About 25 percent of female cases of infertility stem from irregular or abnormal ovulation, according to The American Society for Reproductive Medicine. If, after a thorough medical exam and review of diagnostic tests, your doctor determines this is the problem, you may be a good candidate for fertility medication. There are various medications that all work to stimulate follicle growth. Fertility specialists in the Sutter Health network select from a number of safe and evidence-supported fertility drugs, depending on your particular situation.
Clomiphene Citrate (Clomid® and Serophene®)
These medications are taken orally for five days during the early part of the menstrual cycle. They stimulate the ovaries by causing the pituitary gland to release high amounts of FSH. This prompts ovarian follicles to grow and produce mature eggs ready for fertilization.
Sometimes clomiphene citrate will be followed several days later by a second medication called human Chorionic Gonadotropin (hCG) to make sure the egg releases properly.
Gonadotropins and Human Chorionic Gonadotropin (hCG)
Rather than stimulating the pituitary gland to release more hormones, gonadotropins directly stimulate the ovaries to grow follicles. Gonadotropins are taken by injection. They often are used in conjunction with other fertility treatments, such as artificial insemination and as an integral part of in vitro fertilization (IVF).
Human chorionic gonadotropin helps mature the eggs and trigger their release. It may be used in combination with other ovulation-stimulating drugs, such as clomiphene citrate and gonadotropins. HCG is used in IVF to mature the eggs prior to retrieval.
GnRH Agonists and Antagonists
Gonadotropin-Releasing Hormone (GnRH) controls the production and release of FSH and luteinizing hormone (LH). GnRH agonists and antagonists are injectable medications that are used in IVF to postpone or suppress the LH surge. This enables the body to produce a higher number of mature, healthy eggs. GnRH agonists and antagonists also may be used to treat conditions like fibroids and endometriosis that contribute to infertility.
Progesterone is a hormone produced in the ovaries that rises shortly after ovulation. It is necessary in preparing the inner lining of the uterus to receive a fertilized egg for implantation, and then in supporting any pregnancy that occurs. Your doctor may recommend progesterone medication by injection or intravaginal gel or suppository. The drug is usually administered a few days after ovulation or after egg retrieval in IVF, and continued until the pregnancy test. Then, if you become pregnant, your doctor may continue progesterone treatment for several weeks until the placenta is producing sufficient amounts to sustain the pregnancy.
Risks and Concerns
Fertility drugs carry some risks, including a higher chance of multiple births, especially in the case of injectable medications. Side effects may include mood changes, irritability and anxiety, minor visual disturbances, headaches and changes to the heaviness or duration of your menstrual cycle. Some women also develop ovarian hyperstimulation syndrome (OHSS), a condition in which the ovaries become swollen and painful. Talk to your doctor if you experience abdominal pain, bloating, nausea, vomiting, diarrhea or shortness of breath. Talk to your doctor about any risks specific to your medical history, the medication itself and the length of treatment you choose.
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