Fertility drugs where to get them

This is called controlled ovarian stimulation COS , or superovulation , and may be accomplished with medicines taken by mouth or by injection.

COS combined with either timed intercourse or intrauterine insemination IUI is commonly used as an initial treatment for several types of infertility when the woman has open fallopian tubes.

Before using fertility drugs for COS, it is recommended to make sure the fallopian tubes are unblocked and open. This can be confirmed by injecting dye into the fallopian tubes hysterosalpingogram [HSG] or using a lighted telescope to look inside the lower belly laparoscopy. Patients with blocked fallopian tubes will not become pregnant with fertility drugs or may be at risk for an ectopic pregnancy pregnancy outside the uterus. Patients with blocked fallopian tubes should not undergo ovulation induction unless the purpose of the ovulation induction is to collect the eggs in preparation for IVF.

Before starting ovulation induction, the male partner should have a semen analysis to help decide whether ovulation induction should be combined with timed intercourse, IUI, or IVF. The most commonly prescribed ovulation drugs are clomiphene citrate CC , aromatase inhibitors such as letrozole , and gonadotropins FSH, LH, human menopausal gonadotropin hMG , chorionic gonadotropin hCG.

Other medicines used in ovulation induction include bromocriptine, cabergoline, GnRH, GnRH analogs, and insulin-sensitizing agents, which have very specialized applications which are described below. Table 1 provides a summary of common ovulation drugs and their side effects next page. Clomiphene is the most commonly prescribed ovulation-induction drug used to stimulate ovulation in women with infrequent ovulation or amenorrhea. It also is used to induce more than one follicle to develop in conjunction with IUI as a treatment for unexplained infertility and for those who are unable or unwilling to pursue more aggressive therapies.

The standard dosage of CC is milligrams mg of clomiphene per day for five consecutive days. Treatment begins early in the cycle, usually starting on the second to fifth day after menstruation begins although it can also be started without a period if the woman is anovulatory. If a woman does not have periods, a period can be induced by taking an oral progestin for days. Table 1. Ovulation drugs and their most common side effect.

Clomiphene works by causing the pituitary gland to make more FSH. The higher level of FSH stimulates one or more follicles to develop each containing a single egg. As the follicles grow, they secrete estradiol into the bloodstream.

About a week after the last dose of CC is taken, the higher levels of estradiol cause the pituitary to release an LH surge. The LH surge causes the egg s in the dominant follicle s to be released. It is important to determine whether the dose of CC given results in ovulation. If ovulation does not occur at the mg dose, CC is increased by mg increments in immediate or subsequent cycles until ovulation happens. More than mg each day for five days is usually not helpful, and women who do not ovulate on a clomiphene dosage of mg tend to respond better to a different treatment, such as injections of gonadotropins.

Your doctor will determine the appropriate dose for you. Occasionally, the doctor may choose to add other medicines to a CC regimen if the drug does not induce ovulation. Depending on the timing of the menstrual cycle compared with the time of ovulation, the cervical mucus can either help sperm enter the uterus or act as a barrier. Under the influence of estrogen before ovulation, the mucus is thin and stretchy which helps sperm. In the days following ovulation, when progesterone levels rise, the mucus becomes thick and tenacious.

In some women, CC can alter cervical mucus, making it thicker. IUI can be used along with CC to help overcome this. CC sometimes can alter thickness of the uterine lining, making it thin and less receptive to implantation. For this reason, the lowest dose of CC that causes ovulation in anovulatory women is usually prescribed. Once the CC dose that induces ovulation is established, three ovulatory CC cycles are an adequate trial for most patients and may be continued for up to six cycles.

However, studies show that CC should not be given for more than six cycles, because the chance of pregnancy is very low and alternative treatments should be considered. CC is generally not effective for women who have irregular or absent ovulation due to disorders of the hypothalamus such as those associated with severe weight loss or very low estrogen levels such as those with non-functioning ovaries.

In addition, women who are obese may have better success after weight loss. CC is generally tolerated well. Side effects are relatively common, but generally mild. Mood swings, breast tenderness, and nausea also are common. Severe headaches or visual problems such as blurred or double vision are uncommon and virtually always reversible.

In the event that these severe side effects occur, treatment should be stopped immediately and the patient should inform her physician. It is not advisable to reattempt any further exposure to CC in these cases.

Ovarian cysts, which can cause discomfort, may form but typically resolve with time. A pelvic exam or ultrasound may be done if indicated to look for ovarian cysts before beginning another CC treatment cycle.

Side effects are more frequent with higher doses. Aromatase inhibitors are medicines that temporarily decrease estradiol levels, which cause the pituitary gland to make more FSH. Two medicines, letrozole and anastrozole, are currently FDA-approved to treat breast cancer that occurs after menopause, but have also been used to induce ovulation in women with ovulatory problems.

Treatment begins early in the cycle, usually starting on the second to fifth day after menstruation begins although it also can be started without a period if the woman is anovulatory. The typical dose is 2. Studies show that pregnancy rates with aromatase inhibitors are similar to CC rates, and may be better in certain ovulation disorders such as polycystic ovary syndrome PCOS. Recent research has not shown any increased risk for birth defects in children whose mothers took letrozole for fertility treatment.

Insulin resistance and the associated high levels of insulin in the blood hyperinsulinemia are seen commonly in women with polycystic ovary syndrome PCOS.

When used by themselves for 4—6 months, insulin-sensitizing agents such as metformin can cause regular menstrual periods and ovulation in some women with PCOS. Some PCOS patients do not ovulate in response to either CC or metformin alone but may respond when the two drugs are used together. This is in contrast to an Italian study which showed metformin to be more effective.

However, CC is typically considered the first-line medication in the United States. The most common side effects are gastrointestinal, and include nausea, vomiting, and diarrhea.

Metformin therapy is uncommonly associated with liver dysfunction in infertile women, and, in very rare cases, a severe condition called lactic acidosis. Blood tests to check liver and kidney function should be done periodically. Other drugs used for diabetics that improve insulin sensitivity, such as rosiglitazone and pioglitazone, also have been used for this purpose. Unlike CC, aromatase inhibitors, and insulin-sensitizing agents that are taken by mouth, gonadotropins are delivered by injection.

There are a variety of gonadotropin preparations, and others are in various stages of research and development. Because of rapid changes in the international marketplace, the medicines named in the sections below may not include all those available in the United States and worldwide. Gonadotropins might be prescribed for anovulatory women who have tried CC without conceiving. Gonadotropins are used to cause multiple follicles to develop simultaneously for fertility treatments with superovulation-IUI and IVF.

Gonadotropin therapy can rescue the eggs that would normally die off allowing those eggs to also mature and be available for retrieval or conception. For this reason, we strongly recommend that you only take Clomid under the supervision of a fertility specialist. Find out more about multiple births on our Risks of Fertility Treatment page. Women with 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 reduces insulin in the body to normal levels, allowing ovulation to return to normal. Bromocriptine and Cabergoline can be used by women who produce too much of the prolactin hormone, a condition called hyperprolactinemia. 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.

Gonadotrophins stimulate the release of testosterone which support sperm production in the testicles. Find out more about male hormones and fertility issues from the Pituitary Foundation. However more research is needed before we can say they are proven to work. Find out more about research into antioxidants and male fertility.

There can be, although many people taking fertility drugs feel fine. Make sure you let your clinic know if you have any unexpected reactions, including: stomach pains or a bloated stomach, hot flushes, breathing difficulty, mood swings, heavy periods, breast tenderness, insomnia, increased urination, spots, headaches, weight gain, dizziness, and vaginal dryness. Some of these medications also carry serious side effects. List of Partners vendors. During fertility treatment , the drugs you may take fall into one of four general categories:.

Medications alone may be used, or they may be used alongside intrauterine insemination IUI , IVF treatment, or surgical interventions. Even though infertility impacts men and women almost equally, women are still more likely to take fertility treatment drugs than men.

However, in some situations, men may also take hormones or other drugs as part of fertility treatment. You've probably heard of Clomid before as it's the most common fertility drug. Clomid, or clomiphene citrate , is often the first drug tried when treating ovulatory dysfunction.

It may also be recommended in the early stages of treatment for couples diagnosed with unexplained infertility. While it is not common, some cases of male infertility may be treated with Clomid. Clomid is a tablet taken orally. Most frequently, Clomid is prescribed alone. The most common side effects are headaches, hot flashes, and mood swings. Some risks of Clomid treatment include conceiving twins or a higher-order multiple pregnancy, ovarian hyperstimulation syndrome , and vision disturbances.

Side effects and risks are mild compared to the stronger injectable fertility drugs. However, it is now frequently used off-label to treat ovulation problems. Like Clomid, Femara is taken orally. It may be used alone, alongside other medications or fertility drugs, or as a part of IUI treatment. Side effects and risks are very similar to Clomid. Femara is not safe to use during pregnancy. That said, because Femara is taken early in the menstrual cycle before conception takes place, most doctors consider it safe when used for fertility purposes.

Gonadotropins are the strongest ovulation-stimulating drugs. They contain biologically similar follicle stimulation hormone FSH , luteinizing hormone LH or a combination of the two. In female reproduction, these are the hormones that stimulate the ovaries to mature and release eggs. These drugs are taken via injection, usually into the fatty tissue also known as subcutaneous injections.

Your fertility clinic will instruct you on how to give yourself these injections at home. Gonadotropins are used during IVF treatments. Formerly, these drugs were used with other treatments, such as IUI, but that is no longer a common practice. The most common side effects of gonadotropins include headaches, nausea, bloating, breast tenderness, mood swings, and irritation at the injection site. You and your partner should be evaluated. Your doctor will take a detailed medical history and conduct a physical exam.

Infertility treatment depends on the cause, your age, how long you've been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.

Treatments can either attempt to restore fertility through medication or surgery, or help you get pregnant with sophisticated techniques. Medications that regulate or stimulate ovulation are known as fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. Fertility drugs generally work like natural hormones — follicle-stimulating hormone FSH and luteinizing hormone LH — to trigger ovulation.

They're also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs. These injected treatments stimulate the ovary to produce multiple eggs. Another gonadotropin, human chorionic gonadotropin Ovidrel, Pregnyl , is used to mature the eggs and trigger their release at the time of ovulation.

Concerns exist that there's a higher risk of conceiving multiples and having a premature delivery with gonadotropin use. Pregnancy with multiples. Injectable fertility medications also carry the major risk of triplets or more. Generally, the more fetuses you're carrying, the greater the risk of premature labor, low birth weight and later developmental problems.

Sometimes, if too many follicles develop, adjusting medications can lower the risk of multiples. Ovarian hyperstimulation syndrome OHSS.