Fertility Treatment Medications

Fertility medications at a glance

• For nearly 30 years, clomiphene citrate – sold under the brand name Clomid® or Serophene® – has often been the first treatment against infertility.
• Injectable hormones may be recommended to stimulate or control ovulation for a number of infertility problems, and are often highly successful.
• Other fertility drugs may be prescribed for several other infertility issues.

Clomiphene

For nearly 30 years, clomiphene citrate – sold under the brand name Clomid® or Serophene® – has often been the first treatment against infertility. Patients who do not ovulate or ovulate unpredictably use clomiphene orally for five days. This stimulates the ovaries to produce eggs (ovulation) in 60 percent to 80 percent of women, half of whom will become pregnant with no further assistance. Use of Clomiphene in women who do not ovulate is called ovulation induction. Clomiphene is also used in women who do ovulate to increase the number of eggs produced in hopes of increasing pregnancy rates. This approach is called superovulation induction.

Ultrasounds are often used to monitor stimulation from Clomiphene. Ovulation should begin about seven days after the drug has been administered. If this does not occur, the dosage may be increased until ovulation is achieved. Once ovulation does occur, the medication should be used until pregnancy occurs, with a reassessment performed after six ovulatory cycles.

Side effects are mild and can include:

• hot flashes
• blurred vision
• nausea
• bloating
• headache

Most of these side effects are mild and should resolve after discontinuing the medication. However, if the patient experiences any visual disturbances she should stop taking Clomiphene and inform her provider. Clomiphene can also increase the chances of multiple births.

Injectable Hormones

Injectable hormones may be recommended to stimulate or control ovulation for a number of infertility problems. These medications are highly successful in stimulating ovulation in women, and are given in varying doses depending on how they are to be used.

The various injectable hormones used in fertility treatments include:

• Human Chorionic Gonadotropin (hCG). Includes brand names such as Pregnyl®, Novarel®, Ovidrel®, and Profasi®, Ovidrel®, which are usually used with other fertility drugs to stimulate ovulation.
• Human Menopausal Gonadotropin (hMG). Includes brand names such as Pergonal®, Repronex®, and Menopur®, and is often used to stimulate ovulation in women who do not ovulate or in women needing superovulation to achieve a pregnancy. HMG contains both FSH and LH purified from the urine of post-menopausal women.
• Follicle Stimulating Hormone (FSH). Includes brands such as Bravelle®, Follistim® and Gonal-F®, which work a lot like hMG, causing the ovaries to begin the process of ovulation. Women whose pituitary glands do not produce any FSH or LH should use hMG (see above) because a small amount of LH is required for optimal production of good quality eggs.
• Gonadotropin Releasing Hormone Agonist (GnRH agonist). Includes the brand name Lupron®, which drastically reduces estradiol levels by regulating the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In assisted reproduction cycles, Lupron® is used to prevent premature ovulation which would drastically reduce pregnancy rates.
• Gonadotropin Releasing Hormone Antagonist (GnRH antagonist). Includes brands such as Ganirelix® and Cetrotide®, which control ovulation by blocking the action of GnRH upon the pituitary, thus suppressing the production and action of LH and FSH. This medication is used to prevent premature ovulation.

Injectable hormones may cause side effects, such as swelling, bruising, or infection at the injection site. If the ovaries become enlarged and tender, there is also a risk of ovarian hyperstimulation.

There is also an increased risk of multiple pregnancy when using ovulation-stimulating drugs, which can carry health risks for both the mother and child. Women who are pregnant with more than one baby have more problems during pregnancy and delivery than women carrying a single child. Multiple fetuses have a high risk of being born too early (prematurely), which can cause health and development problems.

Other Fertility Drugs

Aspirin

Studies have shown that low doses of aspirin – a blood thinner – may prevent miscarriage in women who tend to form blood clots in the placenta, which cuts off the nutrients supply to the developing baby. This is controversial and there are studies on both sides of this debate.

Bromocriptine and Cabergoline (Parlodel® and Dostinex®)

Women with pituitary tumors, which decrease ovulation, benefit from taking bromocriptine or cabergoline to reduce the level of prolactin hormone in the pituitary.

Heparin

Women who have blood-clotting disorders linked to recurrent pregnancy loss are prescribed heparin, which is an injectable blood thinner.
It is best to seek advice from the prescribing physician or pharmacist regarding side effects and other conditions of any fertility drug.