Infertility In Women - Medications

Highlights	Diagnosis	Complications of ART
Introduction	Treatment	Resources
The Reproductive System	Lifestyle Changes	References
Risk Factors	Medications
Causes	Assisted Reproductive Technologies

Medications

Fertility drugs are often used alone as initial treatment to induce ovulation. If they fail as sole therapy, then they may be used with assisted reproductive procedures or artificial insemination to produce multiple eggs, a process called superovulation.

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Clomiphene

Clomiphene citrate (Clomid, Serophene) is usually the first fertility drug of choice for women with infrequent periods and long cycles. Unlike more potent agents used in superovulation, clomiphene is gentler and works by blocking estrogen, which tricks the pituitary into producing FSH and LH. This boosts follicle growth and the release of the egg. Clomiphene can be taken orally, is relatively inexpensive, and the risk for multiple births (about 5%, mostly twins) is lower than with other drugs.

Women with the best chances for success with this drug are those with the following conditions:

Polycystic ovaries.
Ability to menstruate but irregular menstrual cycle.

Women with poorer chances to no chances with this drug have the following conditions:

Infertility but with normal ovulation.
Women with low estrogen levels.
Premature ovarian failure (i.e., early menopause).

One or two tablets are taken each day for five days, usually starting two to five days after the period starts. If successful, ovulation occurs about a week after the last pill has been taken. If ovulation does not occur, then a higher dose may be given for the next cycle. If this isn't successful, treatment may be prolonged or additional agents may be added. Experts usually do not recommend more than six cycles.

The drug often reduces the amount and quality of cervical mucous and may cause thinning of the uterine lining. In such cases, other hormonal agents may be given to restore thickness. Other side effects include ovarian cysts, hot flashes, nausea, headaches, weight gain, and fatigue. There is a 5% chance of having twins with this agent, and a slightly increased risk for miscarriage.

Superovulation with Gonadotropins and GnRH Agonists

Superovulation, also called controlled ovarian stimulation, is generally used if clomiphene does not work. This approach is the direct administration of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), collectively called gonadotropins. The intent is to mimic the natural process leading to ovulation and produce multiple follicles. Superovulation is generally used in conjunction with assisted reproductive technologies.