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Working in a physically demanding job, having high blood pressure, and taking multiple medications are among health risks that may undermine a man's fertility, according to a study by researchers at the National Institutes of Health and Stanford University, Stanford, California. The investigators followed more than 500 couples in Texas and Michigan over a yearlong period. Of the men who reported receiving a physician's diagnosis of high blood pressure, diabetes, or high cholesterol, the researchers found that only those with high blood pressure had a lower percentage of normally shaped sperm, compared to men who reported no high blood pressure. To that end, the researchers observed that the more medications a man reported taking, the higher his risk of a low sperm count. There are several medications that are used to stimulate the ovaries to assist with the ovulation process or to produce several eggs during one cycle. Call 602-956-7481 to speak with a Fertility Specialist today about medications and other fertility treatment options. Clomiphene (Clomid, Serophene) is a medication that has been used for more than 50 years to stimulate follicular development.
Clomid is a SERM (Selective Estrogen Receptor Modulator), it can bind to the estrogen receptor, but depending on the tissue, it may stimulate it or block it. Clomiphene is dispensed as 50 mg tablets and is capable of inducing ovulation in 80% of users but only half of those conceive over 6 months. At IVFMD we are very proactive and maximize your pregnancy rates per cycle by modifying your Clomid dose, incorporating other strategies such as Metformin, Dexamethasone, HCG and even FSH injections. If there are no pregnancies after 3 or more cycles or there is no response, often we will consider laparoscopy, injectable gonadotropins with IUI, and in some cases IVF. You usually only need only 2 sonograms during the cycle, one initially to confirm that your pelvic anatomy is normal, and another to assess your response to the medication, predict the best day for insemination, and determine if there are any negative side effects, such as a thin endometrial lining.

Clomid can bind at the endometrial level and in some patients prevent the action of estrogen and thus cause a thin lining. Letrozole (Femara) is a newer medication that belongs to the family of Aromatase Inhibitors. A small Canadian study in 2005 reported an increased incidence of birth defects with Letrazole but this has been disproved by larger, better designed studies that followed. Most were white (77 percent) and college-educated (91 percent); more than half had never fathered a pregnancy. For example, 7 percent of the men who did not take medications had sperm counts below 39 million (a normal sperm count is between 40 million and 300 million). During a natural cycle one follicle is selected to continue to grow to maturity and is then released (ovulation). The higher the dose, the more often we observe this side effect which can lead to lower implantation levels. This drug rapidly lowers Estrogen levels, stimulating the Pituitary to release more FSH and thus induce ovulation. The half life of Letrazole is very short and thus it is out of the body by the time pregnancy occurs.
All male participants completed preliminary interviews in which they were asked about their reproductive history, health, lifestyle and occupational activity. The researchers found that 13 percent of the men who reported heavy work-related activity had lower sperm counts, compared to 6 percent of the men who reported no workplace exertion. Of the men who reported taking two or more medications, 15 percent had sperm counts below 39 million.

Because each medication has a different mechanism of action, the medications can be taken alone or can be taken in combination with each other.
The chances of conceiving per cycle are about the same on the 1st 3 ovulatory cycles but decrease thereafter, such that 90% of pregnancies from clomiphene occur by the fifth cycle.
In some cases we can minimize the effect of Clomid on the endometrium by changing the dose, supplementing with Estrogen tablets, or switching to Letrazole. Letrazole is commonly used in breast cancer patients to lower recurrence by decreasing estrogen levels.
We, as many other fertility specialists, feel that this is an excellent alternative for patients. This medication was originally intended for breast cancer treatment and its use in fertility medicine is off-label. In contrast, no other work-related exposure, such as heat, noise or prolonged sitting, appeared to influence semen quality. The decision to prescribe one medication over another one will depend on the woman’s menstrual history and what type of a cycle is planned. Other common temporary side effects are headache, hot flushes, and alterations of the cervical mucous. Letrazole carries a lower risk of multiples and no endometrial effects when compared to Clomid.

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