Infertility

Background

Infertility is a term to describe a condition that impairs the reproductive system and affects the ability to conceive children. Clinically, infertility is defined as not being able to achieve pregnancy after 1 year of having regular, unprotected intercourse, or after 6 months if the woman is older than 35 years of age.

Many different medical conditions and factors can contribute to fertility problems. Both women and men can be affected with infertility.

Causes

The most common overall cause of female infertility is the failure to ovulate.

  • Polycystic ovary syndrome (PCOS) is one of the most common conditions that affect ovulation. It's a condition in which a woman's ovaries and adrenal glands produce more androgens (a type of hormone) than normal. High levels of these hormones interfere with the development of ovarian follicles and release of eggs during ovulation. As a result, fluid-filled sacs, or cysts, can develop within the ovaries.
  • Aging which refers to a low number of eggs in a woman's ovaries due to normal aging and endocrine disorders (conditions that affect the hormones produced by the body) can also cause ovulation issues.

The following list includes some of the other causes of infertility in females. It's not all-inclusive.

  • Problems in the menstrual cycle
  • Structural problems of the reproductive system
  • Infections
  • Failure of an egg to mature properly
  • Implantation failure
  • Endometriosis
  • Primary Ovary Insufficiency (POI)
  • Uterine fibroids
  • Autoimmune disorders

The most common issues that lead to infertility in men are related to the testicles which make and store sperm. Certain conditions (such as diabetes, injury to the testicle, thyroid problems) can lead to sperm that is abnormally shaped or lead to low amounts of sperm. Infertility can also be caused by how or whether the sperm move around.

Lifestyle and environmental factors may also be involved with infertility for both men and women which include:

  • Stress
  • Poor diet
  • Being overweight or underweight
  • Smoking, drugs and alcohol
  • Sexually transmitted diseases (STDs)
  • Excessive exercise

Treatment

There are many ways to treat infertility, including medication, surgery, intrauterine insemination/artificial insemination or assisted reproductive technology (ART). Often, medication and intrauterine insemination are used at the same time. ART includes all fertility treatment in which both eggs and embryos are handled outside of the body. The main type of ART is invitro fertilization (IVF)

Male infertility will be treated based on the cause of the infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.

Some medications used to treat infertility in women include:

  • Clomid® (clomiphene citrate) causes ovulation by acting on the pituitary gland. It's often used in women who have polycystic ovary syndrome (PCOS) or other problems with ovulation. It's also used in women with normal ovulation to increase the number of mature eggs produced.
  • Menopur® (menotropins) is human menopausal gonadotropin or hMG which acts directly on the ovaries to stimulate development of mature eggs.
  • Follistim® AQ (follitropin beta)/Gonal-F® (follitropin alfa) is a recombinant version of human follicle-stimulating hormone (FSH). These products stimulate development of mature eggs within the ovaries.
  • Gonadotropin-releasing hormone (GnRH) analogs (e.g., chorionic gonadotropin) and GnRH antagonists (e.g., ganirelix, cetrotide) act on the pituitary gland to prevent a woman from ovulating. They are used during in vitro fertilization cycles, or to help prepare a woman's uterus for an embryo transfer.

Resources

Let an Optum® Specialty Pharmacy expert help you with your specialty medication needs. Call our dedicated fertility team at 1-877-358-9016.