Medications Used with Infertility Treatment
Prescription drugs can be useful when treating infertility issues. These medications are forms of reproductive hormones that stimulate the ovaries into producing and releasing eggs. This section contains information about the medication we often use for treatment.
- Clomiphene Citrate / Clomid
- Human Chorionic Gonadotropin
- GnRH Antagonists
- GnRH Agonists
- Growth Hormone
- Injection Training
Clomiphene Citrate / Clomid
Clomid (clomiphene citrate) is a fertility drug used to stimulate the ovaries. It causes the release of high amounts of follicle stimulating hormone (FSH), which initiates the growth of ovarian follicles.
How is Clomid taken?
Clomid is taken orally for five days during the early menstrual cycle. It can be started as early as the second day or as late as the fifth day of the menstrual cycle. It is usually given on the third to seventh day of the cycle, but the first pill can start as early as the second day or as late as the fifth day in the cycle. If a woman is undergoing consecutive treatment cycles or has not had an ultrasound to confirm the absence of persistent cysts, she should have an ultrasound prior to using these medications.
To ensure that ovulation actually occurs, human Chorionic Gonadotropin (hCG) is sometimes given. A woman is given hCG on day 12 of an optimally stimulated Clomid cycle to ensure that ovulation occurs.
The most common side effects are mood changes, hot flashes, minor visual disturbances, headaches, irritability and anxiety, vaginal dryness or thinning of the endometrial lining. In some cases, your period may be lighter or heavier than usual, and your cycles may be longer or shorter than usual. The side effects are temporary and subside once Clomid is stopped. Ovarian cysts may develop and remain for four to six weeks once a woman stops taking Clomid, but these cysts are usually harmless. Very rarely, a large number of cysts will develop because of high estrogen levels. If you experience visual disturbances such as spots, contact your doctor right away.
How common are multiple births with Clomid?
There is a higher multiple birth rate in women who conceive following Clomid therapy (5 to 10 percent) than in the rest of the population. In most cases, the multiple pregnancies are twins. The risk of having twins in women who do not take any fertility drugs is about 1.2 percent.
Does Clomid cause birth defects?
Clomid has not been shown to cause the development of birth defects in humans.
Clomid with Intrauterine Insemination
Clomid taken in conjunction with intrauterine insemination has an 8 to 10 percent success rate per cycle for unexplained infertility of three years duration and an 8 percent chance of multiples.
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Gonadotropins may be used in women with ovulation disorders or in women undergoing ART procedures, such as IVF. Their role during these treatments is to stimulate the ovaries to produce multiple eggs.
Follicle stimulating hormone (FSH) and luteinizing hormone (LH) are known as gonadotropins. They are the primary hormones responsible for regulating the female reproductive cycle. The pituitary gland produces and releases both hormones in the brain.
Some women have a hard time conceiving because the pituitary gland either fails to produce the appropriate amount of gonadotropins needed for ovulation, or fails to release gonadotropins at the appropriate time during the reproductive cycle. If the right amounts of gonadotropins are not released at the right time, mature follicles may not develop and ovulation may not occur.
Commercially produced gonadotropins are derived from two sources: biological or manufactured. Biological products have been used to enhance fertility for over thirty years. These products, often referred to as human menopausal gonadotropins (hMG), are purified medications extracted from the urine of postmenopausal women through a complex bio-technical engineering process. Manufactured products contain only FSH. Both biological and manufactured products have been proven to be safe and effective for women who fail to ovulate due to pituitary failure and in women undergoing ART procedures, such as IVF.
How are Gonadotropins taken?
Manufactured products are administered by subcutaneous (under the skin) injection. With the exception of one medication, biological products are administered by intramuscular (within a muscle) injection. Subcutaneous injections allow a woman to self-inject the medication, whereas intramuscular injections require the assistance of a health care provider or partner. The purity of manufactured gonadotropins may allow women to use lower doses for a shorter duration of time compared to biological products.
Side effects include headache, breast pain and ovarian hyperstimulation syndrome (OHSS), a condition characterized by enlargement of the ovaries due to overstimulation by fertility medications. Symptoms of OHSS include abdominal pain and/or swelling, pelvic pain, nausea, vomiting, diarrhea and weight gain. However, because of their purity, manufactured products may be associated with fewer injection-site related side effects, such as pain, redness, itching or swelling.
Gonadotropin Plus Intrauterine Insemination
Gonadotropin in conjunction with intrauterine insemination cycle has a 15 to 20 percent success rate per cycle for unexplained infertility of three years duration, and a 15 percent chance of multiples (including higher order multiples).
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Human Chorionic Gonadotropin (hCG)
Human Chorionic Gonadotropin (hCG) is a hormone that controls reproductive function and is used for the treatment of infertility. It is derived from two sources: biological or manufactured. Biological products have been used to enhance fertility for over thirty years. HCG helps to mature eggs and stimulate ovulation.
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Progesterone is a medication administered by a variety of methods including injection and intravaginal gel or suppository. It is a naturally occurring hormone produced primarily by the ovaries. In a regular menstrual cycle, very small amounts of progesterone are present prior to ovulation. The progesterone levels then rise sharply shortly after ovulation. Higher levels of progesterone are required to enable this hormone to carry out one of its major responsibilities, preparing the inner lining of the uterus to receive a fertilized egg. If the body determines that an egg has not been fertilized, the ovaries stop producing progesterone and menses begins within 24 to 48 hours. If fertilization occurs, the ovaries continue to produce progesterone, which is important in maintaining the pregnancy.
Some women do not produce sufficient progesterone on their own and, therefore, may have difficulty conceiving. In these cases, supplemental administration of progesterone is required.
Another instance where supplemental administration of progesterone is needed is in women who are undergoing certain assisted reproductive technology (ART) procedures. In order to mimic a regular menstrual cycle, therapy with progesterone is usually started a few days after ovulation and is continued until either menses occurs or pregnancy is confirmed. If pregnancy is achieved, treatment with progesterone may be continued for 10 to 12 weeks. By this time, the placenta is producing sufficient amounts of progesterone for the remainder of the pregnancy.
Some of the adverse effects associated with the use of progesterone include nausea, constipation, breast enlargement and tenderness, headache, drowsiness, vaginal discharge, joint discomfort and depression. Progesterone may also cause fluid retention; therefore, patients with certain medical conditions such as epilepsy, migraine headaches, asthma and cardiac or renal impairment require close observation.
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GnRH is a hormone the hypothalamus gland produces in the brain that controls the pituitary gland’s production and release of luteinizing hormone (LH) and follicle stimulating hormone (FSH). The amount of GnRH released fluctuates throughout a woman's menstrual cycle. Halfway through each cycle, a large amount of GnRH is released. This increase in GnRH is responsible for initiating ovulation.
When used as part of an infertility treatment regimen, such as IVF, GnRH Antagonist medications block the effect of GnRH on the pituitary gland. Therefore, natural ovulation is prevented. This allows the timing of ovulation to be better predicted and coordinated with procedures such as egg retrieval. These medications are administered by injection once daily during the mid to late follicular phase.
Side effects reported during treatment include abdominal pain, nausea, headache, vaginal bleeding and injection site reactions (redness or swelling). Another reported side effect is ovarian hyperstimulation syndrome (OHSS), a condition characterized by enlargement of the ovaries due to overstimulation by fertility medications. Symptoms of OHSS include abdominal pain and/or swelling, pelvic pain, nausea, vomiting, diarrhea and weight gain.
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GnRH Agonists are used to treat a variety of conditions including fibroid tumors and endometriosis lesions. They are also used in conjunction with ovarian stimulation to prevent a premature LH surge and to help induce uniform follicle development.
Side effects of GnRH Agonists include a chance of transient and mild worsening of symptoms early in treatment, discontinuation of menses, hot flashes, vaginal dryness, mood swings, headaches, and spotting and localized skin reaction at the injection site.
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