Multiple Births Not Necessarily a Consequence of CONCEPTION DRUGS - Brief Article

Fear and misinformation may be keeping infertile couples from seeking medical treatment that could solve their problem. A backgrounder report by Serono Laboratories, Inc., Norwell, Mass., points out that fertility drugs produce multiple births of three or more babies in less than six percent of cases.

Successful reproduction is a complicated process that depends upon many factors, including production of healthy sperm by the man and healthy eggs by the woman; normally functioning fallopian tubes that allow the sperm to reach the egg; the sperm's ability to penetrate and fertilize the egg; implantation of the fertilized egg (embryo) in the woman's uterus; and a proper hormonal balance to maintain the pregnancy to full term. If any of these factors are impaired, infertility can result.

According to the Centers for Disease Control and Prevention, National Center for Health Statistics, infertility affects approximately 6,100,000 American women and their partners, or 10-15% of people of reproductive age. One in 10 couples is infertile. This number is expected to rise as more women postpone childbearing until their 30s and 40s--ages associated with reduced fertility.

Around 40% of infertility cases are attributable to male factors and 40% to factors that affect women. In about 10% of cases, infertility is caused by a combination of factors in both partners. Approximately 10% of couples are diagnosed with "unexplained infertility" because no specific reason can be identified. The most common cause of female infertility is anovulation, which is brought about by irregularities in the hormones needed to produce and release healthy eggs. Another is blocked fallopian tubes, a condition which can result from pelvic inflammatory disease or endometriosis. Studies have shown infertility rates increase in women older than 35.

Male infertility may be caused by a number of factors, including problems with sperm and/or hormone production, blockage of the sperm delivery system, injury to the testicles, and anatomical abnormalities or the presence of a varicose vein in the testicle (varicocele)--all of which may affect sperm quality and quantity. Past illnesses, infections, certain diseases, and medications can cause infertility as well.

Infertility can be treated with various assisted reproductive technologies, such as in vitro fertilization, gamete intra-fallopian transfer, intrauterine insemination, zygote intra-fallopian transfer, and intracytoplasmic sperm injection. All of these procedures employ sophisticated scientific techniques conducted in vivo (in the body) and in vitro (in the laboratory) to facilitate fertilization and/or implantation of embryos in the uterus. These approaches are performed in conjunction with drug therapy that stimulates egg production.

Ovulation-inducing drugs are the most widely prescribed treatment for infertile couples. They regulate levels of hormones needed by the ovaries to produce and release healthy eggs for fertilization via sexual intercourse or by assisted reproductive technologies (ART). Careful monitoring of ovulation induction (to address excessive egg production) and transfer of appropriate numbers of fertilized eggs in ART procedures are critical components in reducing the risk of multiple births for patients taking infertility drugs.

Clomiphene citrate typically is considered first-line therapy for patients experiencing ovulatory failure. The orally administered drug triggers the gonadotropin-releasing hormone, which signals the pituitary gland to produce higher levels of hormones that stimulate ovulation.

Follicle-stimulating hormones usually are prescribed for patients who have not responded to clomiphene citrate or failed to conceive following three ovulatory cycles of that therapy. Follicle-stimulating hormones are indicated for ovulatory patients undergoing an ART procedure and generate a heightened hormonal response beyond that induced by clomiphene citrate. Recombinant follicle-stimulating hormone (FSH) is administered by subcutaneous (under the skin) injection with a small needle.

Human chorionic gonadotropins (hCG) causes the release of mature eggs from the ovaries in women who have been appropriately pretreated with FSH. It is usually administered intramuscularly 24 hours after the last dose of FSH to stimulate ovulation.

All of these drugs have been proven effective in helping infertile women conceive when used alone or as part of ART procedures. The most widely prescribed gonadotropin, follitropin alfa for injection, has an 84% cumulative ovulation success rate, and the majority of patients using it have ovulated within three cycles. In clinical studies, it has achieved cumulative clinical pregnancy rates of 35-37% over three cycles.

Media and public fascination with the McCaughey septuplets and the Chukwu octuplets has reinforced a misperception that multiple births of this magnitude are a regular result of infertility treatment. Careful monitoring of ovulation induction (to address excessive egg production) and transfer of appropriate numbers of fertilized eggs in ART procedures can minimize the risk of multiple births.

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