go any further, let’s delve into Infertility/Subfertility a little.
Infertility or Subfertility
Infertility is defined as the failure to achieve a pregnancy after 12 months of unprotected intercourse. It is a prevalent condition that affects about 15% of couples and is commonly encountered by family physicians in the community. The majority of couples conceive within the first 3 months of trying, after which time the chances of pregnancy decline substantially. After 1 year, 85% of couples will have achieved a pregnancy, while after another year only an additional 5% to 8% of couples will become pregnant.
Subfertility on the other hand is a delay in conceiving.
The possibility of conceiving naturally exists, but takes longer than average.
What causes Infertility?
Around 30% of fertility problems in couples originate in the woman. About 30 per cent originate in the man and 30 per cent is found in both partners.
The major causes of Male Infertility are:
- Obstructions to the passage of sperm
- Problems with sperm (such as low sperm count)
- Functional problems (such as Erectile Dysfunction)
- Hormonal problems.
The major causes of Female Infertility are:
- Failure to ovulate
Ovulatory disorders are one of the most common reasons why women are unable to conceive, and account for 30% of women’s infertility. Fortunately, approximately 70% of these cases can be successfully treated by the use of drugs.
- Poorly functioning fallopian tubes
Tubal disease affects approximately 25% of infertile couples and varies widely, ranging from mild adhesions to complete tubal blockage. Treatment for tubal disease is most commonly surgery and, owing to the advances in microsurgery and lasers, success rate is as high as 30%
Approximately 10% of infertile couples are affected by endometriosis. In fact, 30-40% of patients with endometriosis are infertile.
This condition is characterized by excessive growth of the lining of the uterus, called the endometrium. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvic peritoneum.
- Additional factors
Other variables that may cause infertility in women:
Abnormal uterus: At least 10% of all cases of female infertility are caused by an abnormal uterus. Conditions such as fibroid, polyps, and adenomyosis may lead to obstruction of the uterus and Fallopian tubes.
Congenital abnormalities: Congenital abnormalities such as septate uterus, may lead to recurrent miscarriages or the inability to conceive.
Cervical mucus: Approximately 3% of couples face infertility due to problems with the female’s cervical mucus. The most common reason for abnormal cervical mucus is a hormone imbalance, namely too little estrogen or too much progesterone.
- Lifestyle factors
It is well-known that certain personal habits and lifestyle factors impact health; many of these same factors may limit a couple’s ability to conceive. Fortunately, many of these variables can be regulated to increase not only the chances of conceiving, but also one’s overall health.
- Environmental and occupational factors
The ability to conceive may be affected by exposure to various toxins or chemicals in the workplace or the surrounding environment. Substances that can cause mutations, birth defects, abortions, infertility or sterility are called reproductive toxins.
How Can Hormones Help Female Infertility?
Fertility drugs regulate or stimulate ovulation. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders.
Fertility drugs generally work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They’re also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs.
Fertility drugs may include:
- Clomiphene citrate
Clomiphene citrate is taken by mouth and stimulates ovulation by causing the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
Instead of stimulating the pituitary gland to release more hormones, these injected treatments stimulate the ovary directly to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin( HMG) and FSH. Another gonadotropin, human chorionic gonadotropin or HCG is used to mature the eggs and trigger their release at the time of ovulation
Metformin is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin helps improve insulin resistance, which can improve the likelihood of ovulation.
Letrozole belongs to a class of drugs known as aromatase inhibitors and works in a similar fashion to clomiphene. Letrozole may induce ovulation. However, the effect this medication has on early pregnancy isn’t yet known, so it isn’t used for ovulation induction as frequently as others.
Bromocriptine, may be used when ovulation problems are caused by excess production of prolactin (hyperprolactinemia) by the pituitary gland.
What about us Guys?
No, we didn’t forget about you. As mentioned earlier around 30% of infertility originates from Males. “Male factor” infertility is seen as an alteration in sperm concentration and/or motility and/or morphology.
The following are the most common medications used to treat male fertility factors:
- Clomiphene citrate (Clomid)
It may come as a surprise to learn that the same oral medication prescribed to women to promote ovulation is also prescribed to some men in order to improve sperm count. Most men experience positive side effects from taking clomiphene citrate, including enhanced sex drive, longer and harder erections, more energy, increased muscle mass and weight loss. In a recently published meta-analysis trial regarding the use of Clomiphene showed significant increase in sperm concentration and percent sperm motility.
- HCG and HMG
This is another type of hormone therapy that can be used individually or in combination. It improves sperm quality and has proven to be useful in treating male infertility.
- Anastrazole (Arimidex)
Arimidex was initially developed for women with breast cancers that are estrogen-sensitive (stimulated by estrogen). It prevents excess testosterone from converting into estradiol inside the body’s tissues. Arimidex been studied for use by infertile men to balance testosterone levels and maintain a healthy sperm count.
Entering into the infertility zone is like walking into an unfamiliar dark room and shutting the door.
This is a journey that no one intends to start, and no one can be sure how it will end. The first step is the recognition that there may be a problem.
Get the ball rolling with a visit to your doctor and get your hormones tested today.
Next read: IUI In Malaysia