When we talk about fertility treatment, it is usually IVF and other assisted conception techniques that spring to mind, but there may be much simpler solutions for some women who are having difficulty getting pregnant. Your individual situation and the nature of your fertility problem will determine the type of treatment that is appropriate.
Drug treatments
Many women are offered some kind of fertility drug as a first treatment, which can boost your fertility if you have ovulation problems.
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Clomifene citrate and tamoxifen
Clomifene citrate is probably the most commonly prescribed drug, along with tamoxifen. These drugs are used to stimulate the ovaries. Clomifene citrate can help women who don't usually ovulate to produce eggs, and can regulate your cycle if you aren't ovulating every month. It may also be given to women who have unexplained infertility. Although the drug undoubtedly helps many women to conceive, it is sometimes prescribed in a rather ad hoc fashion to anyone who is trying to get pregnant unsuccessfully, when there may be other fertility problems that have not been identified.
Clomifene citrate is given in the form of tablets, which are taken for five days each month early in the menstrual cycle. Women usually start with a dose of 50mg, which may be increased if you aren't responding to the drug. It is not advisable to take clomifene citrate for more than six months at a time, as there are questions about long-term use of the drug and possible links to ovarian cancer.
When you are taking clomifene citrate, you should be monitored to check whether you are ovulating. Some women are given the drug without any checks or monitors, and so have no idea whether it is working, whereas others may be offered just blood tests. It is good practice to monitor the use of clomifene citrate or tamoxifen with ultrasound scans in at least the first cycle, as this allows doctors to see how your ovaries are responding. It can also alert them if there is a risk of a multiple pregnancy, as the drugs may stimulate the ovaries to produce not just one but a number of viable eggs.
'They put me straight on clomifene. They didn't check whether ovulation was a problem. They weren't tracking me at all. I was on these strong drugs with no supervision. I had no appointment to go back. It was a situation of take this and go away for six months even though the drug is probably going to do nothing for you.' Nicol, 33.
Some women take clomifene citrate and tamoxifen without any problems, but others have unpleasant side effects. These are usually described in literature about the drugs as menopausal symptoms such as headaches and hot flushes. In fact, what most women find difficult to cope with is the way the drug affects their moods.
'The first time I took clomifene I had really bad mood swings and was depressed. I didn't get many physical side effects; it was more emotional and mental. I did take it first thing in the morning, but now I take it at night, so hopefully I sleep through the worst of it. I've just had it this month and I've had pains and hot flushes. It's the first time it has affected me like that.' Lisa. 32
Metformin
Women with polycystie ovary syndrome may be offered metformin, either instead of or along with clomifene citrate. Metformin was developed to treat age-related diabetes by lowering blood-sugar levels and reducing high insulin levels. Women who have PCOS produce high levels of insulin. Metformin can help by making the body more sensitive to insulin, which means less is produced. However, it is not licensed for use for fertility problems, as it was not originally intended for this purpose.
Metformin is most commonly prescribed for women who have PCOS who are also overweight, and for those who haven't responded to clomifene citrate or tamoxifen. Combining metformin with these drugs increases the chances of ovulation. Metformin works better for women who are overweight, although it is no substitute for weight loss. The drug can have side effects such as nausea, vomiting and diarrhea.
'Just for a few weeks I had some bad side effects. I had diarrhea, and was a little bit sick but once that wore off I've not had anything since. I think some women just don't get over the side effects of metformin and simply aren't able to take it, but I got used to it relatively quickly.' Lucy, 27. To find out more, you can check out PCOS Infertility Treatment.
