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Fertility Drugs Used to Induce Ovulation
The following common fertility drugs are used for ovulation induction.
Clomiphene Citrate -- Seraphene and Clomid
Clomiphene citrate induces ovulation by blocking estrogen receptors. This artificial estrogen effect causes your body to believe estrogen levels are low, which stimulates the production of more follicle stimulating hormone (FSH) and leutinizing hormone (LH).
Clomiphene citrate is available as 50 milligram tablets. The dosage range is 25 milligrams (1/2 tablet) to 150 milligrams (three tablets) once a day for five days early in a woman's menstrual cycle -- frequently cycle days two through six. The dosage and the days the drug is taken are determined by your doctor based on your diagnosis.
Some form of monitoring is necessary while you are taking clomiphene citrate and may include ultrasounds, blood estrogen levels and/or urinary LH testing.
Side effects may include:
- Hot flashes
- Ovarian enlargement
- Breast tenderness
- Nausea
- Vomiting
- Visual disturbances
- Headache
- Multiple pregnancy
Human Menopausal Gonadotropin (hMG): LH/FSH -- Pergonal, Humegon and Repronex
Human menopausal gonadotropin (hMG) is a medication that is composed of follicle stimulating hormone (FSH), with or without leutinizing hormone (LH), and is used to stimulate egg development in women who do not ovulate spontaneously, who ovulate extremely irregularly or, in IVF, to increase the number of eggs developed in a single cycle. Due to the variability in response from patient to patient no fixed dosage regimen can be recommended and each patient and cycle must be individualized.
Some form of monitoring of the ovarian response is necessary. A combination of blood estrogen measurement (E2) and a href='/adult/adam/data/003336.html'>ultrasound is the best approach at the present time.
hMG is available only in an injectable form. Therefore, your partner will be taught intramuscular (IM) or subcutaneous (SQ) injection techniques. This injection should be given between 6 and 10 p.m. each evening.
Side effects may include:
- Ovarian enlargement
- Hyperstimulation syndrome
- Multiple gestation
- Abdominal pain
- Headache
In addition, discomfort and bruising may occur at the injection site. Monitoring, with ultrasounds and estradiol level tests, minimizes the risk of complications.
Follicle Stimulating Hormone (FSH) -- Follistim and Gonal-F
Follistim and Gonal-F are genetically engineered, or recombinant, forms of follicle stimulating hormone (FSH), which is used to stimulate the recruitment and development of multiple eggs in women during an ovulation induction cycle. FSH products may be used alone or in combination with human menopausal gonadotropin (hMG).
Due to the variability in response from patient to patient, no fixed dosage regimen can be recommended and each patient cycle must be individualized. This requires that ultrasounds and blood estrogen levels be used to assess ovarian response.
FSH is available only in an injectable form. Therefore, you will need to learn injection techniques -- specifically, subcutaneous (SQ) injection techniques. If FSH and hMG are used together, a single injection is possible. As mentioned above, this injection should be given between 6 and 10 p.m. each evening.
Side effects may include:
- Ovarian enlargement
- Hyperstimulation syndrome
- Multiple gestation
- Abdominal pain
- headache
In addition, discomfort and bruising may occur at the injection site. Monitoring with ultrasounds and estradiol minimizes the risk of complications.
Human Chorionic Gonadotropin (hCG) -- Profasi or Pregnyl
Human chorionic gonadotropin (hCG) is a natural hormone that helps with the final maturation of the eggs and triggers the ovaries to release the mature eggs. It also stimulates the corpus luteum to secrete progesterone to prepare the lining of the uterus for implantation of the fertilized egg. Ovulation usually occurs about 36 hours after the hCG is given.
hCG is available in an injectable form. Therefore, you and your partner will be taught intramuscular (IM) injection techniques.
Side effects may include:
- Headaches
- Irritability
- Restlessness
- Depression
- Fatigue
- Edema
- Ovarian hyperstimulation
Leuprolide (Lupron) and Synthetic Gonadotropin (FSH/LH) Inhibitor
Lupron suppresses the brain's secretion of more leutinizing hormone (LH) and follicle stimulating hormone (FSH). Therefore, it is used in preparation for cycles of treatment with ovulation induction drugs, such as exogenous hMG-LH/FSH and or FSH. It improves the recruitment of follicles by preventing the recruitment of a dominant follicle for the next menstrual cycle. Lupron enables the ovaries to respond with the recruitment of multiple follicles since in most cases we are able to override the selection of a single dominant follicle. It also will prevent premature ovulation by preventing LH release.
To confirm the effectiveness of the Lupron treatment, an ultrasound will be performed before the ovarian stimulation is begun and a blood estrogen level test may be required. Lupron also may be used to stimulate FSH if it is used early in the menstrual cycle. This property of the drug is helpful in patients expected to respond poorly.
Lupron is available in an injectable form. Therefore, you and your partner will be taught the subcutaneous (SQ) injection technique. The multiple-dose vial should be kept cool, at less than 75 degree Fahrenheit, which can be achieved through refrigeration. This drug should be given at the same time everyday, with one hour leeway. If you are starting Lupron after a spontaneous menstrual cycle, you should use barrier contraception for the preparatory cycle.
Side effects may include:
- Hot flushes
- Vaginal dryness
- Skin rash
In addition, side effects of long-term treatment that is longer than six weeks include hot flushes, vaginal dryness and bone loss. These side effects are extremely rare after short-term use associated with standard IVF and no long-term side effects occur after treatment.
More Information:
Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
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