Fertility Drugs for Women

Which is the right fertility drug treatment for you?

There are many fertility drugs to treat your infertility. They will be your first step in treating your infertility and from your doctor’s point of view they are the mainstay of treatment for women who are infertile due to ovulation disorders. Remember all fertility drugs are used to influence ovulation.

There are various different drug treatments to help you regulate or induce ovulation. Overall, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation.

Some fertility drugs are meant to strengthen or trigger ovulation, while others suppress ovulation. Fertility drugs can also be used in men to treat male factor infertility, but this is less common.

In general, fertility drugs are used to treat problems with ovulation or recurrent miscarriage. However, this is not always the case. For example, sometimes the woman does not have ovulatory problems, but the man's fertility issues require treatment. In this case, fertility drugs may be used to increase the number of eggs the woman produces, in order to retrieve the eggs for IVF treatment.

The most commonly prescribed fertility drug treatments include:

• Anti-oestrogen drugs such as clomiphene (Clomid), or sometimes known as Serophene are the mainstay of infertility female treatment. Clomid is taken orally and is among the most well known and is frequently prescribed as first line of all fertility drugs. It stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg. Clomid is used predominately for inducing ovulation in women with ovulatory disorders like anovulation, PCOS, and other infertility symptoms. Click here to see if Clomid is for you.

• Human menopausal gonadotropin, or hMG, (Repronex, Humegon, Metrodin, Pergonal). This injected medication is for women who don't ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, hMG and other gonadotropins directly stimulate the ovaries. This type of drug contains both FSH and LH hormones.

• Follicle-stimulating hormone, or FSH, (Fertinex, Bravelle,). FSH works by stimulating the ovaries to mature egg follicles. These hormonal drugs mimic or copy FSH, except instead of being artificially created in the lab, the FSH hormone is extracted and purified from the urine of post-menopausal women. These drugs are considered less potent than FSH created using recombinant DNA technology, but they are less expensive. They are taken by injection, usually in a home setting.

Gonal-F and Follistim are infertility drugs that mimic the hormone FSH in your body. They are created in a lab using recombinant DNA technology. As you may know, FSH is the hormone, which stimulates the oocytes in your ovaries to grow and mature egg follicles. These drugs are taken via injection, which you can do yourself, and may be used during IVF or IUI treatment, or with timed sexual intercourse at home.

• Human chorionic gonadotropin, or HCG, (Ovidrel, Pregnyl, Novarel). These drugs are often used in combination with clomiphene. hMG is derived or extracted from the urine of post-menopausal women, the mode of action of the drug is to stimulate the follicle to release its egg (ovulate). The hMG hormone is similar to LH in the body. These types of drugs are cheaper than those made with recombinant DNA technology and again taken by injection in the home setting.

• Gonadotropin-releasing hormone (Gn-RH) analogs (Antagon, Cetrotide). This treatment is for women with irregular ovulatory cycles or who ovulate prematurely — before the lead follicle is mature enough — during hMG treatment. Gn-RH analogs deliver constant Gn-RH to the pituitary gland, which alters hormone production so that a doctor can induce follicle growth with FSH. If a woman is unable to achieve pregnancy due to low levels of luteinizing hormone (LH) or follicle-stimulating hormone (FSH) production, or if she is undergoing in vitro fertilization treatment, gonadotropins may be administered, often in combination with other fertility drugs. These hormones come in two drug forms: recombinant and urine-based. Both fertility medications can be effective and are administered through injection. Recombinant drugs have proven slightly more successful, but if levels of LH are low, urine-based drugs may be preferable. The fertility doctor and the couple should make the decision about which drug is the best choice before treatment is begun.

• Aromatase inhibitors. This class of medications, which includes letrozole (Femera) and anastrozole (Arimidex), is approved for treatment of advanced breast cancer. Doctors sometimes prescribe letrozole for women who don't ovulate on their own and who haven't responded to treatment with clomiphene citrate. The Food and Drug Administration do not approve of Letrozole (Femera) for inducing ovulation. The drug's manufacturer has warned doctors not to use the drug for fertility purposes because of possible adverse health effects. These adverse effects may include birth defects and miscarriage. Click here for further information on Femera.

• Metformin (Glucophage). This oral drug is taken to boost ovulation. It's used when insulin resistance is a known or suspected cause of infertility. Insulin resistance may play a role in the development of PCOS.

• Bromocriptine (Parlodel). This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.

Fertility drugs and the risk of multiple pregnancies

Injectable drugs increase the chance of multiple births. Oral fertility drugs such as Clomid increase the chance of multiple births but at a much lower rate. The use of these drugs requires careful monitoring using blood tests, hormone tests and ultrasound measurement of ovarian follicle size. Generally, the greater the number of foetuses, the higher the risk of premature labour. Babies born prematurely are at increased risk of health and developmental problems. These risks are greater for triplets than for twins or single pregnancies.

The risk of multiple pregnancies can be reduced. If a woman requires an HCG injection to trigger ovulation, and ultrasound exams show that too many follicles have developed, she and her doctor can decide to withhold the HCG injection. For many couples, however, the desire to become pregnant overrides concerns about conceiving multiple babies.

When too many babies are conceived, removal of one or more foetuses (multifetal pregnancy reduction) can offer improved survival odds for the surviving foetuses. This presents serious emotional and ethical challenges for many people. If you and your partner are considering fertility drug treatment, discuss this possibility with your doctor or consultant before starting treatment.

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