Fertility drugs are typically the first step. Up to 90 percent of infertile women are treated with these drugs. Fertility drugs are designed to correct specific hormonal imbalances. The most common fertility drugs — clomiphene citrate (Clomid) and gonadotropins — are used to stimulate the production of mature eggs.
Fertility drug treatment can include the following:
- Clomiphene citrate, also known as Clomid or Serophene®. This drug
is inexpensive and easy to use. Sixty percent of women taking Clomid
will ovulate following treatment and, of these, approximately 40
percent will become pregnant within six months. Clomid is a fertility
medication, taken in pill form, which induces ovulation. Clomid may
cause swelling of the ovaries, multiple pregnancies, hot flashes, mood
swings, depression and irritability. Common side effects include
weight-gain and water-retention.
While Clomid treatment is generally effective in women who experience abnormal ovulation cycles, it seems to have an adverse effect on endometrial thickness, thereby increasing the likelihood of implantation failure. Recent studies have shown that adding progesterone and estrogen when taking clomiphene citrate significantly increases endometrial thickness, thus improving rates of pregnancy while reducing the likelihood of miscarriage. That is, the hormones appear to counterbalance the negative effects of a Clomid regimen.
- Gonadotropin medications. These drugs include:
- Lupron (leuprolide acetate), a synthetic version of the naturally
occurring gonadotropin releasing hormone (GnRH), which triggers the
release of produces follicle-stimulating hormone (FSH) directed at the
ovaries. FSH is a hormone critical to egg maturation and development.
It triggers the development of the follicles, or eggs, inside the
ovary, as well as estrogen production. Lupron is given via injection.
- Synarel (nafarelin acetate) is also a synthetic version of GnRH, but it can be administered via a nasal spray.
- Antagon (ganirelix acetate), and cetrorelix are GnRH antagonists,
suppressing the release of certain hormones. They are administered via
These fertility drugs have a 95 percent chance of stimulating ovulation, giving a woman a 15 percent chance of getting pregnant each cycle if she still has viable eggs. Gonadotropins may cause multiple pregnancies, and, in rare cases, hyperstimulation, which can lead to stroke. Common side effects include weight-gain and water-retention.
- Lupron (leuprolide acetate), a synthetic version of the naturally occurring gonadotropin releasing hormone (GnRH), which triggers the release of produces follicle-stimulating hormone (FSH) directed at the ovaries. FSH is a hormone critical to egg maturation and development. It triggers the development of the follicles, or eggs, inside the ovary, as well as estrogen production. Lupron is given via injection.
- Gonal-F (follitropin alfa for injection) and Follistim (follitropin
beta) are the first follicle stimulating hormones (FSH) to be produced
by recombinant DNA technology. Unlike other fertility drugs that only
encourage hormone production, FSH is the actual hormone responsible for
producing and releasing healthy eggs in women, as well as for the
production of sperm in men.
- Progesterone. The hormone progesterone is essential to the
reproductive process. Inadequate progesterone production, known as a
luteal phase deficiency (when a woman's body doesn't produce enough
progesterone to support an embryo after fertilization), can also be
treated with medication. Progesterone is typically administered with in
vitro fertilization (IVF) and other assisted reproductive technology
(ART) procedures. Women who have no ovarian function and want to pursue
a pregnancy through donor egg technology, for example, must use
progesterone and estrogen supplementation. For these women, an entire
cycle must be simulated using a variety of hormonal therapies.
Although fertility drugs are known for causing a variety of physical and emotional side effects, there also appears to be some risk of developing ovarian cancer. This risk is now believed to be lower than previously reported and is not firmly established with clinical data. Most specialists will limit the duration of drug treatment and carefully consider when and for whom these medications are recommended. If pregnancy is achieved, any increased risk of developing ovarian cancer from taking fertility drugs is reduced to the average risk experienced by other women.
Diagnostic tests that help to identify potential implantation problems (performed prior to the procedures mentioned above) include:
- Hysterosalpingogram (HSG) involves the use of radio-opaque dye
during fluoroscopy (x-ray) of the abdomen, which allows your health
care professional to evaluate both the uterine cavity and tubal patency
(whether the fallopian tubes are blocked).
- Saline-infusion sonogram (SIS) involves administering sterile
saline into the uterine cavity under sonographic guidance, allowing
evaluation of the endometrial contour. SIS differs from HSG in that it
does not require exposure to radiation; however, it is not as effective
as HSG in evaluating tubal function and patency.
In assisted reproductive technology, assisted hatching is sometimes used in an effort to improve implantation rates. Assisted hatching is done in addition to either IVF or IVF and ICSI. After the embryo has formed and prior to its transfer to the uterus, the outer covering of the embryo called the zona pellucida is thinned by a special harmless solution. This will help in hatching so that the cells of the embryo will emerge from the outer shell and hopefully implant in the uterus. This method is suggested in women over age 35 or patients who have repeatedly failed IVF attempts.