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Understanding Fertility Medications
Medications play an essential role in treating infertility. Depending on your personalized treatment plan, you will likely be prescribed fertility medications that are usually self-administered at home. Here’s what you should know about how these medications promote fertility.
Medications to Support Your Fertility
Fertility medications are used alone or in combination with assisted reproductive techniques like Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF). Their purpose is to cause the release of hormones that trigger or regulate ovulation. We only use medications that have been clinically proven or demonstrated effective in treating infertility.
Clomiphene Citrate
Often the first choice for treating infertility, clomiphene citrate (sometimes referred to as Clomid) is an oral medication. It is a very commonly prescribed medication that has been used for decades in infertility treatment. It works by increasing the production of hormones from the area of the brain called the pituitary gland. These hormones stimulate the ovary to recruit and develop a mature egg that is then released through ovulation.
Side effects: Most patients do not have side effects from clomiphene citrate. However, possible side effects include pregnancy with multiples, hot flashes, and (more rarely) headaches or visual disturbances.
Letrozole
Letrozole is a medication used to treat infertility in women. It is a type of aromatase inhibitor that works by reducing the amount of estrogen in the body. This can help to stimulate ovulation and increase the chances of pregnancy. Letrozole is usually taken orally, once a day, for five days, starting on the third day of the menstrual cycle. This medication is generally well tolerated and has been shown to be effective in inducing ovulation and pregnancy in women who are having trouble conceiving. Recent studies have suggested that letrozole may be more effective than clomiphene citrate in women with polycystic ovarian syndrome (PCOS).
Letrozole has a half-life of only two days, which means that when taken during the early part of your menstrual cycle, it should be eliminated from your body prior to ovulation.
Despite many studies suggesting its safety and efficacy, the FDA has not yet approved letrozole for fertility treatment. Therefore, although commonly used for fertility treatment, letrozole is considered an “off-label” medication when used as a fertility treatment.
Side effects: Most patients do not have side effects with letrozole, although possible side effects include multiple pregnancy, mild nausea, fatigue, or joint and muscle pain.
Gonadotropins
Gonadotropins are injectable medications used to treat patients with infertility or ovulatory dysfunction. These medications are often used in an IUI or IVF cycle. There are many different preparations of this drug available — all contain Follicle Stimulating Hormone (FSH), which is a hormone normally made by the pituitary gland that causes eggs in the ovaries to ripen.
The use of gonadotropins usually causes multiple eggs to develop. Thus, employing gonadotropins in an IUI cycle risks multiple pregnancy occurring.
Side effects: Gonadotropins stimulate the ovaries, which may become enlarged during treatment. This could cause some discomfort in your abdomen that will subside in a few days. During an IVF cycle, there is a risk of ovarian hyperstimulation syndrome if too many eggs develop. For these reasons, we monitor you very carefully to adjust dosing as appropriate. That said, given the strict protocols we follow during IVF cycles, your risk of ovarian hyperstimulation syndrome is exceedingly low.
GnRH Antagonists
Cetrorelix (brand name “Cetrotide”) and ganirelix (brand names: “Antagon” and “Fyremadel”) are injectable medications used to prevent premature ovulation. They work by blocking the action of GnRH, a hormone that regulates the release of other hormones responsible for ovulation.
Fertility doctors use medications to stimulate your ovaries to produce more eggs, which means there’s always the risk that when ovarian follicles reach a certain maturity, they may ovulate, thus losing all the eggs. GnRH antagonists are a medication employed to stop ovulation, so we can retrieve mature eggs as part of your IVF cycle. GnRH antagonists are usually given as injections and are often used in conjunction with other infertility medications, such as gonadotropins.
Side effects: The side effects of GnRH antagonists are mild, if present at all. Some patients report headaches, hot flashes, nausea, or irritation at the injection site.
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