Fertility drugs and artificial reproduction techniques – are they worth it?

The human reproductive system is a complex one similar to several other mammals. Hence the problems occurring and the treatments for it – both are complex too. Fertility drugs and artificial reproduction (assisted reproduction) are two major doctoring fields in the section of human reproduction. But to understand these methodologies, first we should know what fertility and infertility are, and why artificial reproduction is required.

Fertility is the ability to reproduce – men who are fertile can become fathers and women who are fertile can bear children by becoming pregnant and carrying them for the 9 months period.  Natural pregnancy is the result of sexual intercourse. The inability to become pregnant within 12 months of sexual intercourse is known as infertility. Infertility is a problem which does not allow about 10-15% couples to start a family. Of these cases, only 20% of cases are due to infertility in the man, 45% cases are due to infertility in the woman and the rest are due to infertility in both.

All causes of infertility cannot be listed down as there are many. For example, reasons for female infertility include hormonal problems, scarred ovaries, follicle problems, abdominal diseases, infection, trauma from previous surgeries and other behavioural factors such as diet, alcohol, smoking or drugs.

Hormonal problems mainly include failure to produce mature eggs also called anovulation. During anovulation, ovaries produce abnormal follicles which do not let the eggs to mature. Scarred ovaries talk about physical damage to the ovaries. Because of this, follicles cannot mature and it causes anovulation. Another problem related to the follicles is the “unruptured follicle syndrome” in which although the egg forms normally, the follicle does not rupture to let out the egg and ovulation does not occur. Other diseases and infections can also affect the reproductive system in a female.

Causes for infertility in men include smoking, use of recreational drugs (drugs used to alter mood), alcohol, excessive exercise, anabolic steroid usage, hormonal problems, physical problems such as damaged sperm ducts; diseases and behavioural problems such as erectile dysfunction.

Smoking leads to decrease in sperm count while anabolic steroid usage leads to shrinkage in the testicles and hence infertility. Intense exercise produces a lot of adrenal steroid which causes deficiency in testosterones and causes infertility. Hormonal problems such as hypothyroidism in which a male encounters low thyroid levels cause poor semen quality and poor testicular function. Damaged sperm ducts do not let the sperms out of the penis and results in infertility. Infections and diseases such as tuberculosis, influenza cause low sperm counts and low mobility of the sperms. Retrograde ejaculation is another condition where the sperms are let into the bladder instead of out of the penis. This too causes infertility.

This is all about some of the causes of infertility. But, if there is a problem, there should be cure too. This is what fertility drugs are meant for. These drugs are used to treat various infertility problems so that proper fertilization can take place. Usually fertility drugs are the first step of treatment. If they work, the treatment is over but if they do not work, the next step is artificial reproduction. Some of the fertility drugs available for women are clomifene citrate, gonadotrophins, and bromocriptine.

The first drug clomifene citrate increases the levels of two important hormones – FSH (follicle-stimulating hormone) and LH (luteinising hormone). These are required for the eggs to get mature enough before they are released. The second drug gonadotrophins mainly are supplements of LH and FSH. These drugs have a direct effect on the ovaries of female to produce ripe eggs. These are basic drugs and are used only in mild cases of infertility like follicles not getting mature enough. Then, a last dose of hCG is released into the female’s body which regulates the condition and release time of the progesterone, which is required to maintain pregnancy. The third drug is bromocriptine which is used to reduce levels of hormone prolactin which reduces the levels of oestrogen. Hormonal imbalances may alter the menstrual cycle and prevent ovaries from releasing an egg. Bromocriptine is used to correct these hormonal imbalances.

There are not many fertility drugs for men as they encounter lesser infertility cases than women. The main fertility drug used in men is same as the second drug mentioned for women. Gonadotrophin unlike in women is used to increase the sperm count in men to cover up what the brain could not do. When the brain does not send signals to the testicles to produce sperms, gonadotrophin is injected into the body which regulates the FSH hormone to improve sperm count.

When these fertility drugs do not work, artificial reproduction (assisted reproduction) is used. There are several techniques for artificial reproduction – separate for problems with male infertility or problems with female infertility or infertility in both. Some of the techniques include intrauterine insemination, in vitro fertilization, sperm donation, egg donation and surrogacy.

Intrauterine insemination is a sub-category of artificial insemination. In this technique, a sample of semen containing sperms is inserted into the woman’s uterus by a long, narrow tube. However, In vitro fertilization is a little more complicated process. In this, an egg and sperms are kept in a dish under incubation. When the embryo is produced, it is placed in the woman’s uterus. However, sometimes the sperms are not able to fertilize the egg. In this case, the sperms are injected into the egg and are placed into the uterus of the woman.

Egg donation is taken when the female has problems in her ovary, cannot conceive using her own eggs, has some genetic disorders (or is a carrier) or is infertile for some reason. Sperm donation is taken when the male has problems in his testes, carries genetic disorders or is infertile. Surrogacy is used where another woman carries the parents’ embryo or a donor’s embryo to give birth.

Well, these are some of the fertility drugs and the next level assisted reproduction techniques. Now, are they really worth the cost and effort? How successful have these treatments been?

The fertility drug treatments are cheaper than assisted reproduction but are they worth the time they take. Clomifene is taken in pill form daily for a course of 3 to 6 months but there is no guarantee they would work. 70-90% would benefit from Clomifene and would ovulate. However, only 20-60% of them would be pregnant. Same is the case with Gonadotrophin.

In assisted reproduction, the success rate of intrauterine insemination is just 20%. This is not worth the cost compared to the cheaper and more effective fertility drug treatment. However, some of the artificial reproduction techniques like IVF have high success rate of >90% although they are very expensive.ART procedures are expensive, invasive and stressful. There are no long-term health effects to mother and child born using these techniques. They can also result in side effects like increasing chances of multiple births.

 

(http://www.isisfertility.com.au/fertility-treatment/success-rates.html)

(http://www.homesemenanalysis.com/oi.html)

And to talk about ethics of these treatments, donating eggs or sperms just for money is not ethical. I would just say that fertility drugs and ART while are not completely ethical they are humanitarian. The joy of parenthood cannot be compared with cost, effort and ethics. That is what drives couples to go for these treatments without caring for these aspects.

-Suhas

2/3/14