Fertility Drugs

Reviewed by Trina Pagano, MD

Fertility drugs remain the primary treatment for women with ovulation disorders; some are taken orally and some are injected. In general, these medications work by causing the release of hormones that either trigger or regulate ovulation.

Even if you're using assisted reproductive techniques such as in vitro fertilization, fertility drugs are still an important part of treatment. Since the number and names of all of the infertility medications may seem dizzying, here are the basic facts on the drugs most commonly prescribed.

Clomid or Serophene for Infertility

Indication:Clomid (clomiphene citrate) is often the first choice for treating infertility, because it's effective and been used for more than 40 years. Clomiphene is given to women who are not ovulating normally. Clomid and Serophene, the brand names of clomiphene, are estrogen blocking drugs from a drug category called Selective Estrogen Receptor Modulators (SERM). As a result, they cause the hypothalamus and pituitary gland located deep in the brain to release hormones -- GnRH (gonadotropin releasing hormone), FSH (follicle stimulating hormone) and LH (luteinizing hormone) -- that will stimulate the ovaries to produce eggs. 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 typically 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 after six months, your doctor will probably prescribe a different medication or refer you to an infertility specialist.

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 for Infertility

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 Novarel, Ovidrel, Pregnyl, 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 Bravelle, Fertinex, Follistim, and Gonal-F. These drugs stimulates the development and growth of eggs in the ovaries.

Human Menopausal Gonadotropin (hMG), such as Menopur, Metrodin, Pergonal, and Repronex. This drug combines both FSH and LH (luteinizing hormone).

Gonadotropin Releasing Hormone (GnRH), 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, Synarel, and Zoladex.

Gonadotropin Releasing Hormone Antagonist (GnRH antagonist), such as Antagon and Cetrotide

Indication: Any of these hormonal drugs can be used to stimulate or control ovulation as a way of treating a number of infertility problems.

Use: All these drugs are given by injection only and in varying doses depending on how they are being used. Some are given beneath the skin while others are injected into the muscle. Injection sites can include the stomach, upper arm, upper thigh, or buttocks. The injections are usually started on the second or third day of your cycle (with the first day being the first day you see bright red blood) and given for seven to 12 consecutive days. Some patients will be prescribed both injections and oral Clomid.

Effectiveness: As with clomiphene, the injectable hormones have a high rate of success in stimulating women to ovulate. Of those who ovulate, as many as 50% are able to get pregnant.

Side effects: Most side effects are mild and can include tenderness; infection; and bloodblisters, swelling, or bruising at the injection site. There is also a risk of ovarian hyperstimulation, a condition in which the ovaries become enlarged and tender. Ovulation-stimulating drugs also increase the chances pregnancy with multiples, which can raise the risks for both mother and child.

 

 

Other Fertility Drugs

Aspirin. Studies have shown that aspirin can reduce the risk of miscarriage in certain cases, although you should talk to your doctor about whether it makes sense for you.

Heparin. A drug used to lower the risk of miscarriage in women who have repeated spontaneous miscarriages for specific causes.

Antagon (ganirelix acetate). An injected drug that is used to inhibit premature ovulation in women undergoing fertility procedures. Side effects can include stomach pain, headache, and fetal death.

Parlodel and Dostinex (bromocriptine and cabergoline). These are medications used to lower prolactin hormone levels and reduce the size of a pituitary tumor that may be decreasing ovulation when present. They are usually given orally in small doses and increased as needed. They can also be administered by placing the tablet in the vagina. Side effects include dizziness and upset stomach.