If the clomiphene treatment is not successful, hormonal therapy with human menopausal gonadotropins can be tried. These hormones are extracted from the urine of postmenopausal women. This hormone is very expensive and they have severe side effects. So, this is recommended only after the doctors are sure that ovulation problems, not problems with sperm or fallopian tubes, are the cause of infertility. Treatment cycles will be closely supervised by doctors experienced in using these hormones.
Human menopausal gonadotropins are injected into the muscle. It stimulates the ovarian follicles to mature. Woman's response to the hormones is carefully monitored and the doses are adjusted. After the follicles are mature, the woman is given an injection of a different hormone, human chorionic gonadotropin (HCG), to trigger ovulation. Although more than 95 percent of the women treated with these hormones ovulate, only 50 to 75 percent become pregnant. In women treated with human menopausal gonadotropins, 10 to 30 percent of pregnancies are multiple, primarily twins. Many doctors do not like to go for this approach because of the danger of multiple births.
Side effects: Increased risk of ovarian cancer, ovarian hyperstimulation syndrome. OHS develops in 10 to 20 percent of the women treated. It can be life threatening but usually can be avoided if the doctor closely monitors the treatment and withholds human chorionic gonadotropin when the woman's response becomes excessive.
Artificial insemination with male partners sperm has a 50 percent chance of success and is your best bet if he is fertile but impotent. (He is making plenty of healthy sperm but can't muster the kind of erection needed to deliver them effectively so that fertilization can take place.). It's also the method of choice if the womans cervix, for one reason or another, does not allow sperm to gain entry to the uterus. In some cases, the sperm is "washed" to improve their ability to fertilize an egg. Semen is mixed and washed with a protein called Hams solution and then used in artificial insemination. In still another modification of this technique, a swim-up technique is used. The sperm is allowed to swim up the protein solution. The better, more mobile sperm is used in the artificial insemination.
This may be an appropriate solution if the husbands semen does not contain any healthy sperm. This also hast a 50 percent success rate. Reputable clinics specializing in this field screen the genetics of the contributors very carefully, and also examine the purchased sperm for evidence of infection and AIDS antibodies. Always check the credentials and reputation of the particular sperm bank you're planning to use; some of them are not good.
This is a more expensive and complicated way to have your own baby. You go for this when the fallopian tubes of the woman (that lead from the ovary to the uterus) have been so scarred by infection that the egg cannot get through them to get to the uterus. In this technique, one of your eggs is removed from the womans ovary with a needle guided by ultrasound. It is then placed in a culture dish where it is fertilized with the mans sperm. The egg is then transferred from the dish and implanted into the womans own uterus where it continues to grow for the usual 9 months. Embryo transfer has a 20 to 30 percent success rate, and can be attempted as often as necessary. The woman is normally given clomiphene (Clomid) or follicle-stimulating hormone (Pergonal) to stimulate the development of more eggs to improve the chances of a "hit" by the needle. This technique has now been used for almost 15 years, and has resulted in the birth of more than 25,000 babies in over forty different countries.
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