Angela’s Story: A Case Study on the ReproductiveSystem

You are a columnist for a popular website that deals withwomen's health issues. Visitors to the site can submit theirstories and questions through an “Ask the Expert” link on the site.In this scenario, a 26-year-old woman has posted her story and somequestions regarding reproductive health.

My name is Angela. I am a 26-year-old married woman with nochildren. My husband, Doug, and I have been trying to get pregnantfor over two years now and my doctor has suggested that I considerfertility drug treatments. The irony of our situation is that Ihave been taking a birth control pill for five years to preventgetting pregnant, and now my doctor suggests that I take anotherdrug to help me get pregnant.

When I went off birth control, about a year ago, my menstrualcycle became very irregular. I had been taking a birth control drugcalled Ortho Tri-Cyclen. To be perfectly honest, I don't understandhow it works because my periods were more regular when I was on thepill than when I went off of it. My doctor told me that the pillworks because it tricks your body into thinking that it ispregnant. That just confused me even more.

When I looked back on my decision to take birth control pills, Irealized that I did not really understand how they work. I just donot want to make that mistake again. Before I consider taking anymore drugs, I want to understand more about how they work. The drugwe’re looking into is called Clomid. I asked my doctor a bunch ofquestions, but I still feel confused. I looked up some stuff onlinewhen I got home. Here is some information that I learned from awebsite about how Ortho Tri-Cyclen works:

Estrogen and progestin work in combination to suppress thehypothalamic-pituitary- gonadal (HPG) axis. This suppression leadsto a decrease in the release of gonadotropin-releasing hormone(GnRH) from the hypothalamus and luteinizing hormone (LH) andfollicle-stimulating hormone (FSH) from the anterior pituitary.Maturation of the dominant follicle is inhibited under thedecreasing levels of FSH and LH. Hormonal contraceptive use alsoleads to an increase in the viscosity of the cervical mucus, whichinhibits sperm penetration and movement through the cervicalcanal.

I am hoping that you would be able to help me understand howthese drugs actually work.

Short Answer Questions:

1. In my research, I found that the levels of “gonadotropins” inthe body are critical to understanding how the drugs Clomid andOrtho Tri-Cyclen work. What are gonadotropins? What role do theyplay in fertility?

1. Some of the references talk about how “negative feedback” isinvolved in understanding how these drugs work. Can you explainwhat is meant by negative feedback?

2. My doctor told me that birth control pills contain small amountsof estrogen and progesterone, and these hormones prevent me fromovulating. I don’t understand how giving me these hormones in apill would prevent me from ovulating. I assume that it hassomething to do with the levels of the gonadotropins that I askedabout earlier. Can you explain this to me?

3. In the information about Ortho Tri-Cyclen, it mentions that thehormones in the pill make cervical mucus thicker and stickier. Doesthis happen during my natural cycle? How are estrogen andprogesterone involved in this process?

4. My doctor also explained that birth control pills “trick thebody into thinking it is pregnant.” She explained that women do notnormally ovulate when they are pregnant. Can you explain to me whya pregnant woman does not ovulate? How is this related to how thebirth control pill works?

5. My doctor explained that Clomid works by “tricking the braininto thinking that estrogen levels in the body are low.” Sheexplained that this is what leads to the extra stimulation of theovaries to encourage eggs to be released. One of the references forClomid said this happens because there is less negative feedback.Can you explain to me how this “trick” and the decreased negativefeedback are related? Why would these factors lead to thestimulation of the ovaries?

6. My doctor told me that if I take Clomid, I would be taking it ondays five through nine of my normal menstrual cycle. She explainedthat this is when it will have the greatest chance of stimulatingthe ovaries. What is going on during this part of the menstrualcycle that makes it the best time to take this drug?

8. I read an article that mentioned that women on Clomid may bemore likely to get pregnant with twins, triplets, or more! Thearticle said that normally there is a dominant follicle thatreleases a single egg, but Clomid can potentially make lots offollicles release an egg in a given month. How does Clomid dothat?

please answer these questions in detail. Thankyou!