We are led to believe that couples aren't into children much anymore. That if a man and a woman want to have a really meaningful relationship, they'll continue childless. At the most, we are told, a couple might agree to sharing their lives with a single child. That's where they're coming from today.
| That may sound very trendy but the fact is that having children remains very popular. In the United States live births still top 3 million a year. Raising a family may seem to some to be old-fashioned but to many it is a fond desire. And to thousands it is, unfortunately, unrealized. The burden of being barren has weighted down women throughout history. At the same time, it has often crushed the male ego. That the problem hasn't gone away is best exemplified by figures from the National Disease and Therapeutic Index compiled by IMS America, a pharmaceutical marketing research firm. Those figures indicate that women visited doctors about fertility problems some 1.5 million times in the year ending Sept 30, 1982. About 19 percent, or 285,000, of those visits were first visits. One study concluded that 15 percent of U.S. marriages are infertile. While the problem hasn't gone away, we do know a little more about it today. We know that 30 to 40 percent of the cases may be traced to male infertility, and that although there are many causes of female infertility, a few of the major problems can very often be cured with drugs. For men, infertility is generally associated with insufficient or weak sperm. A normal male provides 400 million sperm in an emission. When the sperm count gets below 100 million, the odds on one of them fertilizing an egg are extremely thin. Weak or defective sperm may be unable to make that tremendously difficult nine- or ten-inch upstream swim to the Fallopian tubes where the ready-to-be-fertilized egg waits. Male sterility problems may be caused by diseases or may result from physical or metabolic disorders. Elevated scrotum temperatures can limit the production of sperm. A hot bath can cause it, as well as an infection. Today's fashionable tight clothing is also believed to contribute to higher testicular temperatures. |
While the causes of infertility in women are many, they are often traced to blocked Fallopian tubes, or failure to produce eggs or to retain fertilized eggs. Blocked Fallopian tubes prevent the egg, which is travelling down from the ovaries, from meeting up with the upcoming sperm. The reason for the blockage may be physical or may be due to scars left from diseases. In such cases, surgery may alleviate the problem. However, many Fallopian tubes are blocked by a condition called endometriosis.
Endometriosis is a painful condition in which tissue from the lining of the uterus is found in other parts of the abdominal cavity. The strayed tissue grows, causing much pain and any number of other problems, including blocked tubes. An accidental discovery involving a long-time endometriosis sufferer who had a Caesarean section performed led to the treatment of the disease with a hormone-suppressing drug. In addition to creating a pseudo-menopause condition, the drug causes the endometrial tissue to atrophy and die. Treatment usually lasts six to nine months. Pregnancy, if desired, follows in about 50 percent of the cases.
The drug Danocrine (chemical name: danazol) is prescribed mainly for treatment of endometriosis and not for infertility. However, according to IMS America, 10 percent of the 327,000 prescriptions written for it in 1982 were for treating infertility.
Drugs are often used successfully for inducing ovulation. However, they may have a major side effect - multiple births.
Lack of ovulation or infrequent and irregular ovulations may be a cause of up to half of female infertility problems. Drug therapy can result in pregnancy in about 25 percent of those cases.
The drugs used in such cases work by stimulating the pituitary gland to produce needed hormones. The hormones, known as FSH and LH, are believed to act on the ovaries in the following ways: FSH helps the follicle or egg sac to grow in the early stages of a woman's menstrual cycle that will prompt the pituitary to release enough LH to cause the follicle to rupture and release its egg.
Clomid (clomiphene citrate) is a drug quite widely used in infertility cases. Taken orally, it is usually prescribed for days 5 through 9 after menstrual bleeding has ended. The National Prescription Audit put the number of Clomid prescriptions at 658,000 in 1982.
Women who take Clomid and become pregnant deliver more than one child in 7 to 10 percent of the births. Three-fourths of the multiple births are twins. By comparison, in the population as a whole, multiple births represent but 1 percent, with twins accounting for slightly better than 98 percent of those.
The multiple births result because the ovaries are overstimulated by the drug. Thus, more than one egg may be ripe and ready for fertilization at the mid-cycle time of conception.
If Clomid doesn't result in pregnancy and if tests show that not too many ovary sacs are ripening, a more powerful drug, Pergonal (menotropins), may be prescribed. Injected into the muscle, Pergonal provides both FSH and LH and is given for nine to twelve days. Pergonal is known technically as human menopausal gonadotropin. It is extracted and purified from the urine of postmenopausal women. Human chorionic gonadotropin (HCG) (trade names: Antuitrin-S, A.P.L., Pregnyl and Follutein) is injected one day after the last dose of Pergonal.
HCG is extracted from the urine of pregnant women and is used in pregnancy tests. HCG acts to sustain the action of progesterone, a hormone important to the early growth and nesting of the fertilized egg.
Because Pergonal and HCG are injected in a doctor's office, it is difficult to track their usage records through prescription audits. Use of the combination is effective, bringing on pregnancy in 25 percent of the patients, if the women are properly selected. Multiple births result in 20 percent of the pregnancies. That's 20 times the national average. As with Clomid, a fourth of those multiple births are triplets or more.
After use in women for some years, Pergonal with HCG has been approved by FDA for males with pituitary gland problems. The combination may stimulate sperm production.
Infertility cases are not always so difficult as to need the more powerful drugs. Sometimes for women, doses of the single hormones estrogen or progesterone will do the job. And sometimes a douche with baking soda is all that is needed. Such a pre-intercourse douche can neutralize overly acidic cervical secretions that might be killing off sperm.
A hormone has also been used on men to suppress sperm count so that advantage can be taken of the rebound effect that follows when the hormone is withdrawn.
In addition, a study reported recently (March 3, 1983) in the New England Journal of Medicine noted success in achieving pregnancies for previously infertile couples by treating the husbands for a relatively minor but prevalent social disease caused by the microorganism T mycoplasma or Ureaplasma urealyticum. This infection of the genital tract was treated with a tetracycline type antibiotic. Researchers believe that the mycoplasma infection may be a major cause of infertility.
THE PROBLEM WAS SOLVED EMPHATICALLY
The problem had been one of lack of ovulation, a condition known as absolute amenorrhea. It had not always been so. She had menstrual cycles in her early teens but that was some years ago.
The problem was not solved and she had pretty well learned to live with it until marriage and the realization that they could be destined to be childless. Consulting experts, she discovered that she had a high level of the hormone prolactin, a substance that helps to develop breast milk. High prolactin readings are often associated with amenorrhea.
A drug was tried to bring the prolactin levels down. It worked somewhat, but not enough. Next the doctor looked for a tumor or cyst on the brain's pituitary gland. High prolactin levels can also indicate that problem. A tumor was found. It was removed by microsurgery.
However, the prolactin levels remained high even after the surgery, and the amenorrhea continued. A year after the surgery, the doctor suggested trying the drug Pergonal to stimulate the ovaries. She was given one injection a day for two weeks along with two injections of HCG. But she still failed to conceive.
Two weeks later she got another series of Pergonal injections. This time the blood level readings of hormones indicated that conditions were ideal for conception - the ovaries had ripened and the readings were not so high as to signal a strong possibility of multiple births.
So once again, HCG was given.
Two weeks later, she was confirmed pregnant.
They had been told of the high possibilities of multiple births with the fertility drugs, and they were ready to accept twins or even triplets.
But she was carrying five children.
After learning of the quintuplets, they researched other quints in the country. One set was 20 years old. They visited another family with five 13-year olds. The mother had also had a pituitary tumor that was removed and had also taken Pergonal.
They know that, unlike the famous Dionne quints of the 1930s, theirs won't be identical. And they know that they can expect at least an initial barrage of publicity.
How does one cope with the prospect of going from a family of two to a family of seven? Her smile tells you that it's a better prospect than being childless.
Roger W. Miller is editor of FDA Consumer
Reprinted from June 1983 FDA CONSUMER HHS Publication No. (FDA) 83-3136
Department of Health and Human Services Public Health Service Food and Drug Administration 5600 Fishers Lane Rockville, MD 20857
??
©1986-2008 Hopkins Technology, LLC