Drugs Commonly Used in Infertility Treatment

 

Aspirin (low-dose or "baby" -- usually 81-82 mg): Used in treatment of immune problems such as presence of anti-phospholipid antibodies or the lupus anticoagulant -- mostly in conjunction with Heparin. Also used by some to increase thickness of the uterine lining. Basically to prevent clotting in the lining. Very few side effects are observed with low-dose aspirin. Full-strength aspirin and NSAIDs such as Advil and Aleve should not be used as they may interfere with ovulation and reduce the chance or pregnancy.

Birth control pills: Commonly used for suppression of the ovaries prior to a stimulated cycles. Common side effects include headaches, weight gain, light periods, mid-cycle spotting, and elevated blood pressure.

Bromocriptine, brand Parlodel: Used for reduction of prolactin levels in both men and women. Side effects include dizziness and drowsiness, as well as more serious ones such as convulsions, black stool, nervousness, shortness of breath, and more.

Clomiphene citrate, brands Clomid and Serophene: Used to induce or enhance ovulation in women by stimulating the hypothalamus to release more GnRH and the pituitary to produce more LH and FSH. Common side effects include drying of cervical mucus, headaches, dizziness, cramping, hot flashes, moodiness, sore breasts, stomach upset, bloating, vision problems, skin rash thinning of uterine lining and formation of cysts. For men, it is used to lower estrogen and to increase LH and FSH to increase sperm counts.

Conjugated estrogens, brands, Premarin, Premaril and many others: Given mostly as hormone replacement. Side effects for men include muscle spasms, weakness, numbness, shortness of breath, change in vision, and headache. In women it can cause profuse bleeding. In both sexes it may cause increased chance of yeast infection, hair loss, acne or rashes, gastrointestinal problems, nausea and vomiting

Danazol, brand Danocrine: Synthetic androgen used to treat endometriosis. Side effects include acne and oily skin, muscle cramps, weight gain, swelling of feet or lower legs, tiredness and weakness.

Estradiol: Given often after IVF to keep E2 levels up. Side effects include nausea and bloating.

Follitropins, alpha and beta,(recominant FSH, R-FSH, R-hFSH) brands Follistim, Gonal-F, Puregon: Recombinant FSH (lab made, rather than made from urine of post menopausal women), most often used for superovulation. Received through subcutaneous injection, though Follistim is approved for intramuscular injection in obese women. Side effects include hyperstimulation, abdominal or pelvic pain, bloating, and body rashes.

Glitazones, brands Actos (pioglitzone) and Avandia (rosiglitazone): These are insulin-sensitizing meds used primarily for diabetics, but gaining popularity in the treatment of insulin resistance in women with PCOS. These medications are usually tolerated better than metformin, and may be more effective in improving glucose tolerance. The downside is that they are less likely to assist weight reduction (if desired) and they are both Pregnancy Category C medications and most doctors will want to take patients off the medication once a pregnancy is achieved. Liver function should be monitored quarterly while on these meds, and patients should be aware of signs of liver troubles such as jaundice, dark urine, vomiting and stomach pain. The most common side effect is headaches.

GnRH-antagonist, ganirelix acetate, brand Antagon: Used to inhibit premature luteinizing horomone (LH) surges in women undergoing controlled ovarian hyperstimulation (COH). It's use is similar to Lupron, but it is newer on the market and has the added benefit of shortening up the IVF cycle. Side effects include abdominal pain, headache, ovarian hyperstimulation, vaginal bleeding, injection site reaction, nausea, and gastrointestinal discomfort

Gonadotropin releasing hormone (GnRH): Used in treating PCO and low sperm count.

Guaifenesin, brand Robitussin (many generics available): Used to thin cervical mucus. Recommended dose is 2 teaspoons three times per day with a full glass of water. Should be taken starting 5 days prior to ovulation and continued until ovulation has occurred. Side effects include nausea and gastrointestinal problems.

Heparin: Used in treatment of immune problems -- to prevent blood clotting in the uterine lining. This is an anticoagulant which may have side effects such as nosebleeds, blood in urine or stool, and bruising. Recommended that you take calcium supplements in addition to pre-natal vitamins since Heparin depletes the supply.

Human chorionic gonadotropin (hCG), brands A.P.L, Profasi, Pregnyl, Chorigon, Novarel, and recombinant brand Ovidrel: For women hCG is used to induce ovulation, usually after taking clomiphene citrate, menotropins or urofollitropins. Also used to support the corpus luteum and keep progesterone levels elevated. Side effects include pregnancy symptoms such as nausea and breast swelling. Interferes with the ability to take a pregnancy test. Used to help a man's sperm count if the FSH, LH, and testosterone levels are low. Sometimes used in conjunction with menotropins. Only for men with the rare condition of hypogonadotropic hypogonadism. Side effects include moodiness and tiredness. The new recominant hCG, Ovidrel, is supposed to cause less localized reaction, and may help with empty follicle syndrome.

Intravenous immunoglobulin (IVIg): Treatment for immune disorders. Side effects are fast or pounding heart and trouble breathing.

Leuprolide acetate, brands Lupron and Decapeptil: used to treat Endometriosis, uterine fibroid tumors, and to suppress women prior to IVF. Side effects include moodiness, hot flashes, and irregular vaginal bleeding.

LHRH antagonist, cetrorelix, brand Cetrotide: used to block LH surge/premature ovulation. It blocks the effects of gonadotropin-releasing hormone (GnRH). The GnRH controls the secretion of LH, the hormone that triggers ovulation. Like Antagon, it allows for a shorter stimulation cycle for IVF or IUI. Side effects include, reddening, itching, or swelling at injection site, nausea, and headache.

Menotropins, brands Pergonal, Humegon, Repronex, Menogon: FSH and LH, commonly used for superovulation. Side effects in women may include hyperstimulation, soreness around ovaries, bloating and rash. For men, side effects include dizziness, loss of appetite, headache, irregular heartbeat, nosebleeds, and shortness of breath

Metformin, brands Glucophage and Glucophage XR: Metformin is a diabetes medication used to to improve insulin utilization. For several years it has also been used to treat insulin resistance that often accompanies PCOS. For some women it will restore ovulation or improve response to ovulation stimulation medications. Side effects are mostly gastroinstestinal and usually lessen with continued use.It is a Pregnancy Category B medication that is sometimes continued in all or part of pregnancy.

Paternal white blood cell immunization: White blood cells from the father are injected into the mother as a way of fighting certain immune problems. Commonly given when partners are very similar genetically because the woman's body may fail to recognize the pregnancy and fight it.

Progestins, brand Provera: Used to induce a period when there is no natural cycle. Side effects, bloating, headaches, mood swings, swelling of face and extremities, increased blood pressure, and weight gain.

Progesterone, brands Crinone, Prometrium, or compounded at pharmacy: Can be given as suppositories, vaginal capsules, oral capsules/pills, lozenges/troches, Crinone gel applicator, and injections. Used to keep progesterone levels elevated in the luteal phase. Side effects include bloating, cramps, constipation or diarrhea, dizziness, drowsiness, headache, nausea, breast pain or swelling, and pain during intercourse. Serious side effects that warrant doctor consultation include pain, swelling or redness of an arm or leg, one-sided muscle weakness, vision problems, trouble breathing, fainting, itching, or skin rash.

Progynon C (Ethinylestradiol 0.02mg): used to increase thin uterine lining.

Steroids such as dexamethasone and prednisone: used to suppress androgens in women with PCO and for certain immune problems. Side effects include weight gain, blurred vision, and increased thirst. May increase insulin resistance.

Tamoxifen citrate, brand Nolvadex: Used to treat men with elevated estrogen levels. It is also used for women who fail to ovulate. The typical starting dose is 20mg on days 2-5 of the cycle. Women with irregular cycles can start it any time, and the dose may be increased as needed. It is used in a similar manner as clomiphene citrate, but may have less damaging effect on cervical mucus and uterine lining. Side effects include nausea, hot flashes, weight gain, and headache. Any vision changes, vomiting or skin rash require doctor consultation. This medication is used primarily for breast cancer.

Urofollitropins, brands Metrodin and Fertinorm (discontinued): Pure FSH, most often used for superovulation. Received through intra-muscular injection. Side effects include hyperstimulation, abdominal and pelvic pain and bloating.

Urofollitropins, highly purified, brands Fertinex, Fertinorm HP and Metrodin HP: Pure FSH, most often used for superovulation. Received through subcutaneous injection. Side effects include hyperstimulation, abdominal and pelvic pain and bloating. May not be as effective in those with a body mass index over 26 (meaning higher dose may be needed).