What do fertility medications do?
For many couples who are having difficulty conceiving, fertility medications are the first step in treatment. Some fertility medications are used in IVF treatment because controlling the development and release of eggs from your ovaries can improve your chance of success.
Fertility medications do different things:
- Stimulate (ovulation) – a tip from our Access Fertility nurse is to drink plenty of water when on stimulation. Follicles are fluid filled sacs and, as they grow, they draw on fluid from other parts of your body so keep up the hydration.
- Control your cycle (down regulation)
- Prevent early ovulation (LH Antagonists)
Your clinic may also offer you oral contraceptives as a way of synchronising your cycle.
Fertility medications are not restricted to those undergoing IVF treatment. Medication such as Clomid may be prescribed for you if it is found that you are ovulating rarely or irregularly. For some patients, this may be enough to help get a successful outcome, for others IVF may be required.
Who might be recommended to have fertility medications?
Your doctor may recommend that you have medication if:
- You’ve been diagnosed with Polycystic Ovary Syndrome (PCOS).
- You have a very irregular cycle or ovulation that’s totally unpredictable.
- You’re a man or a woman with fertility problems linked to your pituitary gland (hormones).
- You’re producing small numbers of sperm or you have sperm with an abnormal movement (low motility).
- You’re a man and you have certain infections or inflammations.
What fertility medications are there?
The most commonly used fertility medications for women are:
- clomifene citrate
- metformin hydrochloride
- dopamine agonists
All these medications help ovulation to happen, but which drug is right for you will depend on the reason why you’re having difficulty ovulating and conceiving. Your consultant will advise on the best course of action for your individual situation based on your test results and history.
Fertility medications in a bit more detail:
Many people talk about fertility medications like ‘Clomid’ or ‘Menopur’ but these are actually brand names and they fall under different headings depending on their purpose. There are lots of different brand names, we’ll cover some of these below.
Clomifene citrate is an effective treatment which stimulates your ovaries to produce more eggs. It’s often the first course of treatment for women with polycystic ovaries but it can also be used by women who have late or irregular periods. You usually take clomifene as a pill for five days early in your cycle, for up to six months. Brand names for clomifene citrate are Clomifene and Clomid.
Clomifene citrate blocks the effect of the hormone oestrogen in your brain. This blocking effect tricks your body into bumping up the levels of two other hormones that are essential for ovulation.
These two other hormones are:
- Follicle-stimulating hormone (FSH) – FSH causes the eggs in your ovaries to ripen, ready for release.
- Luteinising hormone (LH) – LH triggers the release of one or more mature eggs from your ovaries.
The egg or eggs then move down into one of your fallopian tubes, where they’ll hopefully be fertilised with sperm.
Metformin isn’t technically a fertility medication; it’s a drug used in the treatment of people with diabetes. However, it can be used by some women with polycystic ovaries who aren’t ovulating properly because of abnormal insulin levels in the body.
Women with polycystic ovary syndrome (PCOS) can develop insulin resistance, which means their body stops reacting to normal insulin levels. To compensate, the body will produce more insulin than it needs, and this can lead to high androgen (male hormone) levels which affect ovulation.
Metformin works by lowering levels of insulin circulating in your blood. This in turn can restore the balance between testosterone and oestrogen levels and help the body to ovulate normally.
Can help stimulate ovulation in women and may also improve fertility in men. Luteinising hormone (LH) and follicle-stimulating hormone (FSH) are types of gonadoptrophins and these are used to stimulate your ovaries, as we discussed above.
These fertility medications are injectable hormones. You can have LH and FSH as a course of injections over 10 days to 12 days. The injections make your ovaries start to develop and mature egg follicles. The gonadotrophin injections will be followed by a final injection of another hormone called human chorionic gonadotrophin (hCG).
HCG tells your ovaries to mature the egg (or eggs) that they have just developed. FSH ensures sufficient numbers of follicles and LH stimulates the follicle to release the egg. HCG ensures the follicle is in the right condition to release a mature egg and produce the progesterone that’s needed for the womb lining to help implantation and in maintaining a pregnancy.
There are several brand names for gonadotrophins:
- Merional and Menopur contain FSH and LH.
- Bemfola, Fostimon, Gonal F, Pergoveris and Puregon contain FSH only.
- Choragon, Ovitrelle and Pregnyl contain hCG.
Women who take gonadotrophins can develop a side effect called ovarian hyperstimulation syndrome (OHSS) which can, in rare cases, be fatal so it’s essential you’re aware of the symptoms of OHSS. Read our previous blog about OHSS here.
Gonadotrophin-releasing hormone and dopamine agonists
These are other types of medication prescribed to encourage ovulation. If you have endometriosis you may take the GnRH agonist Cetrotide for several months to help improve your egg quality and chances of success.
These can be used by women who produce too much of the prolactin hormone. Prolactin is produced by the pituitary gland in the brain and too much of it can reduce levels of oestrogen in the body, making ovulation difficult. Bromocriptine and Cabergoline both increase levels of dopamine in the brain, which helps to reduce levels of prolactin production and return ovulation to normal.
Are there side effects of fertility medications?
Side effects are unwanted and unintentional symptoms that result from a medication. Not everyone will develop side effects and whether or not you will develop side effects, and how severe they are, often depends on the dose, your own individual body and which medication you have been prescribed.
The most common fertility medication side effects are bloating, headache, breast tenderness, upset stomach, hot flashes, and mood swings. The most common fertility medication risks are multiple pregnancies (like twins etc) and developing ovarian hyperstimulation syndrome (OHSS). These aren’t the only potential side effects and risks, just the most common ones. This website contains a lot of information on the different side effects of the different medications: www.verywellfamily.com.
OHSS can be a side effect and is potentially life threatening so you should ensure you are aware of the signs of OHSS before you start treatment.
Speak to your doctor for more information about the possible side effects of specific medicines.
What fertility medications are there for men?
Some men have a low sperm count because the pituitary gland in the brain isn’t producing enough gonadotrophins. Gonadotrophins stimulate the release of testosterone which support sperm production in the testicles.