There are many approaches used to treat female infertility. Medications are often used alone, particularly for women who have medical conditions that cause infertility. They may also be used along with assisted reproductive technologies (such as in vitro fertilization).
Medications for Ovarian Stimulation
Women are born with their lifetime supply of eggs within the ovaries. During each monthly menstrual cycle, eggs develop within the ovarian follicles under the influence of the follicle stimulating hormone (FSH). Once the egg matures, ovulation is triggered by the luteinizing hormone (LH).
Several fertility drugs, such as clomiphene, indirectly induce ovulation. Other fertility drugs, called gonadotropins, directly stimulate the ovaries.
Clomiphene (Clomid©) has been used for years to induce ovulation in many women who have irregular or absent periods.
Clomid works at an area of the brain called the hypothalamus. The hypothalamus is responsible for regulating the production of follicle stimulating (FSH) and luteinizing hormones (LH). The hypothalamus produces gonadotropin releasing hormone (GnRH) which signals the pituitary gland to increase its production of FSH and LH. FSH stimulates the development of eggs within the ovarian follicles on the ovaries.
Medications called gonadotropins are used to directly stimulate the ovaries to produce multiple eggs. These drugs contain either the hormones FSH and LH (Repronex), or FSH alone (Follistim, Gonal-F, Bravelle).
These injectable fertility drugs are used in assisted reproductive technology cycles and stimulated intrauterine insemination (IUI) and cause the development of numerous eggs.
FSH is also very effective in treating women who have certain disorders such as hypothalamic amenorrhea.
Medications for Egg Maturation
Human chorionic gonadotropin (hCG) is given to induce ovulation (i.e. cause egg release). The body recognizes hCG as LH which normally triggers ovulation.
During IVF, hCG is administered 36 to 38 hours prior to egg retrieval.
Medications to Prevent Premature Ovulation
When gonadotropins are used in IVF cycles, products such as Lupron or Antagon are given to precisely control hormone levels and time ovulation. This allows for greater control over the IVF cycle.
Lupron (leuprolide acetate) was originally introduced for the treatment of endometriosis. Ovulation cannot occur while taking Lupron unless an injection of hCG is given. This is extremely important since ovulation must be carefully timed with egg retrieval or the IVF cycle could be “lost."
Antagon (ganirelix acetate) produces the same biologic effects as Lupron by a different mechanism. Antagon blocks the action of GnRH at the pituitary gland and causes a much quicker and complete suppression of GnRH levels. This leads to an effective blocking of the LH surge, thereby preventing the premature release of the eggs.
We prefer Antagon due to fewer injections, less FSH, and a much simpler protocol.
Medications for Luteal Phase Support
Progesterone is a hormone that stimulates and supports the development of the endometrium, the tissue lining the uterus. Progesterone is initially produced by the ovary after ovulation. Elevated progesterone levels are one indication that ovulation has occurred.
The endometrium must thicken and become more vascular during the luteal phase of the menstrual cycle in order to accept and support the developing embryo. Both estrogen and progesterone stimulate the development of the endometrium.
After conception, progesterone is secreted by the placenta and is necessary to maintaining an ongoing pregnancy. Progesterone is sometimes administered to women with recurrent miscarriage and it is usually given to women after assisted reproductive technology cycles, such as IVF.
Many other types of medications are used to treat the various conditions causing infertility.
Glucophage (metformin) is often used to induce ovulation in polycystic ovarian disease patients if the patient is insulin resistant.
Metformin reverses insulin resistance by sensitizing the cells to insulin thus lowering insulin levels, reducing androgen levels, and enabling ovulation.
If metformin alone is not effective, Clomid is often added.
Parlodel (bromocriptine) is used to treat a condition known as hyperprolactenemia, or elevated prolactin levels. Prolactin is the hormone responsible for breast milk production which normally rises during and after pregnancy.
Elevated levels in the absence of pregnancy can cause irregular ovulation and are often due to a benign tumor on the pituitary gland. The tumor is sometimes surgically removed depending upon its size and location or prolactin levels can be lowered using bromocriptine.
Antibiotics are used to treat reproductive tract infections including chlamydia, gonorrhea, and others. The choice of antibiotic depends upon the seriousness of the infection and the suspected bacteria.
Corticosteroids are used in many different types of autoimmune disorders including lupus. They may also be used in cases where the adrenal glands cause overproduction of male hormones (androgens). We often use low dose corticosteroid therapy prior to embryo transfer to increase the chances of a successful implantation during IVF.