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Fertility Drugs

by Marjorie Greenfield, M.D.
reviewed and revised by Marjorie Greenfield, M.D.
This article will give you basic information about some of the drugs that are commonly used to treat fertility problems. Your doctor will give you more detailed information and can help you decide if any of these medications is right for you.

Who needs fertility drugs?
Most fertility drugs are hormones that stimulate the development and release of eggs from the ovaries or in some way support ovulation and early pregnancy development. The drugs can be taken when there is a clear-cut ovulation problem or to increase the quantity and quality of the eggs that are released in a given cycle.

To better understand how these drugs specifically work, you may first want to review the actual processes of egg development and ovulation and conception.

Drugs to induce ovulation
  • Clomiphene citrate--This medication, which goes by the brand names Clomid and Serophene, blocks the pituitary gland's ability to detect estrogen. It fools the pituitary into working extra hard to stimulate ovulation. Clomiphene is taken in pill form for five days early in the menstrual cycle. The dose usually starts at a low level and is then increased each month until the cycle appears to be working well. Once a good ovulation cycle has been established, that dose may be continued for a few months.

    If this drug isn't successful in bringing about conception, other treatments can then be tried. But clomiphene is often recommended for initial treatment because it is less expensive than most other fertility drugs and has less risk of causing large ovarian cysts or a multiple pregnancy (about a 5 percent likelihood of twins and a less than 1 percent chance of triplets or greater).

  • Gonadotropins--These medications come in the form of pure follicle stimulating hormone, or FSH (brand names Follistim, Bravelle or Gonal-F), or a mixture of FSH and luteinizing hormone, or LH (Repronex). Gonadotropins are the same hormones that your pituitary produces to tell the ovary to get an egg ready for release, only in much higher doses. They may cost hundreds or even thousands of dollars per month, depending on where you live and the dose you need, and are given as a daily injection.

    Taking gonadotropins requires a huge commitment, in terms of money and time. The treatment can lead to significant complications, including huge ovarian cysts and abdominal fluid, called ovarian hyperstimulation syndrome, or OHSS. Because of this, their dose and duration of use must be monitored by a doctor specially trained in fertility treatment. This usually involves getting an ultrasound and a blood estrogen test every few days and then adjusting the daily dose based on the results. Once the ultrasound shows that the egg-cysts (follicles) are the right size and the blood tests demonstrate appropriate estrogen levels, an injection of human chorionic gonadotropin, or hCG, is necessary to stimulate ovulation, which usually occurs about 36 hours later.

    Depending on the cause of infertility and the specific treatment protocol, the eggs can then be fertilized in the lab (known as in vitro fertilization), through intercourse, or through artificial insemination.

  • HCG--This is the same hormone that is measured when you take a pregnancy test. When used in the treatment of infertility, it acts like luteinizing hormone and stimulates the ovary to release an egg. After ovulation occurs, hCG, which is sold by the brand names Pregnyl, Novarel, and Ovidrel, also serves to remind the ovary to make progesterone, the hormone that maintains the uterine lining for implantation.

    Since the actual hCG hormone is used, treatment can lead to a false positive pregnancy test if the test is run too soon after the hormone is given. If you are being treated with hCG, ask your doctor or nurse when she recommends that you take a pregnancy test.
Using progesterone in fertility treatment
Progesterone is the hormone your ovary makes to ready the uterine lining for implantation of a fertilized egg and to prevent the lining from shedding too soon, which would destroy the environment necessary to nurture the embryo. (Normally, if the ovary has been functional enough to release a healthy egg, it produces enough progesterone.) It usually is taken in the form of a vaginal suppository or gel, or as an injection. Oral use of progesterone is controversial because, while some doctors believe that the oral form is just as effective, most natural human hormones aren't well absorbed when taken by mouth.

Some debate surrounds the use of progesterone to prevent the uterine lining from shedding too early, as there aren't any studies that show it improves a couple's chances of having a successful pregnancy. However, many doctors still offer it as part of their fertility protocols

Clomid or Serophene (clomiphene citrate)

Indication: Clomid is often the first choice for treating infertility because it's effective and been used for more than 25 years. Clomiphene is given to women who are not ovulating normally. Clomid and Serophene, the brand names of clomiphene, are antiestrogen drugs. As a result, they cause the hypothalamus and pituitary gland located deep in the brain to release hormones that will stimulate the ovaries to produce eggs. GnRH is released from the hypothalamus and FSH and LH are released from the pituitary gland. These fertility drugs are often used in combination with assisted reproductive techniques or artificial insemination.

Use: The typical starting dosage of clomiphene is 50 milligrams per day for five days. You take the first pill on the third, fourth, or fifth day after you start your period. You can expect to start ovulating about seven days after you've taken the last dose of the drug. If you don't ovulate right away, the dose can be increased by 50 milligrams per day each month up to 150 mg. After you've begun to ovulate, most doctors suggest taking clomiphene for no longer than six months. If you haven't become pregnant by then, your doctor will probably prescribe a different medication.

Effectiveness: Approximately 60% to 80% of women who take clomiphene will ovulate, and about half will be able to get pregnant as a result of taking the drug. Most pregnancies occur within three cycles.

Side effects: The side effects of clomiphene are generally mild. They include hot flashes, blurred vision, nausea, bloating, and headache. Clomid can also cause changes in the cervical mucus, which may make it harder to tell when you're fertile and may inhibit the sperm from entering the uterus. Like many fertility drugs, Clomid can increase the chances of multiple births, although it's less likely to cause the problem than some injectable hormones.

Injectable Hormones

If Clomid on its own isn't successful, your doctor may recommend injectable hormones to stimulate ovulation. Some of the types are:

  • Human Chorionic Gonadotropin (hCG), such as Pregnyl, Novarel, Ovidrel, and Profasi. This drug is usually used along with other fertility drugs to trigger the ovaries to release the mature egg or eggs.
  • Follicle Stimulating Hormone (FSH), such as Follistim, Fertinex, Bravelle, and Gonal-F
  • Human Menopausal Gonadotropin (hMG), such as Pergonal, Repronex, and Metrodin. This drug combines both FSH and LH.
  • Gonadotropin Releasing Hormone (Gn-RH), such as Factrel and Lutrepulse. This hormone stimulates the release of FSH and LH from the pituitary gland. These hormones are rarely prescribed in the U.S.
  • Gonadotropin Releasing Hormone Agonist (GnRH agonist), such as Lupron, Zoladex, and Synarel
  • Gonadotropin Releasing Hormone Antagonist (GnRH antagonist), such as Antagon and Cetrotide

If you are having problems emotionally or physically undergoing Fertility Treatment, we have an expert who will help you out with these problems.  This can be an emotional time for you, financially and mentally.  We can help.  See:  Coping with Fertility Treatments

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