Clomid

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What is Clomid Infertility Treatment & How Does it Work?

Clomid

Clomid is often a first line treatment for infertility. The goal of Clomid therapy in treating infertility is to induce ovulation. Once ovulation begins, there is no benefit to further increasing the dosage. Numerous studies show that pregnancy usually occurs during the first three months of infertility therapy with Clomid and treatment beyond six months is not recommended.

Clomiphene is marketed in the United States by Aventis Laboratories as Clomid and by Serono Laboratories as Serophene.

How Clomid Works

Clomid works at the level of the hypothalamus where it competes for estrogen binding sites. When these “sites are occupied” by Clomid, the hypothalamus responds by producing more gonadotropin-releasing hormone (GnRH) which then stimulates the pituitary to produce FSH. Remember, in a normal cycle healthy follicles produce estrogen, which signals the hypothalamus to reduce production of FSH. Patients must come to our clinic for periodic monitoring of their follicular development via ultrasound and blood tests to measure estradiol.

Possible Clomid Side Effects

Clomid can cause side effects such as ovarian hyperstimulation (rare), visual disturbances, nausea, diminished “quality” of the cervical mucus, multiple births, and others.

Fertility Drugs and Cancer

To date there have been no studies that identify a link between fertility drugs and cancer.

The National Institutes of Health (NIH) recommends only selective ovarian cancer screening in women. They state that annual ovarian cancer screening is justifiable only for a small well-defined segment of the population: women who have two second-degree relatives or one first and one second degree relative who have had ovarian cancer. The NIH, however, has not specifically looked at the issue of women who take fertility medications and they suggest more studies are needed in this subgroup.

Notwithstanding the above, as a precautionary measure, HRC recommends that patients who have had treatments with fertility drugs should have ovarian cancer screening performed once a year in much the same way as they have routine Pap tests done. Ovarian cancer screening includes pelvic examination, transvaginal ultrasonography, and possible measurement of serum levels of the tumor marker CA-125.

Studies have shown that several treatments and factors can reduce the risk of ovarian cancer. For example, pregnancy has been shown to reduce the risk of developing this disease by 40 percent. Recent studies suggest that tubal ligation, hysterectomy, and surgically removing the ovaries after completing childbearing for women of high risk (such as those who have relatives who have had ovarian cancer) may also reduce the risk of developing this disease. Multiple studies have demonstrated a 40-50 percent decrease in ovarian cancer in women who use oral contraceptives.

Follicle Stimulating Hormone (FSH)

Follicle Stimulating Hormone (FSH) containing drugs are used to stimulate a follicle (egg) to develop and mature They are also used to stimulate the development of multiple eggs for in vitro fertilization (IVF).

Serono Laboratories first introduced FSH containing products in the United States under the trade name Pergonal. These first products were “natural” in that they were derived and purified from the urine of postmenopausal women. Because they were human derived, they also contained impurities, notably luteinizing hormone (LH). They also had to be administered by intramuscular injection, which is painful and inconvenient.

More recent products include Gonal-F, and Follistim, which are produced using genetic recombinant technology. These FSH products are pure and can be given subcutaneously (just beneath the skin). Bravelle and Menopur are highly purified “human derived” products that can also be given subcutaneously. Serono recently released Luveris (recombinant LH) for use in patients that are hypogonadotropic (have very low levels of gonadotropins).

How FSH works

FSH is produced by the pituitary gland under the influence of Gonadotropin-releasing hormone (GnRH), also known as Luteinizing-hormone releasing hormone (LHRH), which is released by the hypothalamus. In a normal cycle, levels of FSH vary in relationship to hormones such as estrogen.

When FSH is given by injection, it directly stimulates the recruitment and development of follicles in contrast to Clomid, which works at the hypothalamus. Numerous eggs are needed in IVF cycles as some are immature and cannot be fertilized. As patients undergo ovulation induction with FSH, they are carefully monitored by estradiol measurements, ultrasound to visualize the ovaries and follicles, and physical examination.

There is debate among physicians and embryologists as to the need for LH in FSH stimulated cycles. All physicians administer these products using individualized protocols for each patient. Many physicians believe that a minute quantity of LH causes a “better stimulation” in some patient groups. Mixed protocols using Follistim (FSH) and Bravelle, Menopur or Repronex are often used.

Possible FSH Side Effects

FSH should only be administered by an fertility specialist thoroughly trained in its use. Patients must be monitored and dosages adjusted to avoid potentially serious side effects such as ovarian hyperstimulation. Most high order multiple births (triplets, or more) reported by the media are due to FSH stimulated intrauterine insemination (IUI) cycles that were not managed by a fertility specialist.

Ganirelix Acetate and Cetrotide

Ganirelix Acetate and Cetrotide also suppress FSH and LH production; however, the suppression is more complete than with Lupron. Because the suppression is so complete, these drugs can be used during in vitro fertilization (IVF) treatment for shorter periods of time.

How Ganirelix Acetate and Cetrotide Work

These fertility drugs are gonadotropin-releasing hormone (GnRH) agonists meaning they block the action of GnRH at the pituitary, which virtually stops FSH and LH production.

Possible Ganirelix Acetate and Cetrotide Side Effects

The most common side effects are headache or mild vaginal bleeding.

Administration of Medications

Each couple or individual is responsible for the administration of their medications that are necessary for ovarian stimulation.  The majority of couples/individuals undergoing IVF learn how to administer their own injections, whether it is the partner or yourself giving the injection.

We understand that some couples or individuals may not be able to give their own injections for various reasons.  The patient is responsible for arranging injections needed throughout the week, weekends, and holidays. HRC Fertility nurses are also available during business hours to provide injections for a nominal fee.

Prior to patients administering their own injections our clinical team provides individualized instruction in a preoperative appointment to help patients properly give their own injections.  We also provided links below of videos of injection demonstrations.

Injection Training

Click below for medication instruction information and video tutorials

Other Fertility Injections & Drugs

Human chorionic gonadotropin (hCG)

The placenta produces hCG during pregnancy. It sets up the series of events that causes production of progesterone by the corpus luteum. hCG levels are measured to confirm pregnancy.

HCG can also be used to trigger ovulation in women who are undergoing stimulated IUI or IVF. In a normal ovulatory cycle, a surge of LH triggers ovulation and release of the egg(s).

The body responds to hCG in the same manner as it does LH, so a surge of hCG can also initiate ovulation. In 98 percent of cases, patients who are receiving Lupron or Ganirelix Acetate can only ovulate when they are given an injection of hCG or LH. Insemination or egg retrieval can be precisely timed for 36 hours after the hCG injection.

Profasi and Pregnyl are human derived and Ovidrel is a recombinant product with a higher percentage of hCG per unit mass.

Parlodel (Bromocriptine)

Hyperprolactinemia is a condition in which the levels of the hormone prolactin are abnormally elevated. This leads to abnormal ovulation and infertility. Prolactin levels normally rise in pregnancy to stimulate the production of breast milk. High prolactin levels in the absence of pregnancy can stop a woman from ovulating and are often due to a small tumor at the base of the pituitary gland. Treatment sometimes involves removal of the tumor by a neurosurgeon or the drug Parlodel (bromocriptine) is prescribed to normalize levels.

Antibiotics

Infertility specialists rule out infections in the male and the female that could cause trouble getting pregnant during the initial infertility workup. Infections of the reproductive tract can be very serious and can cause pelvic inflammatory disease, which may scar and damage internal organs including the uterus and tubes in women and the testicles, vas deferens, and other structures in men.

Common infectious agents that can cause infertility include gonorrhea, Chlamydia, and mycoplasma. Fortunately, there are a wide variety of antibiotics effective in treating these infections. The key is early diagnosis and treatment before the damage is done.

Birth Control Pills for Fertility Treatment

Birth control pills are usually used to prevent conception; however, they are sometimes used in fertility treatment. Birth control pills may be administered in the cycle prior to the in vitro fertilization (IVF) cycle. Because oral contraceptives contain progesterone and estrogen, their use suppresses the production of follicle stimulating hormone (FSH). Since FSH is suppressed it is highly unlikely that any dominant follicle will be produced in the cycle where birth control pills are administered. Since the follicle is not produced, the next IVF cycle starts with no residual dominant follicles.

 

To learn more about drug and injection options for treating infertility, contact HRC Fertility today.