Medications

Fertility Medications

Most fertility treatments involve the use of fertility medications to induce ovulation, to improve the quality and the quantity of eggs and to assist in implantation. As treatment is individualized, each woman's experience with these drugs can be different. And while some women do not experience side effects while taking these medications, we have also included a description of the most commonly reported symptoms. You may find it helpful to familiarize yourself with the following medications:

Clomiphene Citrate (Clomid)

Clomid is taken in tablet form to improve and regulate the quality and timing of ovulation and to help increase the chance of pregnancy. It is also useful for women with irregular menstrual cycles.

This medication works by blocking estrogen receptors in the brain. In response, the brain increases production of follicle-stimulating hormone (FSH). FSH acts upon the ovarian follicles, causing eggs to be released. Ultrasound and blood testing are done to confirm that the follicles are developing properly.

Side effects can include irritability, hot flashes, mood swings, insomnia, visual symptoms, pelvic pressure or cramping. Because Clomid may cause more than one egg to be released, there is an 8% to 10% increased risk of twins, and a less than 1% incidence of triplets. A potentially serious condition called ovarian hyperstimulation syndrome (OHSS) can occur, though it is rare. There is no increased incidence of birth defects, stillbirths or miscarriage with Clomid. Nor is there any evidence to support early menopause or pregnancy complication. Some studies suggest that Clomid, if taken for more than twelve months, may increase the chances of ovarian cancer.

FSH and HMG

FSH (Gonal F or Follistim) and HMG (Pergonal or Repronex) are injectable drugs administered to stimulate the ovaries to develop multiple follicles. This is useful in cases where the well-timed production of multiple eggs is required or when the follicles are not developing on their own. These injectable drugs are also used in IVF and to help women for whom Clomid has not been successful. For women who have no problem with ovulation, FSH and HMG can work to increase the chance of pregnancy.

Vaginal ultrasound monitoring and blood estrogen testing are important to ensure proper dosage, as women can respond differently to these medications. Monitoring also aids in triggering ovulation at the appropriate time, when eggs are mature.

Side effects may include breast tenderness, bloating, pelvic discomfort, tiredness and mood swings. Some women develop temporary cysts on the ovaries. Usually, these cysts are not problematic, other than the feeling of pelvic fullness they may cause. However, in some cases, these cysts can grow to considerable size and may cause significant abdominal bloating or pain. If you experience dizziness, decreased urination, shortness of breath, or a weight gain of more than five pounds while using these medications please contact our office, as these are signs of a potentially serious condition called ovarian hyperstimulation syndrome (OHSS). This risk will be explained to you when you begin this therapy.

There is a 25% increased risk of multiple births associated with these medications, usually in the form of twins. Less than 5% of the total pregnancies result in triplets, and less than 1% are higher-order. There is no evidence of increased chance of miscarriage or birth defects with these drugs. Nor is there evidence that these medications can cause early menopause or ovarian cancer.

Human Chorionic Gonadotropin (nCG)

hCG (Profasi or Pregnyl) is an injectable drug that mimics the natural LH surge, causing the maturation and ovulation of the mature egg or eggs from the ovary. It is administered when follicles have reached 18 mm to 20 mm and when the proper level of estradiol is present. Ovulation occurs thirty-six to forty hours later and intercourse or insemination can be timed accordingly. We also use hCG during IVF cycles to mature the eggs prior to retrieval.

Progesterone

Progesterone is a hormone secreted by the ovary following ovulation. It is only administered once the ovulation process is complete. Progesterone affects the lining of the uterus, making it more receptive for implantation. It also raises the body temperature slightly during the second half of the menstrual cycle.

Progesterone is available either as an intramuscular injection or vaginal suppository. It is important to note that progesterone may delay the onset of your period.

Side effects may include itchy discharge or increased chance of a yeast infection, neither of which will affect fertility.

Progestin preparations are required by law to carry a warning disclosing a slight increase in birth defects associated with their use. The studies in which these birth defects occurred were conducted using a synthetic progesterone, which we do not use. Additionally, a higher dosage was used, and it was administered later in the pregnancy. If you have concerns regarding progesterone therapy, please let us know and we will be happy to discuss it with you.