Infertility is often regarded as a sensitive issue and is rarely discussed openly.
However, it is more common than many people realise.
According to the World Health Organization (WHO), infertility refers to the inability to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse.
Infertility may be due to causes in women, in men, in both, or causes that cannot be clearly identified.
In women, common causes of infertility include ovulatory disorders, blocked or damaged fallopian tubes, endometriosis and abnormalities of the uterus.
In men, infertility may be associated with abnormal sperm production, poor sperm quality, hormonal problems, infections involving the testes, undescended testes or varicocele, which refers to abnormal enlargement of veins in the scrotum.
Other factors, such as excessive body weight, smoking, alcohol consumption and frequent exposure to radiation or certain chemicals, may also affect fertility.
In some cases, the cause of infertility cannot be identified even after proper assessment.
This is known as unexplained infertility.
When eggs aren’t released
Ovulation is the process in which a mature egg is released from the ovary and may then be fertilised by sperm.
Ovulatory disorders occur when ovulation becomes irregular or does not occur at all.
When this happens, the chance of pregnancy may be reduced because an egg is not released regularly for fertilisation.
Ovulatory disorders are one of the important causes of infertility in women.
They may be associated with underlying conditions such as polyendocrine metabolic ovarian syndrome (PMOS, previously known as polycystic ovarian syndrome or PCOS), thyroid disorders, premature ovarian insufficiency or excessive prolactin levels.
Women with ovulatory disorders may experience irregular menstrual cycles, missed periods, mood changes or weight changes.
However, symptoms may vary, and proper medical assessment is important to identify the underlying cause and determine the most appropriate treatment.
The role of medicines
Medicines play an important role in the management of infertility caused by ovulatory disorders.
The medicines are usually prescribed to help regulate or stimulate ovulation by influencing the hormones involved in the menstrual cycle, such as follicle-stimulating hormone (FSH) and luteinising hormone (LH).
These hormones are important for the growth and maturation of ovarian follicles.
An ovarian follicle is a small fluid-filled sac in the ovary that contains an immature egg.
When the follicle matures, it may release an egg during ovulation.
Some medicines may help support this process by encouraging the development of a better-quality egg or by increasing the chances of ovulation.
However, these medicines should not be taken without medical advice.
The choice of medicine depends on several factors, including the cause of infertility, age, medical history, current health condition and treatment response.
Medicine usage also requires proper monitoring because inappropriate use may cause unwanted effects or increase certain treatment-related risks.
Common medicines used in the treatment of ovulatory disorders are:
Clomiphene is one of the medicines commonly used to stimulate ovulation.
It is usually taken orally and prescribed for women who have ovulatory problems, including those with PMOS.
Clomiphene works by influencing hormone signals in the body, which then stimulates the pituitary gland to release FSH and LH.
These hormones encourage the growth and maturation of ovarian follicles.
When a follicle matures, it may release an egg that can be fertilised.
In many cases, clomiphene is prescribed for five days during the menstrual cycle, such as from Day Two to Day Six, or from Day Five to Day Nine, of the cycle, depending on the doctor’s instructions.
Like other medicines, clomiphene may cause side effects.
These may include hot flushes, headache, blurred vision, breast tenderness, weight gain, abnormal uterine bleeding and increased urinary frequency.
Since clomiphene may cause visual disturbances, patients should be careful when driving or performing activities that require clear vision and concentration.
Clomiphene may also increase the chance of multiple pregnancies, such as twins.
Patients are advised to discuss this possibility with their doctor before and during treatment.
Gonadotropins are injectable medicines that may be used to stimulate the development of ovarian follicles and trigger ovulation.
These medicines may be considered when oral medicines are not suitable or when the response to previous treatments is inadequate.
Gonadotropins act more directly on the ovaries to support follicle maturation and the release of eggs.
Since they are given by injection and may have a stronger effect on the ovaries, treatment with gonadotropins usually requires close medical monitoring.
This may include ultrasound scans and hormone tests to assess the response of the ovaries and reduce treatment-related risks.
Common side effects of gonadotropins include irritation at the injection site, headache, nausea, bloating and mood changes.
Similar to clomiphene, gonadotropins may increase the chance of multiple pregnancy.
Therefore, patients should follow the treatment schedule carefully and attend all appointments as advised by their doctor.
Bromocriptine may be used when infertility is related to excessive prolactin production.
Prolactin is a hormone that has several functions in the body, but high levels of prolactin may interfere with the ovulation process.
When ovulation is disturbed, the chance of pregnancy may be reduced.
Bromocriptine helps to correct the imbalance of prolactin levels.
By reducing excessive prolactin, the normal hormonal cycle may be restored and ovulation may improve in suitable patients.
Possible side effects of bromocriptine include dizziness, headache, vomiting and constipation.
General advice
Couples who have difficulty conceiving should seek assessment and advice from qualified healthcare professionals.
Fertility treatment should be guided by the underlying cause, age, medical history and current health condition.
Patients who are prescribed medicines should take them at the right dose, timing and duration as advised by the doctor.
They should also attend follow-up appointments for proper monitoring.
Pharmacists also play an important role in supporting patients undergoing fertility treatment.
They provide counselling on the purpose of medicines, correct dose, administration method, storage, effect of missed doses and possible side effects.
For injectable fertility medicines, pharmacists may guide patients on proper preparation and injection techniques to help them feel more confident in managing their treatment.
Pharmacists may also review medicine history, identify possible medicine-related issues and refer patients to doctors when further intervention is needed.
A healthy lifestyle may also support fertility treatment.
Maintaining an ideal body weight, eating a balanced diet, exercising regularly and getting adequate rest may help improve overall reproductive health.
Smoking and excessive alcohol intake should be avoided.
Emotional support from partners, family members, friends, counsellors and healthcare professionals may also help couples cope with stress during the treatment journey.
Infertility due to ovulatory disorders can be challenging, but with proper preparation, medical guidance and regular monitoring, fertility medicines may help improve the chances of pregnancy in suitable patients.
However, not all women are suitable for this treatment, as the choice of medicine depends on the underlying cause of infertility, the patient’s health condition and treatment plan.
Women who are planning for pregnancy are encouraged to obtain appropriate fertility advice from their doctor and determine the most suitable time to start treatment.
Najihah Muhamad is a pharmacist at Hospital Sri Aman, Sarawak. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
