Your first fertility prescription ready for pick up at the pharmacy, but what exactly are you taking and how is it going to help you get pregnant? Here’s a beginners guide to fertility drugs.
💊 Clomiphene Citrate
Clomiphene citrate is a common fertility medication prescribed for infertility.
- How does it work?
Clomiphene makes your body think you have low estrogen levels by acting as an estrogen receptor blocker. As a response, your body sends extra stimulation to your ovaries. With this extra stimulation, you grow follicles in your ovaries. This increases your chances of pregnancy because you can ovulate more than one egg. This is a delicate balance though, as there is a risk of twins (or more)!
- How do I take it?
Clomiphene citrate is an oral pill. You take it daily for 5 days during the beginning of your menstrual cycle. Your doctor may perform a mid cycle ultrasound to measure the number and size of your follicles. When your follicles are sufficiently large, you will either ovulate on your own (measured with an ovulation test) or your doctor will prescribe you a trigger shot to cause ovulation (see below).
Letrozole is an oral fertility medication that is commonly prescribed for polycystic ovarian syndrome (PCOS) or for women who aren’t ovulating on their own.
- How does it work?
Letrozole lowers estrogen levels by preventing estrogen production. Similar to clomiphene (above), your body senses the low estrogen level and sends extra stimulation to your ovaries. This extra stimulation causes women who may not ovulate on their own to recruit an egg and ovulate!
- How do I take it?
Letrozole is an oral pill. You take it daily for five days during the beginning of your menstrual cycle. Just like clomiphene, your doctor may perform a mid cycle ultrasound to measure the number and size of your follicles. When your follicles are sufficiently large, you will either ovulate on your own (measured with an ovulation test) or your doctor will prescribe you a trigger shot to cause ovulation (see below).
Gonadotropin medications are injectable fertility drugs that act similarly to your body’s naturally produced follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
- How do they work?
In a natural cycle, your body releases FSH and LH stimulate the ovaries to recruit an egg for ovulation. In an IVF cycle, you inject gonadotropins to cause extra ovarian stimulation. This results in the growth of not just one follicle containing an egg, but hopefully MANY follicles containing eggs.
- How do I take them?
Gonadotropins are injected daily just under the skin (subcutaneous). The needle is small, but that doesn’t make it any less scary to give your first shot! There are a surprising number of steps involved. These include mixing the medications, securing needles and measuring doses. Before your first shot, take some time to put out all your supplies and make sure you have everything you need. There are also educational videos available online to help guide you.
💉 Ovulation Blockers
During an IVF cycle, your doctor needs to control when you ovulate. That means blocking ovulation when it’s not supposed to happen. There are several medications that can be used to block ovulation (GnRH agonists and antagonists). They are administered as subcutaneous injection. Examples include Ganirelix, Cetrotide and Lupron.
💉 Trigger Shot
In a natural cycle, ovulation is caused by your body’s naturally produced LH surge. The trigger shot is an injection that mimics the natural LH surge and causes you to ovulate. We prescribe a trigger shot when follicles are large, just prior to an intrauterine insemination or egg retrieval procedure.
Hopefully this brief overview helps clarify the major categories of medications commonly used for fertility treatment! Soon you will be a pro!
Dana McQueen, MD MAS received her medical degree from the University of California, Irvine, completed her residency in Obstetrics and Gynecology at the University of Chicago, completed a one year Fellowship in Recurrent Pregnancy Loss at the University of Illinois, and received a MAS (Masters of Advanced Studies) in Clinical Research from University of California, San Diego. Dr. McQueen will complete her fellowship at Northwestern University Feinberg School of Medicine in Reproductive Endocrinology and Infertility in Summer 2020 and will be joining Reproductive Science Center in Oakland in Fall 2020. You can follow her on Instagram @drdanamcqueen.