As couples make the decision to seek fertility treatment, they may often become quickly overwhelmed with all the different medications they will need to take. Before treatment begins, fertility patients will likely learn about their treatment protocol, which may include taking drugs that provide or suppress hormone activity.

Obviously physicians practicing in this area of medicine understand all the medications and the best protocols for patients, but may not always have the time to explain in great detail all the drugs and why they are being used. Here, we will help better explain fertility medications, including simple explanations about the purpose and timing at which they are being prescribed.

We have all heard the expression “Knowledge is Power”, and understanding your fertility medications before you seek treatment can only help your chances of achieving a pregnancy.

Contributed by: Russell Gellis, Rph, is President and owner of Apthorp Pharmacy, which has been serving customers in New York City since 1910. Gellis holds a BS in Pharmacy from St John’s University.

Disclaimer – this article was not written by a physician and should not in any way be considered as substitute for the medical advice of your healthcare provider.

Help me understand the different fertility medications.

FSH and LH Medications:

Just like the natural FSH produced by the brain, commercially produced FSH drugs also act on the ovaries to produce follicles and eggs. The following FSH drugs listed below are commonly prescribed today: Follistim, Gonal-f, and Bravelle.

Common Dosage: All FSH preparations require injections. Gonal F, Bravelle, and Follistim are all injected just beneath the skin (subcutaneous injections). Injections start on day 2, 3, or 4 at 75 IU (international units) to 225 IU or more per day. Dosage may be adjusted as the cycle progresses. This will be determined through blood (measuring estrogen-estradiol levels) and ultrasound monitoring (measuring follicular growth

Menopur and Repronex, hMG also act on the ovaries to produce follicles and eggs but contain equal amounts of both FSH and LH. Physicians often prescribe these medications because they have LH activity, and it is theorized that LH is essential to the follicles ability to produce the hormone estrogen. It is not uncommon for physicians to use both FSH only drugs and FSH and LH drugs in combination in the same treatment protocol.

Dosage: hMG comes in vials of 75IU (international units) or 150 IU of FSH and LH. It is given by subcutaneous injection once or twice a day. Doses vary depending on patient response and type of treatment.

HCG:

The next class of medications contains HCG (human chorionic gonadotropin) activity, and are prescribed to mimic the LH surge that occurs in the natural menstrual cycle. From the onset, this may not make sense because HCG was described as a hormone being produced by the implanted embryo in the natural menstrual cycle.

To mimic the natural LH surge, physicians can prescribe a single dose of HCG to final grow the eggs because HCG has the same biological activity as LH. HCG will cause your follicles to rupture, like an LH surge does in a natural menstrual cycle. However, your physician will schedule your egg retrieval well before follicle rupture will occur.  The following HCG drugs listed below are commonly prescribed today: Pregnyl, Novarel, Ovidrel, and HCG (Generic).

GnRH Agonist and antagonist Medications:

While HCG medications reflect naturally occurring hormones in the natural menstrual cycle, the next two medications we will discuss are hormones that impact the action of GnRH (gonadotropin releasing hormone). Naturally occurring GnRH is produced by the hypothalamus in the brain and works with the pituitary gland to produce both FSH and LH.

GnRH agonists are synthetic drugs that cause the release of FSH and LH initially but with continued use quickly suppress these hormones, thereby creating a clean slate on which to create a controlled ovarian hyperstimulation cycle for IVF.

GnRH antagonists are used in controlled ovarian hyperstimulation cycles for IVF.GnRH agonists and antagonists are prescribed by physicians during fertility treatment to essentially disable the pituitary gland from producing both LH and FSH. So if FSH and LH are so important to helping the ovary produce follicles and eggs, why would a physician want to disable the production of these two hormones during an IVF treatment protocol?  Simply put the answer is control: Allowing the physician to have control over the patient’s response to medications that are prescribed. If a physician prescribes hormones like FSH and LH and then allows the body to also produce its own hormones, the cycle may be become unpredictable and result it poor outcomes.

The GnRH Agonist medications are:  Leuprolide Acetate Injection (Generic), Synarel

Dosage: Short acting GnRH agonists come in two forms: Lupron, a drug taken by subcutaneous injection daily, and Synarel, a nasal spray taken twice a day. The long acting form is taken by injection once a month

The GnRH antagonists are: Ganirelix Acetate Injection and Cetrotide

Dosage: The drug is given by subcutaneous injection, usually starting on cycle day 8, and continued for several days. It is given in combination with ovulatory stimulating drugs.

Progesterone Medications:

The last group of medications are the progesterone products. Progesterone production is generated by the corpus luteum, and is essential for helping maintain a pregnancy. The vast majority of physicians will prescribe progesterone shortly after the egg retrieval to prepare the uterine lining for embryo implantation. If it’s discovered that the IVF treatment cycle resulted in a successful pregnancy, progesterone is often times continued for the first 6-12 weeks post pregnancy.

Progesterone products discussed above are commercially available under the following drug names: Crinone, Endometrin, Prometrium and Progesterone in Oil injection.

What are some other medications that my doctor may prescribe?

Aspirin:

Aspirin is used alone or with Heparin to reduce the risk of recurrent spontaneous pregnancy loss. In addition, it is often used for the prevention of miscarriage.

Heparin:

Heparin is used on its own or in conjunction with aspirin to prevent recurrent pregnancy loss due to elevated levels of antiphospholipid antibodies.

Clomiphene Citrate (Clomid, Serophene):

If your basic infertility work-up indicates that you are not ovulating regularly or if you are ovulating very late or early in the cycle, your physician may suggest clomiphene citrate.  In women, clomiphene is used to induce ovulation, to correct irregular ovulation, to help increase egg production, and to correct luteal phase deficiency.

Common dosage: Clomiphene comes in 50-mg tablets. The usual starting dose is one tablet on day 3, 4, or 5 of your cycle, and for 5 days afterward. Ovulation usually occurs on cycle day 13 to 18. If you do not ovulate, your physician may increase the dose in increments in future cycles; the maximum dose is usually 200mg daily. The American Society for Reproductive Medicine (ASRM) recommends that clomiphene be prescribed for three to six cycles only.

Bromocriptine Mesylate and Cabergoline:

Parlodel and Dostinex: In both men and women, hyperprolactinemia (overproduction of the hormone prolactin) can cause fertility problems by interfering with the normal production of FSH and LH.

Dosage: Bromocriptine, an oral medication, comes in 2.5-mg (milligram) tablets. Because bromocriptine may cause gastrointestinal discomfort and dizziness, most physicians suggest taking one-half tablet per day at first, then slowly increasing it to 2.5 mg per day.

These medications are some of main drugs prescribed during fertility treatment, but do not represent by far all drugs being used to treat infertility today.