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Pregnancy / Fertility

Our Pregnancy/Fertility category contains cost-effective, branded medicines and generic alternatives to treat infertility.  Our infertility medication helps restore hormonal balance to induce ovulation, which will increase your chance of conception and help you to get pregnant.

You can search for the product you want using the search box, by entering either the active ingredient, e.g. clomiphene or the product name, e.g. Fertomid. 

Our Fertility class of Pregnancy/Fertility medications are used to induce ovulation as treatment for infertility in women who have no other obvious cause for infertility. 

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. Clomiphene or the product name e.g. Fertomid.

Stages of conception

For a pregnancy to be successful there are several stages of a process that must be achieved. These include:

  • Ovulation, which is the release of the egg from the ovary.
  • Passage of the egg through the fallopian tube into the uterus.
  • Fertilisation of the egg by the sperm, which usually takes place as the sperm meets the egg on its way through the fallopian tube towards the uterus. 
  • Embryo development from the fertilised egg (now the zygote), which remains in the fallopian tube for 2-3 days and begins to divide forming the embryo. 
Implantation of the embryo at day 5-7 post fertilisation into the endometrial lining of the uterus to form the placenta. 

What is infertility?

Infertility is defined by the World Health Organisation as the inability to become pregnant after one year of unprotected intercourse.  

Causes of infertility

In about 30% of infertility cases the problem lies with the woman and this can be the result of several factors:

  • Ovulation failure (anovulation) due to hormonal problems, such as overproduction of testosterone (usually associated with polycystic ovary syndrome), or over production of prolactin by the pituitary gland, which suppresses oestrogen production by the ovaries.
  • Luteal phase defect, which is due to insufficient production of progesterone by the ovaries, and can result in failure of the endometrium to develop sufficiently for implantation. 
  • Blocked or damaged fallopian tubes (salpingitis) which prevents the egg from becoming fertilised and reaching the uterus. This could be due to pelvic inflammatory disease (usually caused by a sexually transmitted disease) endometriosis, adhesions, or surgery for ectopic pregnancy.
  • Endometriosis can be the cause of infertility and is the growth of endometrial tissue outside the uterus, which can affect the normal functioning of the female reproductive system.
  • Problems with the uterus, which can be a defect in the shape or the growth of benign tumours called fibroids.
  • Treatments for cancer, particularly if they affect the cervix, uterus, endometrium or other parts of the female reproductive system.
  • Certain medical conditions that can affect the normal menstrual cycle, such as kidney disease, thyroid problems or diabetes.
  • Early menopause related to early ovarian failure.

Ovulation

Ovulation is dependent on a series of hormonal interactions that result in the release of an egg from the ovary.

Oestrogen levels produced by the ovary are low during the first phase of the menstrual cycle; known as the follicular phase and when oestrogen levels drop this induces the release of FSH (follicle stimulating hormone) from the hypothalamus, which stimulates growth and maturation of the ovarian follicle that releases the egg.  As the ovarian follicles mature, oestrogen levels rise and this induces the release of LH (luteinizing hormone) from the pituitary gland. 

Both LH and FSH are under the control of regulating hormones produced by the hypothalamus called gonadotropin releasing hormones (GnRH).  An intricate feedback mechanism exists between the hormones involved in regulating the menstrual cycle and if any part of the interaction of hormones malfunctions, this can prevent ovulation a condition known as anovulation

When LH reaches a peak, known as the LH surge, this stimulates rupture of the dominant follicle releasing a mature egg and this is ovulation.  The other follicles die down and the active ruptured follicle becomes the corpus luteum and starts producing progesterone, which induces the endometrium (lining of the uterus) to thicken and ripen ready for conception. 

Treatments to restore ovulation

One treatment for infertility due to anovulation is the use of clomiphene, a drug known as a selective oestrogen receptor modulator or SERM.  This binds to the oestrogen receptor in the hypothalamus and instead of stimulating the receptor it blocks its action, resulting in low levels of oestrogen.  When levels of oestrogen fall this triggers release of FSH from the anterior pituitary and this helps return the menstrual cycle back under normal hormonal control, which should result in ovulation.  

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Fertility and ovulation

Fertility is the natural ability to reproduce and depends on several factors.  These include your age, regularity of your menstrual cycle, nutrition and general health.  Fertility increases from puberty, reaching a peak during the early 20s and then begins to fall after age 35.  However, this is only the general rule, and a woman can conceive both before and after these ages. 

Ovulation is when an egg is released from the ovary, and the days surrounding ovulation are described as the fertile window.  This is when you are most likely to conceive.  Ovulation is dependant on the interaction of several hormones during the menstrual cycle.  The pituitary gland in the brain is the control centre for many endocrine (hormone) systems and produces Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).  These hormones control the production of oestrogen and progesterone by the ovaries, and release of both FSH and LH is regulated by Gonadotropin-Releasing Hormones (GnRH), produced by the hypothalamus in the brain. 

Oestrogen levels produced by the ovary are low during the first phase of the menstrual cycle (the follicular phase).  When oestrogen levels are low, this induces the release of FSH from the hypothalamus, which stimulates growth and maturation of an ovarian follicle containing a ripening egg.  As the ovarian follicles mature, oestrogen levels rise, and this induces the release of LH. 

When LH reaches a peak (LH surge), this stimulates rupture of the dominant ovarian follicle, and an egg is released.  The ruptured follicle becomes the corpus luteum and starts producing progesterone.  This induces the endometrium (lining of the uterus) to thicken and ripen ready for conception.

Any malfunction in the intricate feedback mechanism between hormones that regulate the menstrual cycle can prevent ovulation. 

What is infertility?

Infertility is the inability to conceive after one year of trying to become pregnant, or not being able to carry a live pregnancy to full term.  The concept of a ticking biological clock is related to the natural fall in fertility and therefore, a reduced chance of conception.  However, infertility can be unrelated to age and can be due to several other factors.  These include blocked or damaged fallopian tubes; early menopause, endometriosis (growth of endometrial tissue outside the uterus); certain medical conditions, such as kidney disease, thyroid problems or diabetes; and insufficient production of progesterone by the ovaries.

Failure to ovulate is also a cause of infertility.  Lack of ovulation can be due to several hormonal problems.  These include overproduction of testosterone (usually associated with polycystic ovary syndrome), and overproduction of prolactin by the pituitary gland.  Prolactin is the hormone that stimulates milk production but also suppresses oestrogen production by the ovaries. 

Medical treatment for infertility

Clomiphene is a medication used to treat infertility due to a lack of ovulation, where there is no other apparent cause.  This drug is known as a selective oestrogen receptor modulator or SERM, and it works by acting directly on the oestrogen receptor in the hypothalamus.  Binding to the oestrogen receptor blocks its action and results in reduced levels of oestrogen.  When levels of oestrogen fall, the release of FSH from the pituitary gland is triggered, which helps return the menstrual cycle under normal hormonal control, and increases the chance of ovulation. 

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