Clomiphene citrate is often the first treatment for infertility. It was the first fertility drug – discovered in Augusta, Ga., by Dr. Robert Greenblatt (who Dr. Edouard Servy later studied under). It’s sold under the brand names Clomid® or Serophene®. Clomiphene is taken orally for five to 10 days by non-ovulating women. Clomiphene causes the release of hormones that stimulate egg production by the ovaries. Over nearly 30 years, it’s proven its effectiveness—60 percent to 80 percent of women taking clomiphene will ovulate, according to WebMD.com, and about half will get pregnant.
These fertility drugs are often used during assisted reproductive techniques to increase the number of eggs produced during ovulation.
While taking clomiphene, ultrasounds are required. Seven to nine days after the drug has been used, ovulation should occur. If not, the dosage may be increased until ovulation does happen. Once ovulation occurs, it is often suggested that continued treatment be limited to three cycles. However, women who are just beginning to ovulate may continue clomiphene for a longer period. Those using clomiphene for multi-ovulation should consider moving to injectable gonadotropins after three cycles.
The side effects of clomiphene can include hot flashes, blurred vision or spots in front of the eyes, nausea, bloating, and headache. Clomid® can increase the chances of multiple births.
Your infertility specialist may recommend injectable hormones to stimulate ovulation. Any of these hormonal drugs can be used to stimulate or control ovulation as a way of treating a number of infertility problems:
Human Menopausal Gonadotropin (hMG), such as Menopur®, is often used to stimulate ovulation in women who don’t ovulate due to problems with their pituitary gland, as well as ovary stimulation for IUI or IVF treatment.
Follicle Stimulating Hormone (FSH) - such as Follistim®, Bravelle®, and Gonal-F® – works much like hMG. It causes the ovaries to begin the process of ovulation, or enhances this process for ovulation induction.
Human Chorionic Gonadotropin (hCG), with brand names such as Pregnyl®, Novarel®, and Ovidrel®, are usually used with other fertility drugs to trigger ovulation.
Gonadotropin Releasing Hormone Agonist (GnRH agonist), such as Lupron®, regulates the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). It initially has a stimulating effect on the ovaries and can be used to “flare” the ovarian response. If given in a long protocol it suppresses the ovaries, and helps coordinate the follicles for stimulation. Later in the cycle, it helps prevent premature LH surges, and the follicles maintain their healthy state until HCG trigger is given.
Gonadotropin Releasing Hormone Antagonist (GnRH antagonist), such as Antagon®, Ganirelix®, and Cetrotide®, is used to control ovulation by blocking the action of GnRH upon the pituitary, thus suppressing the production and action of LH. This is an alternative way to keep the follicles healthy in preparation for IUI or IVF.
Gonadotropin Releasing Hormone (Gn-RH), such as Factrel® and Lutrepulse®, stimulates the release of follicle stimulation hormone (FSH) and luteinizing hormone (LH) from the pituitary gland, and is rarely prescribed.
All these drugs are given by injection in varying doses depending on how they are being used. Injectable hormones have a high rate of success in stimulating women to ovulate.
Side effects include infection, swelling, or bruising at the injection site. Headaches, irritability, breast tenderness and a number of other less common side effects may occur. There is also a risk of ovarian hyperstimulation, when the ovaries become enlarged and tender. Ovulation-stimulating drugs also increase the chances of multiple pregnancy, which can raise health risks for both mother and child. Women who are pregnant with multiple fetuses have more problems during pregnancy and delivery. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.
Aspirin acts as a blood thinner. Studies have shown that low dosages of aspirin may prevent miscarriage in women who tend to form blood clots in the placenta, cutting off the supply of nutrients to the baby.
Heparin is an injectable blood thinner prescribed to women with blood-clotting disorders linked to recurrent pregnancy loss, and is usually taken twice a day. Lovenox® (also available in the generic form enoxaparin sodium) can also be used instead of Heparin. Lovenox® is a once-a-day, prefilled syringe that is injected into the abdomen.
Bromocriptine and cabergoline are used in women with pituitary tumors that decrease ovulation.
For any and all of the drugs used in fertility, seek advice from the prescribing physician or pharmacist regarding side effects and contraindications.