Fertility Medications

Clomiphene Citrate (Clomid®, Serophene®) has been available since 1968 and is commonly used for women who have infrequent periods or long menstrual cycles. It is in pill form and is taken for 5 days at the beginning of the menstrual cycle. It works by preventing estrogen from binding to estrogen receptors and gives the body the false impression that estrogen levels are low. This causes your body to produce more FSH (follicle stimulating hormone), which will result in the growth of follicles in the ovary. It is the follicle that contains the egg.

Side effects include nausea, headaches, mood swings, vaginal dryness and hot flashes. In some patients, Clomiphene Citrate can decrease cervical mucus and cause thinning of the endometrial (uterine) lining. Complaints of visual disturbances may necessitate stopping the medication. 90% of women who are going to conceive with clomiphene do so in the first 3-4 cycles of taking this medication and for this reason it is recommended not to use Clomiphene Citrate more than 4 cycles.

Clomiphene Citrate may be very effective in women who do not ovulate and women under the age of 35. Women’s ovaries tend to become more resistant to Clomiphene Citrate as they age and for this reason more effective medications such as HMG (human menopausal gonadotropin) and FSH (follicle stimulating hormone) are considered for use in women over 35 with infertility.

These fertility medications are given as an injection under the skin (subcutaneous injection). They are taken on a daily basis to stimulate follicular growth in the ovaries. The dose used depends on multiple factors including the woman’s age, ovarian reserve test results, weight as well as previous response to fertility medications. All patients must be monitored very closely with laboratory blood tests and ultrasounds in order to determine the lowest dose of medication required as the risk of ovarian hyperstimulation syndrome and multiple pregnancies is much higher than with the use of oral fertility medications. As with all injectable medications, bruising, redness, swelling, or discomfort can occur at the injection site. Rarely, there can be an allergic reaction to these drugs. The intent of giving these medications is to mature multiple follicles, and many women experience some bloating and minor discomfort as the follicles grow and the ovaries become temporarily enlarged. Some of the other risks and side effects of gonadotropins include fatigue, headaches, weight gain, mood swings, nausea, and clots in blood vessels.

The various forms of gonadotropins include:

Follicle Stimulating Hormone- FSH (Follistim®, Gonal-F®, Bravelle®)
These medications contain only FSH.
Luteinizing Hormone- LH (Luveris®)
This medication contains only LH.
Human Menopausal Gonadotropins- HMG (Menopur®, Repronex®)
These medications contain equal amounts of FSH and LH.

HCG (Profasi®, Novarel®, Pregnyl®, Ovidrel®) is a natural hormone, which is given as a subcutaneous injection. HCG is used to induce the final maturation of the egg and triggers ovulation and the release of the mature egg. Ovulation usually occurs 36 hours after HCG is given.