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Infertility is a medical condition characterized by the inability to conceive a child after 1 year of trying. The diagnosis of infertility can be both overwhelming and challenging for the couples who face this condition, because several possible causes of infertility must be evaluated.
In 2002, a survey conducted by the Centers for Disease Control and Prevention (CDC) revealed that infertility affects approximately 7.3 million people in the United States. This number represents an increase from the 6.1 million identified cases in the last CDC survey in 1995.1 Approximately 20% of infertile couples are diagnosed with unexplained infertility.2
Most couples are advised to seek medical consultation if they have been unsuccessful in achieving pregnancy after 1 year, or after 6 months if the woman is over 35 years of age. In some cases, couples may be advised to seek consultation earlier if other health conditions are involved: for example, if the woman has a history of menstrual irregularities or miscarriages, or if the woman or the man has a history of certain infections that may affect fertility.3
Types of Infertility
In addition to the many couples that experience primary infertility, another 3 million couples are affected by another type of infertility known as secondary infertility.3 Secondary infertility is the inability to conceive or deliver a pregnancy to term after the birth of 1 or more biological children. Many couples are unaware of this form of infertility because they were able to conceive once, and they tend to attribute the cause of not conceiving to stress or other factors.
Possible Causes of Infertility
Infertility may be caused by a variety of factors. Forty percent of the cases are attributed to female factors. Another 40% are attributed to male factors. Infertility in the remaining 20% of cases is attributed to either a combination of male and female factors or to unknown causes.3 Factors can include abnormality of the reproductive organs or of hormone levels. Certain infections and diseases also may cause infertility.
Common causes of infertility in women include ovulation disorders, endometriosis, obstruction of or damage to the fallopian tubes, cervical factors, and polycystic ovary syndrome (PCOS). The most common cause of infertility in men is abnormal sperm production or function. Other cases of infertility can be attributed to other medical conditions, as well as environmental or occupational factors. Pharmacists are in a key position to review patient medication profiles and to identify those medications that may affect an individual's fertility.
Diagnosis of Infertility
In general, a fertility specialist will review a patient's medical history and perform a physical examination, which may include certain tests (Table 1). Prior to the initiation of therapy, thorough gynecologic and endocrinologic evaluations typically are conducted. Documentation of ovulation patterns and determination of serum hormone levels also should be obtained. Eighty to ninety percent of infertility cases are treated with some type of fertility agent.4
Because infertility can be caused by a variety of factors, treatment options are dependent on the cause. Types of therapy can include the use of pharmacologic agents, surgery, or assisted reproductive technologies. Therapy may encompass the use of 1 or more means of treatment.
Numerous pharmacologic agents currently are being prescribed for the treatment of infertility (Table 2). In addition, other drug classes are used for infertility. For example, in some women with PCOS or insulin resistance, the use of metformin has been shown to restore ovulation or to increase the chances of responding to fertility medications. Current studies for classes of drugs under investigation that also may aid in the treatment of infertility include the aromatase inhibitors, such as anastrozole or letrozole, and the selective estrogen receptor modulator tamoxifen.6,7
It is important that pharmacists be prepared to counsel patients on the appropriate use of these agents, as well as to inform them about potential adverse effects. These effects can range from mild to severe?such as ovarian hyperstimulation syndrome, which occurs in about 10% to 20% of women treated with human gonadotropins.8
Role of the Pharmacist
It is imperative that patients undergoing fertility treatments be adequately counseled and trained on the proper preparation and administration of these medications (Table 3). Although patients receive training from the physician's office, it is important that this information be reiterated by the pharmacist. The pharmacist can be a beneficial source of information for couples facing infertility by providing effective counseling regarding medication therapy, as well as emphasizing the importance of strict compliance when using these products. Pharmacists also can aid patients by reviewing a patient's medication profile to identify other medications that may cause infertility.
Many couples facing the challenges of infertility can experience both physical and emotional difficulties. Pharmacists can exemplify the true role of a health care professional by acting as a source of information and support. Several pharmacies throughout the country specialize in the dispensing of fertility drugs and also aid patients through the ordeal of infertility.
As the medical profession learns more and more about infertility, more couples who must face this ordeal will have new hope that one day they may realize their dream of having a child. For more information on infertility, visit the following Web sites:
Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.
For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Stahl, Pharmacy Times, 241 Forsgate Drive, Jamesburg, NJ 08831; or send an e-mail request to: firstname.lastname@example.org.