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What do fertility drugs for women do?
For many infertile couples, fertility drugs are the first step in treatment. Fertility drugs work by increasing the levels of certain hormones in your body. These hormones help to mature and release one or more eggs each month (ovulation).If you ovulate rarely or irregularly, fertility drugs could help you (NCCWCH 2013). Fertility drugs are also necessary as part of some assisted conception treatments, such as IVF (NCCWCH 2013).
Some fertility drugs are used in IVF treatment cycles because controlling the development and release of eggs from your ovaries can increase your chance of success (NCCWCH 2013).
Many fertility drugs have been used safely and successfully for decades. But some can result in severe side-effects and a higher chance of multiple pregnancy (NCCWCH 2013). Bear in mind that monitoring by a fertility specialist using ultrasound scans will significantly reduce the risks (NCCWCH 2013).
Which fertility drugs for women are available?
The most popular fertility drugs for women are:All of these drugs help ovulation to occur, but which one is right for you will depend on the reasons you are having difficulty ovulating and conceiving.
Clomifene citrate
Clomifene citrate blocks the effect of the hormone oestrogen in your body. This blocking effect tricks your body into bumping up levels of two other hormones that are essential for ovulation. These two other hormones are:
- follicle-stimulating hormone (FSH)
- luteinising hormone (LH)
FSH causes the eggs in your ovaries to ripen, ready for release. LH triggers the release of one or more mature eggs from the ovary follicles. The egg or eggs then move down into one of your fallopian tubes.
You usually take clomifene in pill form for five days early in your cycle, for up to six months at a time (NCCWCH 2013). Brand names for clomifene citrate are Clomifene and Clomid.
Metformin hydrochloride
Metformin hydrochloride is a drug that makes the body more sensitive to the hormone insulin. It is licensed as a treatment for diabetes but is also effective for treating ovulation problems in women with polycystic ovary syndrome (PCOS) (NCCWCH 2013). It may be used on its own or in combination with clomifene. But some experts believe that Clomid is more effective for ovulation induction than metformin.
Metformin is more likely to be useful for women who are obese, as they are more likely to have problems with their insulin levels. It may also be useful for women who are resistant to the effects of clomiphene when it is used on its own (NCCWCH 2013).
You take metformin daily in several doses (NCCWCH 2013). It works by lowering levels of insulin circulating in your blood and this in turn can lower testosterone levels and help the body to ovulate normally. You may be prescribed metformin under the brand name Glucophage.
Gonadotrophins
Luteinising hormone (LH) and follicle-stimulating hormone (FSH) are types of gonadoptrophins. LH and FSH directly stimulate your ovaries to produce and ripen eggs. Gonadotrophins are usually used for women with PCOS who have not responded to other drugs or for women undergoing IVF (NCCWCH 2013).
FSH, which is generally the only hormone needed to develop your eggs, can be taken as a course of injections over about 12 days. The injections make your ovaries start to develop and mature egg follicles. The injections of FSH will be followed by a final injection of another hormone, called human chorionic gonadotrophin (hCG).
hCG tells your ovaries to release the egg (or eggs) that they have just developed. While LH stimulates the follicle to release the egg in a natural cycle, hCG is structurally similar to LH and has the same physiological effect on the ovaries causing final maturation and egg release.
Following egg release some patients may require further hormone supplementation with hCG to ensure adequate levels of progesterone release from the ovaries. In some cases progesterone supplementation will be given in the form of pessaries or injections.
There are several brand names for gonadotrophins. Menopur contains FSH and hCG. Gonal F and Puregon contain FSH only. Ovidrel and Pregnyl contain hCG.
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