Infertility can be overwhelming. Not only are you faced with the shock of not being able to have a child, but suddenly you are thrust into learning an entirely new language. This section of our site is intended to provide you with factual information on the most common fertility drugs. Your physician and medical team will discuss use of the drugs that are appropriate for you. Be sure to properly store all medications to ensure their potency.
Cetrotide (cetrorelix acetate)
Used in assisted reproduction to inhibit premature luteinizing hormone (LH) surges. The drug works by blocking the action of GnRH upon the pituitary, thus rapidly suppressing the production and action of LH and FSH. It is administered as either multiple 0.25 mg daily subcutaneous injections or as a single-dose 3 mg subcutaneous injection. The duration of the 3 mg single dose is four days; if hCG is not administered within four days, a daily 0.25 mg dose is started and continued until hCG is administered. In IVF use it is injected daily after follicle stimulation has been initiated and evidence of follicle maturation is approaching; given daily it prevents an endogenous LH surge that would trigger an untimely ovulation prior to the hCG administration by the treating physician.
Watch an instruction video for preparing and administering Cetrotide here.
Clexane (Enoxaparin sodium)
An anticoagulant given as a subcutaneous injection. Clexane contains the active ingredient enoxaparin, which is a type of medicine called a low molecular weight heparin. In fertility treatment it is used to thin the blood and the theory is that it helps implantation and helps prevent miscarriage.
Watch an instruction video for preparing and administering Clexane here.
Clomid / Fertomid (Clomifene / clomiphene citrate)
Clomid/Fertomid is used to stimulate ovulation (the release of an egg) when a woman’s ovaries can produce a follicle but hormonal stimulation is deficient. It is also used to correct irregular ovulation, to help increase egg production, and to correct luteal phase deficiency.
Therapeutically, clomifene is given early in the menstrual cycle. It is typically prescribed beginning on day 3 and continuing for 5 days. By that time, FSH level is rising steadily, causing development of a few follicles. Follicles in turn produce the estrogen, which circulates in serum. In the presence of clomifene, the body perceives a low level of estrogen, similar to day 22 in the previous cycle. Since estrogen can no longer effectively exert negative feedback on the hypothalamus, GnRH secretion becomes more rapidly pulsatile, which results in increased pituitary gonadotropin (FSH, LH) release. Increased FSH level causes growth of more ovarian follicles, and subsequently rupture of follicles resulting in ovulation. Ovulation occurs most often 6-7 days after a course of clomifene.
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.
(Sources: Wikipedia & Resolve)
In recent times Covort has been prescribed for the same reasons as Meticorten.
In some women, insufficient progesterone is produced during the luteal phase and this causes problems with implantation of fertilised eggs into the womb lining and maintaining a pregnancy in the early stages. Crinone vaginal gel is used to treat this hormone deficiency. One applicatorful is inserted into the vagina every day, starting either one day after ovulation is known to have occurred, or on day 18 to 21 of the woman’s cycle. (Day one is the first day of your period.) The gel is usually continued until the placenta is producing enough progesterone to support the pregnancy. Crinone vaginal gel is also used to support pregnancy in women having IVF. In this case the gel is used daily, starting after the embryo has been transferred into the womb, for the first 30 days of confirmed pregnancy. The gel is inserted into the vagina from the pre-filled applicator. The gel coats the inside of the vagina and provides prolonged release of progesterone into the vagina, from where it is absorbed into the bloodstream.
Cyclogest / Utrogestan (Progesterone)
Cyclogest/Utrogestan pessaries contain the active ingredient progesterone, which is a naturally occurring female sex hormone. Cyclogest/Utrogestan pessaries are inserted either into the vagina or rectum. In both cases, the pessaries melt and the progesterone from the pessaries is absorbed into the bloodstream via the the rich supply of blood vessels in these areas.
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.
Estrofem / Estropause (Estradiol / Oestradiol)
Estrogen therapy may be used in treatment of infertility in women when there is a need to develop sperm-friendly cervical mucus or an appropriate uterine lining. In the female, estradiol acts as a growth hormone for tissue of the reproductive organs, supporting the lining of the vagina, the cervical glands, the endometrium, and the lining of the fallopian tubes. It enhances growth of the myometrium. Estradiol appears necessary to maintain oocytes in the ovary. During the menstrual cycle, estradiol produced by the growing follicle triggers, via a positive feedback system, the hypothalamic-pituitary events that lead to the luteinizing hormone surge, inducing ovulation. In the luteal phase, estradiol, in conjunction with progesterone, prepares the endometrium for implantation. During pregnancy, estradiol increases due to placental production.
Femodene & Minulette (Gestodene & ethinylestradiol)
Femodene/Minulette tablets are a type of hormonal contraception commonly known as ‘the pill’ or combined oral contraceptive pill. Femodene/Minulette tablets contain two active ingredients, ethinylestradiol and gestodene. These are synthetic versions of the naturally occurring female sex hormones, oestrogen and progesterone. Ethinylestradiol is a synthetic version of oestrogen and gestodene is a ‘third generation’ synthetic form of progesterone. Combined oral contraceptives like Femodene/Minulette work by over-riding the normal menstrual cycle. In a woman’s normal menstrual cycle, levels of the sex hormones change throughout each month. The hormones cause an egg to be released from the ovaries (ovulation) and prepare the lining of the womb for a possible pregnancy. At the end of each cycle, if the egg has not been fertilised the levels of the hormones fall, causing the womb lining to be shed as a monthly period.
The daily dose of hormones taken in the pill work mainly by tricking your body into thinking that ovulation has already happened. This prevents an egg from ripening and being released from the ovaries each month.
The hormones also increase the thickness of the natural mucus at the neck of the womb, which makes it more difficult for sperm to cross from the vagina into the womb and reach an egg. They also change the quality of the womb lining (endometrium), making it less likely that a fertilised egg can implant there. Used in fertility treatment to prevent ovulation and regulate and plan a cycle.
Fragmin (dalteparin sodium)
Similar to Clexane. Fragmin injection contains the active ingredient dalteparin sodium, which is a type of medicine called a low molecular weight heparin. It is used to stop blood clots forming within the blood vessels. Dalteparin is given by subcutaneous (under the skin) injection, usually in the lower abdominal area. In fertility treatment it is used to thin the blood and the theory is that it helps implantation and helps prevent miscarriage.
Gestone / Prontogest (Progesterone)
Gestone/Prontogest injections contain the active ingredient progesterone, which is a naturally occurring female sex hormone. These injections are used in the treatment of menstrual disorders, in assisted reproduction and to help maintain early pregnancy in women who have had recurrent miscarriages. Progesterone is essential for the normal functioning of the reproductive system. The body produces progesterone at certain times of the menstrual cycle and this hormone regulates the growth and shedding of the womb lining.
In some women, insufficient progesterone is produced during the luteal phase and this causes problems with implantation of fertilised eggs into the womb lining and maintaining a pregnancy in the early stages. Gestone/Prontogest is used to treat this hormone deficiency and help a pregnancy to continue in women who have had three or more miscarriages. The injections are normally started on about day 15 of the woman’s cycle (day one is the first day of your period.). The injections are usually continued until the placenta is producing enough progesterone to support the pregnancy.
The injections can also be used to support pregnancy in women having infertility treatment with in vitro fertilisation (IVF) or gamete intra-fallopian transfer (GIFT). In this case the injections are started on the day the embryo or gametes have been transferred into the womb, to help implantation of the fertilised egg into the lining of the womb. The injections are continued for up to 16 weeks until the placenta is producing enough progesterone to support the pregnancy.
The injections are given into the muscle of the buttock (intramuscularly).
Gonal-F (Follitropin Alfa) / Fostimon (urofollitropin)
Gonal-F/Fostimon injections contain an active ingredient which is a synthetic version of a natural sex hormone called follicle stimulating hormone (FSH). It is used in the treatment of infertility. FSH directly affects the ovaries in women and the testicles in men. In the ovaries in women, FSH increases the number of growing follicles and stimulates their development. Within the follicles are the developing eggs. FSH also increases the production of oestrogen, and under the influence of this hormone, the largest follicle continues to develop. Follitropin alfa & Urofollitropin has the same effects as the natural hormone.
This medicine is used to stimulate the development of follicles and eggs in women who are having difficulties getting pregnant due to problems with ovulation. It is used for women who have tried treatment with clomifene, eg Clomid, when this has been unsuccessful. It may also be used in women who are infertile due to a severe deficiency of the hormones FSH and LH, in which case it is used in combination with a synthetic LH medicine. This medicine can also be used to stimulate multiple follicles and eggs to develop in women who are having assisted conception treatments such as in-vitro fertilisation (IVF).
In men, FSH is involved in the production and development of sperm in the testicles. This medicine is used to increase sperm production in men who have a low sperm count as a result of low hormone levels. It is also used in combination with human chorionic gonadotrophin HCG, which increases the production of testosterone in the testicles and helps the FSH to work.
Dosage: All FSH preparations require 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).
(Sources: www.netdoctor.co.uk and Resolve)
Watch an instruction video for preparing and administering Gonal-F here.
Intralipids (Intralipid® 10%/20% emulsion for infusion)
Intralipid is a brand name for the first safe fat emulsion for human use, approved in 1962 in Europe. It is a synthetic emulsion of soy bean oil, egg phospholipids and glycerin (1.2% egg yolk phospholipids, 10% soybean oil, 2.25% glycerin and water). Intralipids have a suppressive action on certain components of the mother’s immune system, essentially safeguarding the embryo from the immune reactions which might otherwise result in implantation failure. Evidence from both animal and human studies suggest that intralipids administered intravenously may enhance implantation. Some fertility specialists advocate aggressive treatment of immunologic implantation dysfunction in women undergoing IVF treatment. In cases where there has been NK cell activation they recommend the use of intralipids to down regulate (deactivate) the NK cells. Intralipids have been shown to lower the activity of the NK cells component of our immune system. Studies have found that intralipids can help to regulate the NK cells, allowing the embryo to implant on the uterine wall and grow normally. New research has suggested that women who have experienced recurrent miscarriages or multiple failed IUI or IVF cycles as a result of NK cell activation may benefit from the use of intralipids. The method of administration is an IV infusion of around 3 hours’ duration and requires that you are not allergic to soy or egg products, and also do not have a history of high cholesterol or liver disease. It is administered 4-7 days before embryo transfer or insemination. Intralipids are re-administered 4-5 weeks following a positive pregnancy test, to keep the NK cells deactivated until the pregnancy can override the signals being sent by the immune system.
Lucrin / Lupron (Leuprorelin acetate)
Lucrin belongs to a group of medicines called gonadotropin releasing hormone (GnRH) agonists. GnRH agonists are synthetic drugs that cause the release of FSH and LH initially but with continued use quickly suppress these hormones. GnRH agonists are used to prevent premature release of eggs in IVF or gamete intrafallopian transfer (GIFT) and to treat endometriosis or to shrink fibroids. Daily Lucrin injections are administered subcutaneously, whereas the once-off or monthly Lucrin Depot injection is administered intra-muscularly. (Source: Wikipedia)
Menonys / Ovidrel / Pregnyl (hCG)
Available in 75 iu and 150 iu injections.
Human chorionic gonadotropin (HCG) is a hormone that supports the normal development of an egg in a woman’s ovary, and stimulates the release of the egg during ovulation. HCG is used to cause ovulation and to treat infertility in women, and to increase sperm count in men. In the presence of one or more mature ovarian follicles, ovulation can be triggered by the administration of hCG. As ovulation will happen between 38 and 40 hours after a single hCG injection, procedures can be scheduled to take advantage of this time sequence, such as intrauterine insemination or sexual intercourse. Patients that undergo IVF, in general, receive hCG to trigger the ovulation process, but have an oocyte retrieval performed at about 34 to 36 hours after injection, but a few hours before the eggs actually would be released from the ovary. Administered by subcutaneous or intramuscular injection.
Some women using this medicine have developed a condition called ovarian hyperstimulation syndrome (OHSS), especially after the first treatment cycle. OHSS can be a life-threatening condition. Call your doctor right away if you have any symptoms of OHSS: severe pelvic pain, swelling of the hands or legs, stomach pain and swelling, shortness of breath, weight gain, diarrhea, nausea or vomiting, and urinating less than normal. (Source: www.drugs.com & Wikipedia)
Watch an instruction video for preparing and administering Ovidrel here.
Menopur (Human Menopausal Gonadotropin (FSH & LH) )
Menopur injection contains human menopausal gonadotrophin (sometimes known as menotrophin) as the active ingredient. Human menopausal gonadotrophin is a combination of two naturally-occurring female hormones, follicle stimulating hormone (FSH) and luteinising hormone (LH). In the ovaries, FSH and LH increase the number of growing follicles and stimulate their development. Within the follicles are the developing eggs. FSH also increases the production of oestrogen and under the influence of this hormone the largest follicle continues to develop. As the amount of oestrogen in the blood increases, this triggers a surge of LH, which results in the final maturation and release of an egg from the ovary (ovulation).
This medicine is used to stimulate the development of a mature follicle and egg in women who are having difficulties getting pregnant due to problems with ovulation. It is used for women who have tried treatment with clomifene, eg Clomid, when this has been unsuccessful.
When the follicle has developed appropriately, another medicine called human chorionic gonadotrophin (HCG) is given, which causes ovulation to happen. This medicine can also be used to stimulate multiple follicles and eggs to develop in women who are having assisted conception treatments such as IVF. The injections are administered either under the skin (subcutaneously) or into a muscle (intramuscularly).
Dosage: hMG comes in ampules 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.
(Source: www.netdoctor.co.uk & Resolve)
Watch an instruction video for preparing and administering Menopur here.
Prednisone is used as an anti-inflammatory or an immunosuppressant medication. Prednisone also suppresses the immune system. Tablets are taken orally. According to the Arizona Fertility Clinic, “In the field of reproductive endocrinology and infertility, steroids or prednisone, can be used for the treatment of antisperm antibodies; and in females, for the treatment of repeated pregnancy loss as well as antisperm antibodies. It is usually given in low doses 5 or 10 mg daily, and for short periods of time, 6 months.
The mechanism of action is to decrease the immune system’s production of either antisperm antibodies or the elevated phospholipid antibodies found in some patients with repeated pregnancy loss. There is some evidence that empiric treatment with low dose steroids may be beneficial in repeated pregnancy loss, even when the autoimmune testing has been negative.”
Growth hormone (GH or HGH), also known as somatotropin or somatropin, is a peptide hormone that stimulates growth, cell reproduction and regeneration in humans and other animals. At this time, HGH is still considered a very complex hormone, and many of its functions are still unknown. The efficacy and safety of off-label uses of GH are unknown as these have not been tested in a double-blinded clinical trial.
Progesterone is a natural hormone which is given after ovulation to improve the quality of the uterine lining. It can be taken by mouth, by vaginal suppository, gel or by intramuscular injection. Discover the vital connection between progesterone and pregnancy here.