Understanding Infertility Treatment: Emotional & Medical Aspects

Infertility Treatment

Infertility Treatment

The unexpected news that you have a fertility problem can create a great deal of stress and frustration. Being infertile can make you feel out of control and that the next step in your life is blocked. Faced with the loss of a natural part of life, some people feel grief, loss and guilt.

Emotional Aspects of Treatment

Many infertile couples aren't prepared for the emotional roller coaster of grief and loss of infertility treatments. The layers of stress are multiple:

• Financial — How will we pay for treatment easily costing thousands of dollars?
  
  
• Professional — Will I miss job promotions or will my work suffer because of treatment needs?
  
  
• Emotional — How will we cope as a couple if treatment fails?
  

Facing friends, family members or co-workers who have children is another stressor in an infertile couple's life.

There are a number of issues that are critical for a couple facing treatment:

Be prepared to experience a lot of unfamiliar and uncomfortable feelings and to learn how to manage them. Understand there are psychological reactions to infertility that are very real and related to the stress of treatment. Being infertile is overwhelming. So is treatment.

Understand that men and women cope with stress and infertility differently. While a woman is physically and emotionally dealing with the effects of treatment, her outlets may involve many people. She may want to talk a lot about her experiences — with her husband — or with anyone who will listen. Her partner may be perceived as being emotionally and physically distant because he is trying to remain calm, despite his deep concern for and commitment to his partner.

Know that marriages will either be strengthened or pulled apart by infertility treatment. What happens depends on the couple's relationship prior to treatment: Can you discuss intimate feelings? Do you have a good marriage? A good sex life? Are you a cohesive unit as a couple?

Realize that infertility and its wide range of treatment options can be overwhelming. There are many complicated issues, such as preserving eggs by freezing them for future use, adoption, donor eggs, selective abortion, surrogacy and a host of other related topics. Couples who educate themselves as much as possible about treatment have a better chance of not being overwhelmed by its intensity.

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Understand from the outset that treatment may not be successful. It's typical for couples at the beginning of treatment to do whatever it takes to achieve a pregnancy. Eventually, most realize that emotionally and financially there is a limit. However, before a couple can move on to other options, like adoption or remaining comfortably childless, for example, they must resolve their infertility. They have to get to the point that they can grieve and put closure on the fact that one or both biological bodies are not going to give them a child. This stage of infertility has its own stages of grief and loss. Couples must be ready to say, "I'm ready to stop this."

Treatments for Infertility

Fertility drugs are typically the first step. Up to 90 percent of infertile women are treated with these drugs. Fertility drugs are designed to correct specific hormonal imbalances. The most common fertility drugs — clomiphene citrate (Clomid) and gonadotropins — are used to stimulate the production of mature eggs.

Fertility drug treatment can include the following:

• Clomiphene citrate, also known as Clomid or Serophene®. This drug is inexpensive and easy to use. Sixty percent of women taking Clomid will ovulate following treatment and, of these, approximately 40 percent will become pregnant within six months. Clomid is a fertility medication, taken in pill form, which induces ovulation. Clomid may cause swelling of the ovaries, multiple pregnancies, hot flashes, mood swings, depression and irritability. Common side effects include weight-gain and water-retention.
  
  While Clomid treatment is generally effective in women who experience abnormal ovulation cycles, it seems to have an adverse effect on endometrial thickness, thereby increasing the likelihood of implantation failure. Recent studies have shown that adding progesterone and estrogen when taking clomiphene citrate significantly increases endometrial thickness, thus improving rates of pregnancy while reducing the likelihood of miscarriage. That is, the hormones appear to counterbalance the negative effects of a Clomid regimen.
  
  
• Gonadotropin medications. These drugs include:
  
  • Lupron (leuprolide acetate), a synthetic version of the naturally occurring gonadotropin releasing hormone (GnRH), which triggers the release of produces follicle-stimulating hormone (FSH) directed at the ovaries. FSH is a hormone critical to egg maturation and development. It triggers the development of the follicles, or eggs, inside the ovary, as well as estrogen production. Lupron is given via injection.
    
    
  • Synarel (nafarelin acetate) is also a synthetic version of GnRH, but it can be administered via a nasal spray.
    
    
  • Antagon (ganirelix acetate), and cetrorelix are GnRH antagonists, suppressing the release of certain hormones. They are administered via injection.
    

  These fertility drugs have a 95 percent chance of stimulating ovulation, giving a woman a 15 percent chance of getting pregnant each cycle if she still has viable eggs. Gonadotropins may cause multiple pregnancies, and, in rare cases, hyperstimulation, which can lead to stroke. Common side effects include weight-gain and water-retention.

• Gonal-F (follitropin alfa for injection) and Follistim (follitropin beta) are the first follicle stimulating hormones (FSH) to be produced by recombinant DNA technology. Unlike other fertility drugs that only encourage hormone production, FSH is the actual hormone responsible for producing and releasing healthy eggs in women, as well as for the production of sperm in men.
  
  
• Progesterone. The hormone progesterone is essential to the reproductive process. Inadequate progesterone production, known as a luteal phase deficiency (when a woman's body doesn't produce enough progesterone to support an embryo after fertilization), can also be treated with medication. Progesterone is typically administered with in vitro fertilization (IVF) and other assisted reproductive technology (ART) procedures. Women who have no ovarian function and want to pursue a pregnancy through donor egg technology, for example, must use progesterone and estrogen supplementation. For these women, an entire cycle must be simulated using a variety of hormonal therapies.
  

Although fertility drugs are known for causing a variety of physical and emotional side effects, there also appears to be some risk of developing ovarian cancer. This risk is now believed to be lower than previously reported and is not firmly established with clinical data. Most specialists will limit the duration of drug treatment and carefully consider when and for whom these medications are recommended. If pregnancy is achieved, any increased risk of developing ovarian cancer from taking fertility drugs is reduced to the average risk experienced by other women.

Diagnostic tests that help to identify potential implantation problems (performed prior to the procedures mentioned above) include:

• Hysterosalpingogram (HSG) involves the use of radio-opaque dye during fluoroscopy (x-ray) of the abdomen, which allows your health care professional to evaluate both the uterine cavity and tubal patency (whether the fallopian tubes are blocked).
  
  
• Saline-infusion sonogram (SIS) involves administering sterile saline into the uterine cavity under sonographic guidance, allowing evaluation of the endometrial contour. SIS differs from HSG in that it does not require exposure to radiation; however, it is not as effective as HSG in evaluating tubal function and patency.
  

In assisted reproductive technology, assisted hatching is sometimes used in an effort to improve implantation rates. Assisted hatching is done in addition to either IVF or IVF and ICSI. After the embryo has formed and prior to its transfer to the uterus, the outer covering of the embryo called the zona pellucida is thinned by a special harmless solution. This will help in hatching so that the cells of the embryo will emerge from the outer shell and hopefully implant in the uterus. This method is suggested in women over age 35 or patients who have repeatedly failed IVF attempts.