Overview of Common Fertility Treatment Drugs

During fertility treatment, the drugs you may take fall into one of four general categories:

• Medications intended to stimulate ovulation (fertility drugs)
• Medications intended to suppress or control the menstrual cycle (used during IVF)
• Medications intended to treat an underlying medical condition impacting your fertility
• Medications intended to treat other aspects of fertility

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. This is because most male infertility problems can’t be treated with medication. However, in some situations, men may also take hormones or other drugs as part of fertility treatment.

Clomid

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. But it’s also possible to combine Clomid with other medications, fertility drugs, or IUI treatment.

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.

Femara

Femara, or letrozole, wasn’t intended to be a fertility drug. In fact, it’s a breast cancer drug. 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. According to some research, Femara may be more effective than Clomid in women with PCOS and women who are otherwise Clomid-resistant. (Clomid-resistant just means Clomid doesn’t stimulate ovulation as expected.)

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

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. Your risk of conceiving twins, triplets, or higher order multiples is significantly higher with gonadotropins than with oral drugs like Clomid. Your risk of developing ovarian hyperstimulation syndrome is also much higher.

While gonadotropins are used primarily in women, men with hypogonadotropic hypogonadism may be prescribed injectable fertility drugs to improve testosterone levels and improve semen health.

Gonadotropins your doctor may prescribe include the following:

• Bravelle, Fertinex: These hormonal fertility drugs are also FSH, except instead of being artificially created in the lab, the hormone is extracted and purified from the urine of post-menopausal women. These drugs are considered less potent than FSH created using recombinant DNA technology, but they are less expensive.
• Follistim (follitropin beta), Gonal-F (follitropin alpha): These drugs mimic the hormone FSH in your body. They are created in a lab using recombinant DNA technology, which makes them bio-similar to natural hormones.
• Luveris (lutropin alpha): This is LH hormone, created in a lab using recombinant DNA technology.
• Ovidrel (choriogonadotropin alpha), Novarel, Pregnyl, A.P.L.: These drugs are made of hCG, the pregnancy hormone. The hormone hCG is similar to LH in the body. LH is the hormone that triggers ovulation. Novarel, Pregnyl, and A.P.L. are purified from the urine of pregnant women, while Ovidrel is lab created using recombinant DNA technology.
• Repronex, Menopur, Pergonal, Humegon: These fertility drugs are combined LH and FSH, also known as human menopausal gonadotropins (hMG). They are not used frequently but may be used in some special cases.

Ovulation Suppressors

Some medications used during fertility treatment suppress ovulation. During IVF treatment, drugs are used to prevent ovulation before the eggs can be retrieved surgically. Once the eggs are ovulated into the body, they cannot be found or used for IVF. Ovulation may also be suppressed to coordinate cycles with a potential egg donor or gestational carrier.

• Antagon, Ganirelix, Cetrotide, Orgalutran (ganirelix acetate and cetrorelix acetate): These fertility drugs are GnRH antagonists. This means that they work against the hormones LH and FSH in the body, suppressing ovulation. They are taken via injection. The most common side effects include abdominal discomfort, headache, and injection site pain.
• Birth control pills: These may be prescribed for the month before IVF treatment. Birth control may also be used therapeutically. For example, women with PCOS who don’t respond to Clomid may have a better response to the drug if they take birth control pills for two months prior to treatment.
• Lupron, Synarel, Suprecur, Zoladex (leuprolide acetate, nafarelin acetate, buserelin, goserelin): These medications are GnRH agonists or gonadotropin-releasing hormone agonists. They cause an initial surge in FSH and LH production but then cause the body to stop producing FSH and LH. This prevents ovulation. These drugs are usually used during IVF treatment, allowing the doctor to control ovulation with gonadotropins. They may also be used to treat endometriosis or fibroids. The most common side effects are hot flashes, headaches, mood swings, and vaginal dryness.

Other Fertility Issues

Fertility drugs are medications intended to stimulate the ovaries. However, these aren’t the only medications your doctor may prescribe during fertility treatment.

• Aspirin or heparin: If you’ve experienced recurrent miscarriage, or you’re diagnosed with a blood thrombophilia disorder (a situation where tiny blood clots can lead to pregnancy loss), your doctor may prescribe a daily baby aspirin or injections of the blood-thinning drug heparin.
• Estrogen: Your doctor may prescribe estrogen vaginal suppositories if your endometrial lining is too thin, if you experience vaginal dryness or pain during sexual intercourse, or to improve the quality of your cervical mucus. A possible side effect of Clomid use is thicker cervical mucus, which can interfere with conception. Extended Clomid use can also lead to a thinner endometrial lining. Estrogen may help with these issues.
• Progesterone: Your doctor may prescribe progesterone supplementation, either as a vaginal suppository or via injections. Vaginal progesterone suppositories may be suggested if you’re experiencing recurrent miscarriage or have a suspected luteal phase defect. Injectable progesterone is most frequently used during IVF treatment.     

Underlying Conditions

Sometimes, an underlying medical condition is decreasing your fertility. In these cases, that issue must be treated first. Treating the underlying issue is may be enough to improve your fertility. After treatment, you may be able to conceive on your own.

However, in other cases, a combination of solutions is required. You may need to have treatment for the medical issue in addition to fertility drugs or surgical interventions. 

• Antibiotics: Infection of the reproductive tract can reduce fertility in both men and women. In some cases, an infection can lead to scarring. This scarring may prevent the egg and sperm from meeting. As long as there’s no scarring, antibiotics alone may be enough to improve fertility. However, if the fallopian tubes are blocked or filled with fluid, surgery or IVF treatment be also be required.
• Glucophage (metformin): Metformin is a diabetes drug, intended to treat those with insulin resistance. Women with PCOS are frequently diagnosed with insulin resistance. Some research has shown that metformin treatment may help restart or regulate ovulation in women with PCOS. Other studies have found that it may reduce the miscarriage rate and help Clomid work in women who were unable to ovulate on Clomid alone.
• Parlodel and Dostinex (bromocriptine and cabergoline): These medications are dopamine agonists. They may be prescribed in hyperprolactinemia. Hyperprolactinemia is a condition where hormone levels of prolactin are abnormally high. High prolactin levels can cause irregular or absent ovulation in women and cause low sperm counts in men. Parlodel and Dostinex can lower prolactin levels. Possible side effects include headaches, nasal congestion, headache, and dizziness. Sometimes, this can bring back ovulation or normal sperm production. In other cases, surgery or additional fertility treatments are needed.
• Thyroid regulating medications for hypothyroidism or hyperthyroidism: An under- or over-functioning thyroid can cause fertility problems in men and women. Women may have irregular cycles, while men may have low sperm counts. Thyroid deregulation can also cause fatigue and weight gain. Obesity can further impact fertility.