The world of infertility treatment can be confusing, especially when you are new to it all. Clomiphene, gonadotropin, leuprolide acetate. It almost sounds like a different language, and we know that if our patients understand the details of their treatment, it will improve their outcomes.
Many people do become familiar with all of the terms, medicines and treatment options after a period of time, but in this fertility primer, we will share some of the basics.
We will include some of the most common options we explore with patients and include descriptions, how they are used, side-effects and associated risks.
Oral medications (pills)
Clomiphene Citrate: This is the oldest fertility drug on the market in the U.S. It is a selective estrogen receptor modulator (SERM) that binds to the estrogen receptor in the brain and uterus, and allows the brain to increase stimulation of the ovary to release one or more eggs each month.
Letrozole: This is a newer medication, designed to prevent breast cancer, as it blocks conversion of testosterone to estradiol. Estradiol levels remain low, allowing the brain to increase stimulation of the ovaries to grow one or more follicles for ovulation. It is taken in the same way as Clomiphene.
How to use: We have our patients start taking the medication on the third through 5th day of a menstrual cycle. You take the pills for five days.
The side-effects associated with these medications are generally minimal and include abdominal bloating, breast tenderness, hot flashes, headache, nausea, and mood changes. If you have pain, headache, or visual disturbances, we ask that you report this to your nurse or doctor. Letrozole used for fertility treatment is off label, so if you have questions, please ask your doctor.
Specific risks associated with the use of clomiphene citrate or letrozole include:
- Multiple pregnancy — Twins occur in approximately 5-10% of pregnancies; triplets or more occur in <1%.
- Ovarian hyperstimulation — Very rare (<1%) after the use of pill medications; if severe, hyperstimulation may require hospitalization.
- Ovarian cancer — A few reports have suggested that prolonged use of clomiphene may be associated with an increased risk of ovarian cancer; larger studies have disproved this association. A history of infertility and/or infrequent menses are associated with an increased risk of ovarian, uterine, and breast cancer. Please speak with your physician if you have concerns about your personal risk of cancer.
Gonadotropin injections
Trade names for gonadotropin injections include gonal-f, follistim, bravelle, and menopur. These medications simulate the hormones that the brain sends to the ovary to grow a follicle each month. When a patient uses these medications, the natural feedback mechanisms that prevent multiple follicles from releasing is blocked, allowing more follicles to grow.
How to use: Gonalf and follistim are pens with the ability to select your specific dose. Once your doctor tells you your dose of medication, you can dial the pen to your dose, inject it into your abdomen, and the pen will release the amount selected. Each pen has a certain amount of overfill (for instance a 300 unit pen may have 50 additional units). They should be stored in the refrigerator. Always save the used pens that may have overfill for possible use in the future.
You can reconstitute the Menopur by using a total of 1cc (1mL) of sterile liquid into the powder and mixing. If you are taking more than one powder (75 units) you can mix the powders into the same 1mL of fluid.
We recommend you take these medications in the evenings at approximately the same time each day.
The risks of this treatment includes ovarian hyperstimulation and multiple pregnancies. The medications are administered early in your cycle, continuing until the follicles are ready for ovulation, around cycle day 10-12.
‘Trigger’ shot
Trade names for the ‘trigger’ shots include ovidrel, pregnyl, and novarel. The injection is purified HCG (the pregnancy hormone). It gets its name, ‘trigger’, because it triggers the final maturation of the egg that results in ovulation. The reason it works, is that HCG has similar properties to LH, which is the natural hormone that results in ovulation. Because it is the ‘pregnancy hormone’, it will cause false positives on urine (and blood) pregnancy tests if taken within 14 days of the injection.
This is given at your physician’s instruction based on the size of follicles that are measured on transvaginal ultrasound, along with the level of estradiol measured in the blood.
To take some of the mystery out of what you can expect when you visit us at Alabama Fertility, get an idea of the different types of fertility testing we do and meet the team you will be working with.