All About Fertility Drugs: What, When, Why?
If you’re researching fertility treatments to help you get pregnant you’ve probably heard that fertility medications are often part of the program. In general, fertility drugs are used to temporarily correct problems with ovulation and help a woman get pregnant. They are prescribed as part of fertility treatments such as IUI (intrauterine insemination) and IVF (in vitro fertilization.)
Fertility medication cost is a significant portion of the overall cost of fertility treatment, in fact representing about 30 percent of the overall cost of fertility treatment. Here’s a summary of the most frequently used medications, why they are used, and potential side effects.
Clomid and Femara
Clomiphene citrate (Clomid and Serophene) tricks the body into thinking estrogen levels are low, which stimulates the pituitary gland in the brain to produce follicle stimulating hormone (FSH) and luteinizing hormone (LH.) FSH causes the follicles (eggs) in the ovary to ripen, and LH causes ripened eggs to be released. Clomiphene citrate is used to stimulate the production of multiple eggs so they can be extracted and used for IVF. It may also be used in conjunction with IUI.
Possible side effects include vaginal dryness, hot flashes, breast tenderness, nausea, vomiting, moodiness, and irritability. Use of this drug with IUI increases the chance of multiple births and high-order multiples (triplets or more). IVF gives more control over multiple births since you and your fertility doctor decide how many embryos to implant.
Some doctors may prescribe Femara (letrozole) instead of clomiphene citrate to stimulate egg production. Femara is an aromatase inhibitor which reduces the production of estrogen temporarily, causing the brain to secrete FSH and LH.
Injectable Hormones for Infertility
Your fertility specialist may recommend injectable hormones called gonadotropins in addition to clomiphene citrate. Gonadotropins are usually used with IUI and IVF, according to the American Society for Reproductive Medicine (ASRM.) Injections of gonadotropins which contain synthetic FSH and may also contain synthetic LH are started early in the menstrual cycle to cause multiple eggs to grow to a mature size. Common names for FSH injectables are Follistim, Bravelle and Gonal-f. The combination medications, which are called human menopausal gonadotropins, are known as Repronex, and Menopur.
Human chorionic gonadotropin (hCG), another injectable medication, is used to trigger the release of the eggs when they are mature. Pregnyl, Ovidrel and Novarel are commonly used hCGs.
Patients who are using these drugs usually are monitored closely with ultrasound to minimize the side effects and risks. Potential side effects are similar to those of clomiphene citrate. Another possible side effect of FSH injections is ovarian hyperstimulation syndrome (OHSS), which affects 5 to 10 percent of women who get the injections, although less than one percent will experience severe symptoms. Symptoms include bloating, discomfort, swelling of the hands or legs, pelvic pain, shortness of breath, diarrhea, vomiting and, in the most severe cases, blood clots and kidney failure. In milder cases any symptoms usually go away in a week or two. Reproductive endocrinology practices (fertility clinics) carefully monitor patients while they are on these potent medications to minimize severe reactions.
You may receive other injectable hormones such as Ganirelix or cetrotide, gonadotropin-releasing hormone (GnRH) antagonists, which causes the pituitary gland to shut down and temporarily stops ovulation, or leuprolide, known as Lupron, a synthetic gonadotropin inhibitor, which is used during IVF to keep a woman from releasing immature eggs.
Other Medications Used in Infertility Treatments
If you are diagnosed with a blood-clotting disorder which is linked to recurrent pregnancy loss your fertility specialist may prescribe heparin, an injectable blood thinner. Possible side effects of heparin include back pain, stomach pain, skin rash, heavy bleeding and hair loss (with long term use.)
Sometimes a pituitary tumor decreases ovulation. If you have this condition your doctor may prescribe medications to lower prolactin levels and reduce the size of the tumor. They are known as Parlodel and Dostinex (bromocriptine and cabergoline) and are taken in tablet form.
Your fertility doctor may also prescribe vitamins, aspirin, antibiotics or various types of estrogen and progesterone for use at different points in your IVF cycle.
Too Much Information?
Don’t worry. Your fertility specialist will prescribe the fertility medications specific to your medical history and conditions. A nurse will train you to give the injections if they are needed as part of your treatment and you will be given detailed instructions about what to do and when. The fertility center staff will be with you and your partner every step of the way on your journey to start a family.
