Fertility Medications
Ovulation Induction (“Fertility Drugs”)
*Oral (Clomiphene Citrate, Clomid™, Serophene™): Clomiphene citrate tablets function as estrogen antagonists (i.e. they compete with estrogen for receptor sites in the brain and pituitary gland). As a result, they “fool” your brain into thinking that you are not making enough estrogen. The brain responds by sending a signal to the pituitary gland, resulting in an increased production of both FSH and LH, and an eventual increase in egg development. Use of this medication can lead to monthly ovulation for those women who normally do not ovulate on their own, ovulation of more than one egg for those women who either do or do not ovulate on their own, and better synchronization of the uterine lining and oocyte development, ie. correction of a luteal phase defect.
Clomiphene citrate is typically recommended as the “first line” of therapy for women who do not ovulate regularly. It comes in 50 mg. pills, and patients typically take one to five pills per day for five consecutive days early in the cycle (Days 3-7, 4-8, or 5-9). Clomiphene will cause approximately 80% of women with ovulatory dysfunction to ovulate regularly. Once we find the lowest dose of clomiphene that produces regular ovulation, we will ask you to stay on that dose for up to six cycles. There is no evidence that continuing to increase the dose of clomiphene above the lowest dose that produces ovulation is effective. To the contrary, there is significant data that suggest that this may be counter-productive, as clomiphene can have an adverse effect on the endometrium, resulting in a thinner uterine lining and lower pregnancy rates.
Clomiphene can be combined with either intercourse timed by an ovulation prediction kit or IUI. A typical cycle of clomiphene results in a pregnancy rate of 8-12%, with a cumulative pregnancy rate of approximately 60% following six cycles of treatment. The multiple pregnancy rate commonly attributed to clomiphene is 5-8%, almost all of which are twins. Common side effects of clomiphene include headaches, hot flashes, vaginal dryness, and moodiness. A rare side effect is an abnormality in vision. It is very important that you report any visual side effects to your physician or nurse at once.
Clomiphene is typically recommended for women who:
- don’t ovulate regularly
- have short luteal phases, or
- have unexplained infertility
*Injectable (Follistim™, Gonal-F™,Luveris™ Menopur™, Bravelle™): Whereas clomiphene acts to cause the pituitary to produce more of your own FSH and LH, the injectable fertility drugs (gonadotropins) bypass the pituitary by delivering FSH and/or LH directly to your ovaries. These medications, which are taken by subcutaneous injection (ie injected just under the skin using a small needle), are much more potent than clomiphene, resulting in the production of many oocytes per cycle. While clomiphene can be combined with either intercourse or IUI, the injectable drugs are typically used only in combination with IUI, as pregnancy rates are 3-4 times higher than they are when combined with intercourse.
In light of the significant potency of these medications, your physician will request that you come to the office every 2-3 days while you are taking these drugs for a vaginal ultrasound and a blood estrogen level. Through the interpretation of both the ultrasound and the estrogen level, we will be able to maximize your chance for pregnancy while minimizing the side effects and risks associated with gonadotropin treatment. A typical cycle of gonadotropin and IUI results in a pregnancy rate of 15-30%, with a cumulative pregnancy rate of approximately 60% following 3-4 cycles of treatment. The multiple pregnancy rate commonly attributed to gonadotropin therapy is 20-25%. While most multiple pregnancies associated with gonadotropin therapy are twins, on rare occasions, triplets or other higher order multiple pregnancies can occur. We will make every attempt to minimize this risk, especially through the use of close monitoring and titration of your medication dose. However, as every woman responds differently to this medication, it is not always easy for us to accurately predict the number of oocytes that will ovulate. A very important clinical research study that we performed several years ago demonstrated that even the same woman taking the same dose of the same medication may respond very differently in different cycles. This is why we insist on careful monitoring of your response throughout your treatment cycle.
Gonadotropins are typically recommended for women who:
- fail to respond to clomiphene.
- fail to conceive, despite up to six clomiphene cycles
- have significant endometriosis
- have unexplained infertility, and
- have certain types of hormonal abnormalities
