Fertility Drugs

Fertility drugs at a glance

  • Fertility drugs are the main treatment for women who are infertile due to ovulation disorders and are an integral part of the in vitro fertilization (IVF) process.
  • They are also first-line treatment for couples with unexplained infertility.
  • Fertility drugs are used in IVF to stimulate ovulation and prepare a woman’s uterus for pregnancy.
  • Most medications are taken either orally or via injection.
  • Side effects of fertility drugs are usually mild and most commonly involve skin irritation at the injection site.

How are fertility drugs used during IVF?

Fertility drugs are the main course of treatment for women who are infertile due to ovulation disorders such as irregular menstrual cycles. According to the American Society for Reproductive Medicine (ASRM), about 25 percent of infertile women have problems with ovulation.

Several other types of medications, from aspirin and birth control to antibiotics, are also an important part of IVF. The combination of fertility drugs used in IVF works by increasing the number of eggs that are recruited at one time from the woman’s reserve of eggs.

When a woman ovulates normally, she typically recruits from her ovarian reserve a large number of eggs to develop, but only ovulates one of them. The remaining eggs that do not ovulate are absorbed by the ovary.

Fertility medications “rescue” these eggs to allow them to continue developing. The patient therefore has a greater number of eggs to fertilize. This allows the embryologist to select the very best eggs for fertilization and embryo creation in order to enhance the woman’s chance of pregnancy.

Typically, a patient begins the IVF process by taking a birth control pill to prevent ovulation too early in the treatment cycle. From there, the patient will begin stimulating her ovaries using injectable medications, followed by a trigger shot to release mature eggs prior to retrieval.

Common fertility drugs used during IVF

Numerous types of fertility drugs are used during IVF, some taken orally and others injected. The exact drug and dosage used during IVF depends on a patient’s age, test results and the stimulation protocol prescribed by her physician and IVF coordinator.

Before taking any fertility drugs, patients should always talk with their doctor about other medications they are taking and fertility drug options, including the benefits and risks of each type.

A typical IVF treatment will involve a mix of the following medications:

Gonadotropins

These are injectable hormones used to increase development of a woman’s eggs, follicles (the sac-like structures where eggs mature) and estrogen levels prior to ovulation. Depending on the drugs used, the injections contain either follicle-stimulating hormone (FSH) or both luteinizing hormone (LH) and FSH.

Women will typically take gonadotropins for seven to 12 days. A physician will closely monitor follicle size and estrogen levels to decide if the dosing is adequate or if a woman needs to continue injections.

Side effects of gonadotropins are generally minor but may include discomfort at the injection site, headaches and fatigue.

Human chorionic gonadotropin (hCG)

An injection of hCG is used during IVF to trigger release of the mature egg(s) after a woman’s follicles have developed. Human chorionic gonadotropin is a naturally occurring chemical produced during pregnancy that is similar in function and structure to LH.

Common hCG drugs include Pregnyl, Profasi, A.P.L., Novarel and Ovidrel.

Side effects are rare but may include bloating, fatigue, mood swings or breast tenderness.

Follicle-stimulating hormone (FSH)

FSH spurs the development and growth of eggs in a woman’s ovaries. It is also sometimes used to stimulate sperm production in men. Common FSH drugs include Bravelle, Gonal-F and Follistim.

Gonadotropin releasing hormone (GnRH) analogs (antagonists and agonists)

These medications work by preventing premature ovulation and are typically prescribed in combination with other hormones (FSH and hCG). By delaying ovulation, GnRH analogs increase the chance of a woman producing fertile eggs and prevent the release of eggs before an egg retrieval occurs.

These drugs include Ganirelix Acetate, Antagon (ganirelix), Lupron Depot (leuprolide acetate) and Lupron.

Women undergoing IVF will typically take a GnRH analog drug for at least two weeks before a baseline appointment and starting hCG injections, when ovulation is triggered.

Side effects may include hot flashes, headaches, trouble sleeping, mood swings and vaginal dryness. Rarer side effects have been reported with long-term use and may include bone loss and decreased breast size.

Doxycycline

This oral antibiotic decreases the chance of a bacterial infection to both partners involved in IVF treatment. Patients take one doxycycline pill twice a day after they begin hCG injections until their prescription is complete.

Doxycycline increases sensitivity to sunlight and anyone taking it should avoid long exposure to the sun for up to two weeks after taking it. Other side effects include diarrhea, sore mouth and genital itching.

Baby aspirin

Studies show that taking aspirin may increase circulation to the uterus and ovaries, preventing blood clots and reducing miscarriages.

Prenatal vitamins and folic acid

Maintaining a healthy level of vitamins prior to and during pregnancy greatly reduces the chance of birth defects. The Centers for Disease Control and Prevention recommends that women begin taking a multivitamin with folic acid at least a month before becoming pregnant.

Risks and side effects of fertility drugs

Aside from the specific risks and side effects for each drug itself, the biggest risk associated with IVF medications is ovarian hyperstimulation (OHSS). This condition, in which a woman’s ovaries are over stimulated by fertility drugs, causes the ovaries to produce hormones that may cause significant side effects. Most cases of OHSS are mild but some patients may experience a severe reaction.

Patients exhibiting any of the following symptoms of OHSS should contact their doctor right away:

  • Severe pelvic pain.
  • Swelling of the hands or legs.
  • Stomach pain and swelling.
  • Shortness of breath.
  • Weight gain.
  • Diarrhea.
  • Nausea or vomiting.
  • Urinating less than normal.

Other rare side effects may occur. Ectopic (tubal) pregnancies happen in 1 to 2 percent of natural pregnancies, and with IVF the rate is slightly increased. Ectopic pregnancies, in which the embryo implants outside the uterus, can be life threatening and require treatment with medication or surgery.

Some women may experience drug allergy or sensitivity that involve breast tenderness, headaches, mood swings or skin issues. These often go away shortly after an injection or after taking the medication.