A Woman’s Guide To Fertility Drugs
During fertility treatment, our doctors will prescribe several medications for our female patients so they either produce multiple eggs for an upcoming in vitro fertilization (IVF) cycle, regulate their menstrual cycles, or sustain a pregnancy once they conceive.
There are various classifications of fertility drugs with different purposes and methods of administration. Fertility doctors, also called reproductive endocrinologists, are experts in determining which fertility drug protocols and combinations will be best for your particular situation.
In this post, we will provide an overview of the following drugs that may be prescribed during fertility treatment:
- Clomid
- Letrozole
- Metformin
- Lupron
- Gonadotropins
- Human chorionic gonadotropin (hCG)
- Progesterone
Clomid
Clomid, also known as Serophene, is one of the most commonly prescribed fertility medications in the world. If you are having problems with ovulation and have never received treatment, chances are your doctor will prescribe this easy, cost-effective first step. You can purchase it from specialized fertility pharmacies, and in many cases local pharmacies.
Clomid primarily helps stimulate ovulation by starting in the hypothalamus where it blocks estrogen receptors, making your body think estrogen levels are lower than they are. The hypothalamus responds by producing more gonadotropin-releasing hormone (GnRH), which then stimulates the pituitary to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones trigger follicular production and ovulation.
While you are taking Clomid, your fertility specialist will monitor your progress with ultrasounds and blood tests to assess how the follicles are developing and ovulation is proceeding. Your doctor will recommend either engaging in time sexual intercourse or undergoing intrauterine inseminations to conceive.
Clomid is a tried and true method for enhancing ovulation, which it induces in 80% of previously non-ovulatory women. Pregnancy usually occurs during the first three months of therapy, and most doctors do not recommend treatment with it beyond six months.
Letrozole
Letrozole, also known by its brand name Femara, is another oral medication used to encourage ovulation, especially in patients with polycystic ovary syndrome (PCOS) or unexplained infertility. Created to treat hormone-receptor-positive breast cancer patients, doctors found that it also jump-started ovulation. It is an aromatase inhibitor, which blocks androgens from converting into estrogen, telling the pituitary gland to produce more FSH to start egg production. It also can regulate and shorten long cycles.
Like Clomid, Letrozole has few side effects, it is relatively inexpensive, and the risks of multiples are low. Some studies have found that it has a better success rate for women who have PCOS than Clomid does, while recent studies have challenged this idea. In 2014, National Institutes of Health (NIH) researchers found that 27.5% of women treated with Letrozole had a live birth compared to 19.1% of those on Clomid.
Metformin
Metformin, a drug that has been approved to treat type 2 diabetes and which decreases blood sugar levels, can help establish regular menstrual cycles in women with PCOS, especially when combined with Clomid. Women take it orally.
Lupron
If you have endometriosis or fibroids, your doctor may recommend Lupron, a GnRH agonist medication, because it will reduce estrogen levels through the regulation of production of Follicle Stimulating Hormone (FSH) and luteinizing hormone (LH).
Your doctor also may prescribe Lupron for an IVF cycle. Because Lupron shuts down the reproductive system, you will also take a gonadotropin containing FSH to recruit and develop mature follicles.
Lupron Side Effects
An injectable medication, Lupron can cause some unpleasant symptoms. Some side effects of Lupron include:
- nausea
- dizziness
- hot flashes
- insomnia
Gonadotropins
Gonadotropins are fertility drugs that induce ovulation and produce mature follicles and eggs for fertility treatment. They are comprised of FSH or a combination of FSH with LH and sold under the brand names Gonal-F, Follistim, Menopur, and Luveris. You will administer them by injection.
In a normal menstrual cycle, the pituitary gland tells the ovaries to make a single egg. Injected FSH works on the ovaries to create multiple follicles, each with an egg, that will grow to a mature size.
Manufacturers produce gonadotropins in two ways: through recombinant DNA technology or via urinary extraction. Side effects include mood swings, the probability of multiple babies, and ovarian hyperstimulation syndrome (OHSS).
Human chorionic gonadotropin (hCG)
You will inject this drug when your doctor determines, after careful monitoring with laboratory tests and ultrasounds, that your eggs are mature enough to be released.
Progesterone
The ovary produces the hormone progesterone to prepare the lining (endometrium) of the uterus for implantation of pregnancy, and sometimes to help maintain the pregnancy after.
During IVF, you will be taking medications to prevent the premature release of your eggs, but these pharmaceuticals also reduce progesterone levels. You will need an adequate amount of progesterone, taken either intramuscularly or vaginally, in the hopes of sustaining a pregnancy. If you become pregnant, you will continue taking it through your first trimester.
Risks of fertility drugs
Though most of the fertility drugs described here have been used safely by millions of women worldwide, fertility patients should be aware of several common side effects, including multiple embryo pregnancies, OHSS, ovarian twisting, and generalized reactions such as mood swings and breast tenderness.
Multiple gestation pregnancies
The highest risk for multiple gestation (embryos) pregnancies occurs in patients who are using ovulation stimulating medications coupled with timed intercourse or undergoing intrauterine insemination to conceive. In those instances, our doctors will recommend stopping the cycle if you are producing too many eggs. During an IVF cycle, limiting the number of embryos transferred will lower multiple pregnancy rates. Many IVF clinics offer single embryo transfers for the appropriate patients.
Ovarian hyperstimulation syndrome
At HRC Fertility, we are committed to educating our patients to recognize the symptoms of OHSS as well as knowing what to do if they start experiencing any of them. Our first duty to you is to ‘do no harm.’
Women with PCOS and those who respond with a large number of follicle and/or eggs during their IVF cycle, are more prone to OHSS. Other indicators are being under 30, an increasing level of estradiol before an hCG shot, and a history of previous OHSS episodes.
Severe OHSS is rare, affecting one to two percent of women, but our goal is to prevent any of our patients from experiencing it. Education, monitoring, and communication are key to prevention.
The clinical team at HRC Fertility is committed to teaching you about how these medications will improve your treatment outcomes, how and when to administer them effectively, and to recognize signs and symptoms of the small risk of adverse reactions.
Have more questions about what fertility drugs can do for you? Contact an HRC Fertility specialist today.
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