Many medications are used to treat infertility. The
terminology "fertility drug" usually refers to products that
induce, enhance, or regulate ovulation.
- FSH ( follicle stimulating hormone ) is an injected
fertility medication that stimulates and supports the development of
multiple eggs. Used in IVF and stimulated IUI.
- Clomid is also a commonly
prescribed fertility drug that can establish normal ovulation in some
women.
- Metformin
is an effective fertility drug for lowering insulin levels in some women
with PCOS. Normalizing insulin levels allows
normal ovulation to occur.
- Human chorionic
gonadotropins ( hCG ) are an injected hormone used to induce ovulation.
- Other fertility drugs, such as progesterone,
are used to promote the development of the endometrium to adequately
support the growing embryo.
- Corticosteroids sometimes are used to treat immune
disorders that can cause the production of antisperm antibodies.
- Antibiotics are used to treat reproductive tract
infections in the male and female.
- Many other medications may be used to treat diseases
that can affect fertility, such as insulin for diabetes.
 Follicle
stimulating hormone ( gonadotropins; FSH, Gona l- F, Follistim ) is administered
by injection and stimulates the recruitment and development of ovarian
follicles that contain the eggs. FSH is naturally produced by the pituitary
gland upon stimulation by gonadotropin releasing hormone that is produced
by the hypothalamus.
The earliest member of this class of drugs was Pergonal,
which is a combination of FSH and luteinizing hormone ( LH ). Pergonal
is extracted from the urine of post menopausal women and is therefore
"natural." Georgeanna Jones, MD,
of the Jones Institute, performed much of the pioneering work with Pergonal.
Repronex is a newer version of Pergonal that can be administered subcutaneously
and is less expensive than the recombinant products. Menopur is a highly
purified Repronex that has less localized side effects than Repronex.
Some women need a combination of FSH and LH for optimal follicular development
Follistim and Gona l- F are "pure recombinant"
FSH compounds derived from genetically engineered mammalian cell cultures.
They are administered subcutaneously and are the preeminent FSH products
due to their high purity and activity. Bravelle is a newly developed highly
purified urinary FSH.
FSH is used in virtually all assisted reproductive technology
( IVF ) cycles to stimulate the development of
multiple eggs. Many eggs are needed to insure fertilization and the development
of viable embryos for transfer as some eggs are unavoidably damaged during
the handling process. FSH is also employed in stimulated intrauterine
insemination ( IUI ) cycles.
The dosage of FSH is highly dependent upon each patient's
response and often changes during the stimulation cycle. Dosage is influenced
by follicular size and number, which is monitored by ultrasound.
Estrogen increases in proportion to the number and size of follicles;
its measurement helps determine the optimal dosage for each patient.
Lupron is a GnRH agonist ( blocks the production of
FSH and LH after several days of treatment ) administered according to
individual treatment protocols often late in the preceding menstrual cycle
for suppression of endogenous FSH ( produced by the patient ) prior to
an induction cycle. Lupron given in the early follicular phase of the
cycle creates a "rebound effect" leading to a better response
to external FSH ( injections ), as in the flare or "short" protocol.
Patients on the flare protocol begin GnRH agonists at approximately the
same time they begin stimulation drugs.
Lupron eliminates the LH surge, which is the hormonal
event signaling ovulation. A premature surge can cause ovulation before
the follicles are at the appropriate stage for the
IVF ( assisted reproductive technology ) procedure causing cycle cancellation.
With Lupron, the reproductive endocrinologist has maximum
control over the "endocrine events" occurring during the stimulation
cycle thus maximizing the chance of successful egg retrieval and subsequent
conception. Lupron also treats endometriosis
by lowering the circulating levels of estrogen, which is required for
endometrial tissue growth.
Ganirelix and Cetrotide are GnRH antagonists ( blocking
the effect of GnRH ) that immediately suppress luteinizing hormone ( LH
). These medications are initiated during the later part of stimulation
cycle when the follicles begin to increase in size, whereas Lupron requires
ten to twenty days of treatment in the previous cycle. Both antagonists
and agonists can be used to eliminate a premature LH surge.
Luveris ( lutropin alfa ) is a pure luteinizing hormone
( recombinant human LH ) that treats female infertility. It is indicated
for use in combination with human follicle - stimulating hormone ( hFSH
), like Gona l - F, for the stimulation of follicles in the ovaries of
women with severe LH and FSH deficiency. Luveris allows physicians to
tailor LH administration to individual needs, offering treatment flexibility.
Human
chorionic gonadotropins ( hCG ) [ Pregnyl ] mimics LH and induces ovulation
after the administration of gonadotropins in an assisted
reproductive technology ( ART ) cycle. Ovulation occurs precisely
36 hours after administration; egg retrieval is timed between thirty -
four to thirty - five hours after ovulation. Precise timing is needed
to insure the successful fertilization of the eggs. Ovidrel is derived
from genetic recombinant technology and due to its purity can be administered
subcutaneously.
Progesterone is a hormone administered after egg
retrieval to support the development of the endometrium. Progesterone
stimulates an increase in the thickness of the endometrium and increases
its blood supply, thus better preparing it to accept a developing embryo.
Progesterone occurs naturally and is secreted by the corpus luteum, the
small structure formed by the ovarian follicle after ovulation. A progesterone
deficiency can occur after ovulation, referred to as a luteal phase defect,
and can cause pregnancy loss.
Progesterone is available in several forms including
injection ( intramuscular in oil ), gel, vaginal suppository and as micronized
oral capsules ( prometrium ).
Parlodel is a dopamine agonist that inhibits the production
of the hormone prolactin from the pituitary gland. This medicine is used
in some women who have high prolactin levels due to PCOS ( polycystic
ovary syndrome ) or a growth in the pituitary gland. High prolactin levels
can inhibit ovulation, and Parlodel has been effective in producing ovulation
in these cases.
Estrogen stimulates the endometrium to thicken
and increase its blood supply. Externally administered, estrogen prepares
the endometrium for cryopreserved - thawed embryo transfer cycles and
for the recipients in donor egg cycles. Estrogen preparations include
estradiol patches and estrace pills.
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