When Drugs Don't Work
The most widely-used fertility drugs (for example clomiphene) which aim to induce ovulation, don't always work for everyone. For some women, clomiphene is enough to kick start ovulation; however, these women may still find it difficult to time sexual intercourse correctly so that the eggs are fertilized after they have been released. Sometimes a man's sperm has trouble getting all the way to the egg and needs a helping hand, even though the clomiphene has done its job of producing a healthy egg in the first place. These couples may need assistance in the form of an artificial insemination procedure alongside clomiphene treatment.
Women who suffer from PCOS (polycystic ovarian syndrome) are more likely to be resistant to clomiphene treatment and may need to try other drugs or a more radical procedure such as IVF (In Vitro Fertilization). A woman who suffers from sperm allergy (a condition causes a woman's body to attack and kill her partner's sperm) may also find that ovulation-inducing fertility drugs don't solve her problems. She too may benefit from trying IUI (intrauterine insemination) or IVF.
What To Do If Drugs Don't Work
Remember, it's very possible that you won't get pregnant in the first month of clomiphene treatment. Many women need two or three cycles of treatment before ovulation begins. If after six months, you still have not conceived, talk to your fertility specialist about other treatment options or ways of helping clomiphene to do its job. If your doctor decides that you are not responding to clomiphene treatment, there are a range of options he may suggest.
Your doctor might want to experiment with estrogen supplements which, when taken in combination with clomiphene, may increase your chances of getting pregnant. The estrogen supplements' job is to help to the lining of your uterus achieve an ideal thickness for the implantation and nurturing of an egg once the egg has been fertilized. The idea is that clomiphene helps you produce the egg in the first place, and the estrogen supplements help ensure that the fertilized egg gets the chance to grow into a healthy baby.
Another drug which can help to increase your responsiveness to clomiphene is metformin. Metaformin makes your body more sensitive to the hormone insulin. Women who don't ovulate normally sometimes don't process the insulin in their body effectively. Metaformin encourages your body to process insulin in a healthier way and may help clomiphene kick start your ovaries.
ART And Drugs
Another option, which would usually only be recommended after drug treatment has failed, is Assisted Reproductive Technology (ART), used on its own or in combination with fertility drugs (often clomiphene).
One form of ART is Intrauterine Insemination (IUI). In this case, fertility drugs may be used to encourage ovulation. Your doctor will monitor your progress. At the time when he thinks your chances of fertilization are highest, he will use a very thin catheter to transport a sample of your partner's sperm directly into your uterus cavity. The hope is that this direct route will increase your chances of getting pregnant.
IUI can also be used in combination with Follicle Stimulating Hormone Treatment (FSH). FSH is administered via a series of injections. The purpose of the FSH is to encourage the follicles on your ovaries to develop. Each of these follicles contains a growing egg. When the eggs reach maturity, one or more will be released into the fallopian tubes and down into the uterus. At this point, your doctor will use IUI to transport sperm directly to the waiting egg(s).
In-Vitro Fertilization (IVF) is the most radical and intensive fertility treatment and is usually recommended only if all other treatments have not helped. In this case, eggs are removed (harvested) directly from the ovaries using a long, thin, needle. The eggs are then fertilized outside the uterus, using your partner's sperm, in a laboratory. The fertilized eggs are then inserted into your uterus, where they will hopefully implant. Certain drugs may be used to create the best possible conditions for implantation and nurturing of the egg(s).
The chances of a multiple pregnancy as a result of this treatment are quite high. Indeed, nearly all fertility treatments lead to an increased chance of conceiving twins or triplets (or even more). You should discuss the advantages and disadvantages of each treatment with your fertility specialist before deciding on the right course of action for you.