Fertility Drugs used in Infertility, IUI and IVF treatments

The purpose of fertility drugs is to induce ovulation. It stimulates the brain to increase levels of pituitary hormones, such as FSH (follicle-stimulating hormone). The most commonly used fertility drugs are :

Clomiphene citrate

Used for Ovulation Induction orally.Has been used for the last 50 years widely. Possible side effects include
Clomid treatment has some potential for adverse effects. Side effects are definite “cons” of clomiphene use. Adverse effects are seen in some, but not all women using the drug.
• Mood swings, psychological/emotional side effects
• Hot flashes
• Abdominal discomfort
• Visual disturbances
• Ovarian cyst formation
• Nausea
• Thinning of the uterine endometrial lining
• Reduced production of cervical mucous – this can lower fertility (bypassed by insemination)
Use of Clomid increases risks for twins and multiple pregnancies (sometimes the desired outcome)
• 92% singletons
• 7% twins
• 0.5% triplets
• Very rarely higher than triplets

Letrozole

Also used orally for Ovulation induction. Though also an anti-cancer medication it is considered safe for women using it for ovulation induction. Letrozole works based on its ability to reduce estrogen levels. Low estrogen levels of any cause can cause a woman to have symptoms. The data on side effects comes from women who have been using letrozole for an extended period of time in order to treat breast cancer. The treatment duration for letrozole is only five days. In our experience, we have seen side effects that are similar to those seen with clomiphene citrate.

Gonadotrophin

These are injectable medicines used for ovulation induction for both IUI and IVF. They are quite potent hormonal medication and need to be used with caution under the supervision of a well-trained infertility specialist as it has a potential for OHSS ( ovarian hyperstimulation syndrome) and multiple pregnancies.
Signs of serious complications include vomiting, abdominal swelling and breathing difficulties. If these symptoms appear, do not wait for your next ultrasound but call our office immediately. Again, these are unusual and can be avoided with close monitoring. Before your hCG injection, if there are too many follicles or your estradiol is too high, the injection may be withheld or delayed. This reduces the risk of ovarian hyperstimulation. When your estradiol falls to a safer level, then the hCG injection can be given.HCG injections can also be replaced by GnRH agonists as a trigger to prevent OHSS.

HCG

Human chorionic gonadotropin (HCG) is a hormone that supports the normal development of an egg in a woman’s ovary and stimulates the release of the egg during ovulation. It is administered by injection which is injected in the fat ( subcutaneous layer). This medicine also can cause OHSS or multiple pregnancies.

Leuprolide Acetate (also known as gonadotrophin-releasing hormone (GnRH) analogs or pituitary agonists)

Taken by daily injection, or injected monthly under the skin, this stops the natural menstrual cycle by blocking the release of hormones that regulate it. This is usually taken before and during your gonadotrophin injections.

Cetrotide and Orgalutran – gonadotrophin-releasing hormone antagonists

These drugs are usually started a few days after starting gonadotropin injections and are delivered daily under the skin (subcutaneous) injections. They stop ovulation until the eggs are ready to be collected as part of the IVF cycle.

Progesterone (including Cyclogest, Gemstone or Crinone)

Taken to thicken the lining of the womb, progesterone can help to maintain pregnancy after IVF or IUI. It can be taken as a vaginal suppository, pill or gel, or by injection into the buttock. It is delivered either on the day the embryos are returned to the womb or after the injection of the pregnancy hormone hCG. 

Cabergoline

Taken in tablet form to reduce high levels of the hormone prolactin, which can interfere with the production of FSH, these can help reduce the effects of ovarian hyper-stimulation syndrome (OHSS) if you are at risk.

Side effects

You may experience side effects while taking fertility drugs, or you may feel fine.

Make sure you let your clinic know if you have any unexpected reactions. The following symptoms have all been associated with their use: stomach pains, hot flushes, mood swings, heavy periods, breast tenderness, insomnia, increased urination, spots, headaches, weight gain, dizziness, and vaginal dryness.