Magazine article Drug Topics

Pharmacy and Fertility: A Growing Partnership

Magazine article Drug Topics

Pharmacy and Fertility: A Growing Partnership

Article excerpt

Historically, infertility has been assumed to be primarily a woman's concern; however, 40% of cases now involve male-related aspects, and 25% may be solely due to the male factor problem.

Introduction

Over the history of pharmacy and medicine, there has been a greater involvement with contraceptive potions and abortifacient pills than with therapies favoring conception and childbearing. However, that orientation has changed in the latter twentieth century as an increasing number of medications and other technological aids have become available to provide successful therapy of infertility states for both men and women.

The past year, 1997, saw startling evidences for the role of technological aids to reproduction. These ranged from the case of a woman treated with a "fertility drug" carrying seven embryos to a successful 30-week birth of septuplets to a case of a 63-year-old woman giving birth to a healthy infant by receiving into her uterus a pre-embryo comprised of a donor oocyte (egg) that had been fertilized in vitro by sperm from her 60-year-old husband. Moreover, 1997 saw significant advances in the development of techniques for freezing eggs and embryos so as to have them available for uterine implantation years later.

The wide use of methods for new technologies such as in vitro fertilization (IVF) has made a major impact on the reproductive scene of the 1990s. There were 315 fertility clinics operating in the United States in 1997, in addition to many more in other nations. Thus, many infertile couples are overcoming their problem. It is very likely for half of such women to become pregnant after the couple has received proper evaluation and treatment at a fertility clinic.

However, diagnosis and treatment of infertility may be lengthy, time-consuming, and expensive. The more advanced technologies now are so expensive as to preclude the participation of couples who are economically disadvantaged. The adoption process is an answer, but a difficult one that, moreover, does not mesh with the mores of some social and national groups, nor necessarily satisfy psychologically.

An unwanted result of the medical specialty practice of assisted reproduction has been the increasing number of multiple births after use of reproductive technologies. This, in turn, may lead to very premature delivery of the infants in stages of development at which survival is fraught with difficulty. An important economic impact results from the costly clinical care needed by "preemies."

Assisted reproduction is among the least regulated medical specialties in the United States. Unlike most of Europe, the United States does not require fertility clinics to be licensed. Thus, patients are faced with the problem of choosing a reliable, high-quality source of such services.

Factors of infertility

Infertility often is defined as occurring when one year of unprotected intercourse does not result in pregnancy. It is estimated that nonconception occurs in 10% of couples whose coitus is without contraception. Although it may be deemed a low rate, this is enough to make infertility a relatively common problem for which couples seek medical help.

Human conception is a difficult and complex process under even optimal conditions. Normally, strong, viable sperm will be able to complete the path to fertilization. This means first breaking through cervical mucus to enter and travel over the length of the uterus and subsequently enter the fallopian tube/oviduct. Once in the oviduct, sperm must reach the egg, penetrate its protective coating and inner membrane, and finally fertilize the egg.

Beyond the process of fertilization, there also must be uterine implantation of the resulting embryo to accomplish impregnation. Maintenance of the implanted embryo, and its normal developmental process, must occur for a normal pregnancy to be completed. Even the final stage of delivery is complex and at times hazardous to the child. …

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