Fertility Medications for Women and Men

Fertility issues are majorly due to your ovulation disorders and fortunately, there are oral medications of hormonal shots that can help to restore your ovulation. So, that you can keep trying with your desire to have a baby.

Fertility medications that are taken orally for ovarian stimulation

When you visit your fertility specialist for getting your fertility issues treated, he/she will recommend ovarian inducing medicines as the first treatment. Ovulation induction is also called Controlled Ovarian Hyperstimulation (COH). These fertility medicines can help in stimulating or triggering ovulation in your ovaries. When you are taking these medicines, your doctor will monitor egg growth by using pelvic ultrasound and blood tests. Ovulation inducing medicines is prescribed when you wish to have a baby through Assisted Reproductive technology ART procedures. These ARTs include IVF and IUI. These medicines can be taken by mouth (orally) or given as injections. There are more chances of having multiple births at the ratio of 1:10 with these orally taken Ovarian stimulating medications, whereas the ratio is 1:90 for natural conception. Oral ovarian stimulation medicines include:

Clomiphene Citrate

This is also called Clomid or Serophene.

Mechanism of working: Clomid causes ovulation by increasing the amount of FSH that is secreted by your pituitary gland. Your doctor will give you Clomid if you have infrequent periods, or absence of periods or if your cycles are longer.

Dosage: The starting dose is 50 mg of Clomid per day for a period of 5 days. You are asked to take them orally on days 2, 3, 4, or 5 of your cycle. The dosage can be increased from 50 mg to 150 mg. 200 mg or 250 mg depending on your response and on your doctors’ treatment protocol.

While on Clomid, your doctor will check the ovulation progress through ultrasound and blood tests. You may get pregnant either by natural sexual intercourse or through IUI. If you didn’t get pregnant with Clomid even after 6 months, then the doctor may recommend either hormone shots or IVF.

Side effects: You may experience very mild side effects that are mostly temporary like bloating, hot flashes, mood swings, vaginal dryness and headache, and rarely cysts in ovaries.

Letrozole

Brand name for Letrozole is Femara.

Mechanism of working: Letrozole triggers ovulation by increasing FSH secretion from your pituitary gland. This oral pill causes your ovaries to produce eggs, helps to correct irregular ovulation, or causes ovulation if you are not ovulating.

Dosage: Femara induces ovulation by causing the suppression of estrogen, which causes increased FSH production. The higher FSH levels will make the ovarian follicle mature and thus triggers ovulation. You may have to take 2.5 mg of Femara per day on your 5th to 9th menstrual cycle days. Sometimes, the dosage may be increased from 2.5 mg to 5 mg of 7.5 mg per day.

Side effects: You may experience mild dizziness and fatigue with Femara. But side effects are less with Femara when compared to that of Clomid.

A prospective randomized trial study was done on 103 infertile women with PCOS to compare Letrozole (5mg) and clomiphene citrate (100mg) as their first line ovulation stimulating drug. The study showed that women taking Letrozole showed an ovulation rate of 73.08% whereas women taking CC (Clomiphene citrate) showed ovulation rates of 60.78%. The pregnancy rate was higher in Letrozole group women at 21.56% whereas in CC group women it was only 7.84% [1].

Fertility Medications Taken as Injections for Ovulation-Induction

If your body does not respond to oral medications like Clomid and Femara, and if you still wish to conceive with IUI, then your doctor might suggest hormonal shots also called Gonadotropins. You can inject these drugs at home starting at low doses initially and then gradually increasing it every 4 to 7 days until the ovaries start responding. The goal of increasing the dosage is to produce only 1 to 2 mature eggs at a time. When you are getting IVF treatment, then the first step is ovulation induction with these hormonal drugs. For IVF, 10 to 15 eggs are to be retrieved per cycle and for this, you will be given an adequate higher dose (not too heavy) of hormone shots. Some of the hormonal shots that can be prescribed by your fertility specialist are:

FSH

Follicle-stimulating hormone shots are commonly known by brand names of Bravelle, Follistim, and Gonal-F. They are under-the-skin injections i.e. subcutaneous injections. These hormone shots act similarly to your natural FSH causing stimulation and maturation of eggs.

Dosage: You are advised to start FSH shots on the 2nd to 4th day of your cycle. The frequency of the shots is either once or twice a day.

hMG

The brand names of hMG are Menopur and Repronex. These are also given under-the-skin and are a combination of LH and FSH, the hormones that play a key role in stimulating the development and maturation of eggs. hMG used for stimulation of egg development in women who do not ovulate spontaneously or who ovulate extremely irregularly.

Dosage: Your doctor will recommend you to start taking hMG shots on day 2 to 4 of your cycle for about 12 days and is to be taken once or twice a day.

Human Chorionic Gonadotropins (hCG)

These shots are given along with FSH and hMG injections to help in triggering ovulation. You can find them in drug stores by commercial names of Ovidrel, Novarel and Pregnyl. This shot is generally referred to as a trigger shot and is given when one or more follicles get mature and release an egg. hMG shot causes the follicle to rupture and release the egg, by mimicking your natural LH surge. You will start ovulating after 36 to 48 hours of taking this injection.

Gonadotropin-releasing hormone agonist (GnRH)

Sometimes, eggs get released much before they are mature, due to high activity of FSH or hMG hormone shots. In such situations, GnRH agonists like Zoladex or Lupron are given so as to stop the release of immature eggs by preventing the LH surge. GnRH shot is only given to you when undergoing IVF treatment for achieving the development of high-quality eggs. You are suggested to get this injected under your skin before you start taking FSH and hMG shots.

Gonadotropin-releasing hormone antagonist (GnRH)

You can identify these GnRH antagonists in chemist stores by brand names of Ganirelix and Cetrotide. To ensure that your eggs are not released soon before they are mature, GnRH antagonists are given. These GnRH antagonists help to prevent a much-earlier LH surge and thus stop the premature release of eggs. They work faster than GnRH agonists and for this reason, you should take GnRH antagonists at least 5 to 7 days after you start taking FSH and hMG shots. They are taken subcutaneously and might be needed when you are not responding well to FSH and hMG or taken as a measure to prevent ovarian hyperstimulation syndrome where your ovaries are responding too well.

Side effects of Injectable Hormone Shots

Side effects are rare and when present you may experience mood swings, tenderness in your breasts, and pain in the abdomen, nausea, and headache. Most of the time when you are taking hormone shots you may notice an increased secretion of cervical mucus and very rarely ovarian hyperstimulation syndrome is experienced.

you may always think that fertility medicines are available only for women, but it is not true. There are several medicines that can help to improve fertility levels in men as well. These fertility drugs can be in the form of hormonal therapy or fertility injections that can help with improving the structure and motility or movement of your sperms. They are to be used strictly under fertility specialist supervision to avoid any adverse side effects. The following are a few commonly used fertility medications for treating your male infertility factors. We have listed information on their usage, possible risk factors, and side effects. These male fertility medications are:

Clomiphene citrate

The brand name for clomiphene is Clomid and it is not only used for female infertility treatment but also prescribed for your low sperm count problem which is due to low testosterone levels.

Mechanism of action: When you take Clomid, it will make your pituitary gland to prepare more amounts of FSH and LH. Higher levels of FSH and LH in turn result in the natural production of testosterone and sperm in your testes, thereby, your sperm count, morphology, and motility can be improved. The boosted levels of FSH and LH hormone induced by Clomid helps to reduce your symptoms of hyperandrogenism, increases your sperm count, and potentially improves non-obstructive Azoospermia condition, which is a blockage that is preventing the sperms from entering the semen. Among 42 men with non-obstructive Azoospermia, after Clomid dosage, the semen analysis reports that 64.3% of men have shown the presence of sperms at 1 to 16 million sperm/mL and a sperm density of 3.8 million/mL [2].

Benefits of Clomid: Studies have shown that there is an enhanced sex drive, lengthier and harder erections, and more energy to do sexual intercourse, increased muscle mass, and weight loss. There is research-based evidence that 10% of men having Azoospermia noticed the returning of sperm in their ejaculate after 3 months of clomiphene intake [3].

Possible side effects with Clomid: If you are on Clomid treatment, you may experience the following:

• Change in sex drive
• Mood changes
• Irritability and aggression.
• Mild acne
• Headaches
• Altered energy levels
• Blurring of vision due to changes in the field of vision, which is very rare.
• Enlarged prostate
• Tenderness of pectoral or breast muscles

The above side effects can stop once you stop taking your medication. Visit your doctor immediately once you start experiencing any of the above symptoms. A retrospective study was done on 400 men, to identify the efficacy and safety of clomiphene when it is taken for more than 3 years. The results showed that, with more than 3 years of Clomid intake, only a few side effects like mood changes, blurring vision, and breast tenderness was observed and no adverse events happened [4].

Anastrozole

Anastrozole, also known as Arimidex is generally given for women having breast cancer.

Mechanism of work: Aromatase is a hormone that prevents the changing of testosterone into estradiol. Anastrozole works by blocking the receptors of aromatase enzymes and helps your testosterone levels to rise and to lower your estrogen levels. Anastrozole is prescribed by your doctor when your testosterone levels are low and when estradiol levels are higher.

Effectiveness of Anastrozole: The symptoms that are associated with hyperandrogenisms like reduced muscle mass, low sexual drive, fewer energy levels, and erectile dysfunction are significantly reduced with Anastrozole intake.

Benefits: You can notice a significant improvement in your sperm count, sperm motility, and morphology. The sperm recovery rate in Azoospermia is improved with Anastrozole. A controlled study showed that a small dose of Anastrozole at 1 mg daily for 12 weeks will improve naturally available testosterone levels in older men [5].

Side effects: Once you start taking Anastrozole, you may notice the following side effects like.

• Trouble in sleeping
• Cough
• Increased count in red blood cells (RBC)
• Bone or muscle pain
• Increased liver enzymes
• Nausea and stomach pain
• Headache
• The abnormal tingling sensation of hands and feet
• Infections of throat
• Rare and severe effects include blood clots, cataracts, and Stevens-Johnson syndrome (a rash that is caused due to your drug intolerance)

hCG or hMG

If your body does not respond to clomiphene citrate then your doctor will prescribe you hCG or hMG injections. hCG is a hormonal treatment that can increase testosterone levels if you have low testosterone or Hypogonadism due to deficient testosterone. This hCG injection is rarely preferred as it involves 2 to 3 injections per week.

Mechanism of action: Human chorionic gonadotropin acts by triggering your testes to prepare their own testosterone and thus improve sperm production. Your doctor may suggest adding hMG injections to your treatment regimen if there is no improvement in your sperm count even after six months. hMG is a Menotropin, a mixture of hormones that are naturally produced by the pituitary gland that helps your reproductive system. You should take these medications together for a period of 12 months to see the desired results.

Benefits of hCG

Fertility treatment with hCG is found to cause increased energy and strength, increased libido, and mood in hypogonadism men.

Side effects

• hCG intake may include some of the side effects such as:
• Changes in your libido and mood
• Weight gain
• Feeling of pain at the site of injection
• Enlarged prostate gland
• Increased risk of having blood clots

A study was done on idiopathic normogonadotrophic oligozoospermia men by treating them with hMG and hCG for a period of 3 months. Their total sperm output was increased by an average of 15.3 million sperms per ejaculate and an increase in motile sperm was also seen [6].

Sometimes, there might be an underlying disease that is causing issues with your fertility. In such cases, those particular issues must be treated first. When the underlying problem is treated correctly, it may be enough to improve your fertility. This may help you to conceive on your own after the proper care and treatment. Sometimes, the solution to your infertility may be a combination of medical treatment or surgical procedures along with fertility drugs. Some of the commonly prescribed drugs to deal with issues that cause trouble in conceiving are:

Dopamine agonists

Brand names of Dopamine agonists are Parlodel, Dostinex. The doctor prescribes these drugs when there is hyperprolactinemia, a condition in which prolactin hormone levels are abnormally high. With higher prolactin levels, you may face irregular ovulation or absence of ovulation and in your partner, it can cause low sperm count.

Mechanism of working: Prolactin is a hormone that can prevent ovulation and implantation to happen, and can also result in repeated loss of pregnancy. Dopamine agonists act by causing a decrease in this Prolactin.

Dosage: They are taken in the form of pills by mouth.

Side effects: The possible side effects of Dopamine agonists are headaches, dizziness, and nasal congestion.

If no other condition predominates, these drugs can help to bring back your fertility by causing ovulation and normal sperm production.

Levothyroxine

You can identify Levothyroxine with brand names of Synthroid, Levoxyl, and Levothroid in drug stores. Hyper or hypothyroid functioning can also cause fertility issues either in you or in your partner. You may suffer irregular periods while your partner may have a lower sperm count.

Mechanism of action: These drugs improve your fertility by restoring your thyroid hormones to normal levels.

Dosage: You need to take them by mouth as pills.

Metformin

Mechanism of action: Metformin, is prescribed to lower your blood sugar levels and acts to treat type 2 Diabetes and also Pre Diabetic conditions seen in polycystic ovarian syndrome (PCOS).

Dosage: The doctor asks you to take Metformin pills by mouth.

Aspirin

If you have a history of repeated miscarriage or a personal history of tiny blood clots forming that can lead to pregnancy loss, then the doctor suggests you to take a daily dose of baby aspirin or prescribes you with heparin injections.

Progesterone

If you have experienced a recurrent miscarriage in the past or have a history of luteal phase defect, then your doctor will give you progesterone supplements. They can be in the form of either vaginal suppository or as injections.

Estrogen

You are advised to take estrogen vaginal suppositories if there is a diagnosis of a thin endometrial lining, or if you suffer from vaginal dryness or pain during sexual intercourse, or if there is a need to improve the quality of your cervical mucus

Antibiotics

If the infection of the reproductive system remains untreated it may cause infertility in both you and your partner. Some of the infections can cause damage to organs like scarring of fallopian tubes or uterus that can prevent sperm from meeting with the egg.

If the cause of your infertility is due to infections, then taking antibiotics for that particular infection generally is enough to improve fertility. But if there is blockage or severe scarring of fallopian tubes or fluid in your tubes then you may require a surgical procedure or IVF treatment to get pregnant.

As with all other medications, fertility medications for men and women do have contraindications when they are taken along with other medicines and supplements. So, it is your responsibility, to be honest with your fertility specialist about all other medicines that you take.