• Getting Pregnant
• Infertility

Problems Conceiving? Fertility Drugs May Help

One of the most significant medical advancements of the mid-20th century may have been the development of fertility drugs. Since then, these medicines have made it possible for countless people to fulfill their dream of becoming parents.  

Unfortunately, solving fertility problems doesn’t always begin, or end, with taking a pill, according to Jeremy Groll, MD, SpringCreek Fertility. First and foremost, he says, it’s important to determine the underlying cause of the problem, including whether the problem lies with you, your male partner, or both. 

“Prescribing fertility drugs without a proper diagnosis can be like putting a cast on an arm when it’s the leg that’s broken,” Dr. Groll explains.

If, however, it’s determined that the infertility is due to a problem with your ovulation (egg production), then fertility medications may help, Dr. Groll says. These drugs usually fall into one of two categories: oral (taken by mouth) or injectable. 

“Prescribing fertility drugs without a proper diagnosis can be like putting a cast on an arm when it’s the leg that’s broken,” Dr. Groll explains.

Oral Fertility Drugs 

Oral fertility drugs contain ingredients that help with egg production. The two most commonly prescribed include: 

• Clomiphene citrate (Clomid®): Clomid® acts on the pituitary gland, causing the body to make more of the hormones that help eggs to mature in the ovaries. It is often used in women who have polycystic ovary syndrome (PCOS), as well as other ovulatory problems. 
• Letrozole (Femara®): Femara® is a more recent addition to the list of medications used to induce ovulation. (It’s also used to treat breast cancer in women after menopause.) Femara® works by inhibiting aromatase, an enzyme involved in estrogen production, and suppressing estrogen production. With lower estrogen levels, the pituitary gland produces more of the hormones needed to stimulate the ovaries to produce an egg. 

Other oral drugs that may be recommended, depending on your diagnosis, include:

• Bromocriptine and Cabergoline (Parlodel®, Dostinex®): Pituitary growths, certain medications (like antidepressants), kidney disease and thyroid disease can cause abnormally high levels of the hormone prolactin, which can interfere with ovulation. These medications help reduce prolactin levels. 
• Glucophage (Metformin®): Metformin® is commonly used to treat Type 2 diabetes. In fertility treatment, doctors use it for women who have insulin resistance and/or polycystic ovary syndrome (PCOS). It helps lower the high levels of male hormones in women with these conditions, which in turn helps the body to ovulate. 

Injectable Fertility Treatments  

If oral drugs aren’t successful, and/or you’re preparing to undergo in vitro fertilization, your doctor may recommend injectable treatments (some may be given in the form of a nasal spray instead.) Injectable treatments tend to be substantially more expensive than oral drugs. 

Some of the more common injectables include: 

• Human Menopausal Gonadotropin or hMG (Repronex®, Pergonal®): hMG is a combination of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which work together to directly stimulate follicle growth in the ovary. A follicle is a fluid sac which contains an egg. 
• Follicle-Stimulating Hormone or FSH (Gonal-F®, Follistim®): FSH directly stimulates the growth of follicles in the ovary. 
• Gonadotropin-Releasing Hormone (Gn-RH) analog: These medicines may be prescribed if you don’t ovulate consistently each month, or if you ovulate before your eggs are ready. Gn-RH analogs act on the pituitary gland to change when the body ovulates.  

Risks from Fertility Drugs

Taking fertility drugs does pose risks. Depending on the medication you’re prescribed, side effects may include: 

• Hot flashes 
• Headaches or migraines 
• Ovarian pain 
• Weight gain 
• Bloating 
• Ovarian cysts 
• Ovarian hyperstimulation syndrome (ovaries become swollen and painful) 
• Fatigue 
• Swelling of the hands or legs 
• Shortness of breath 
• Diarrhea 
• Nausea or vomiting 
• Urinating less than normal 

The most concerning risk, however, may be the possibility of multiple births: twins, triplets, or more. While for some women, any number of infants may be welcome news, women who are pregnant with “multiples” face higher risks during pregnancy, including premature delivery. Premature infants face greater health and developmental problems than those born at full term. 

How Successful Are Fertility Drugs? 

The success of oral drugs varies, depending on your age and what’s causing the ovulation problems. Typically, says Dr. Groll, in older patients who have less than a 1 percent chance of conception, oral drugs raise the odds by 10 percent (and the percentage drops after three attempts at conception.) Combined with artificial insemination, the likelihood of conception rises to 20 percent. 

If you want to improve your odds and reduce the risks from treatments, Dr. Groll emphasizes the importance of starting off right with a precise analysis of the fertility problems, under the expert and watchful care of a fertility specialist. 

“It’s important to be evaluated and monitored by a fertility specialist,” he says. “If you have an appropriate and accurate diagnosis, and you treat any underlying factors, fertility treatment is more likely to be safe and effective, and you maximize the chance of conception.”  

Source: Jeremy Groll, MD, SpringCreek Fertility; National Institute of Child Health and Human Development (National Institutes of Health); Medical News Today; American Pregnancy Association; WomenandInfants.org; Office of Women’s Health, U.S. Department o