During fertility treatment, the drugs you may take fall into one of four general categories:
- Medications intended to stimulate ovulation (fertility drugs)
- Medications intended to suppress or control the menstrual cycle (used during IVF)
- Medications intended to treat other aspects of fertility
- Medications intended to treat an underlying medical condition impacting your fertility
Medications alone may be used, or they may be used alongside intrauterine insemination (IUI), IVF treatment, or surgical interventions.
Even though infertility impacts men and women almost equally, women are still more likely to take fertility treatment drugs than men. This is because most male infertility problems can’t be treated with medication. However, in some situations, men may also take hormones or other drugs as part of fertility treatment.
Clomiphene citrate is often the first drug tried when treating ovulatory dysfunction. It may also be recommended in the early stages of treatment for couples diagnosed with unexplained infertility.
Clomiphene citrate is a tablet taken orally. Most frequently, it is prescribed alone. But it’s also possible to combine Clomiphene citrate with other medications, fertility drugs, or IUI.
The most common side effects are headache, hot flashes, and mood swings. Some risks of Clomiphene citrate treatment include conceiving twins or a higher-order multiple pregnancy, ovarian hyperstimulation syndrome, and vision disturbances.
Side effects and risks are mild compared to the stronger injectable fertility drugs.
While not common, some cases of male infertility may be treated with Clomiphene citrate.
Letrozole is now a frequently used off-label to treat ovulation problems.
Like Clomiphene, letrozole is taken orally. It may be used alone, alongside other medications or fertility drugs, or as a part of IUI treatment.
According to some research, letrozole may be more effective than Clomiphene in women with PCOS and women who are otherwise Clomiphene resistant. (Clomiphene resistant just means Clomiphene doesn’t stimulate ovulation as expected.)
Side effects and risks are very similar to Clomiphene citrate.
Letrozole is not safe to use during pregnancy. That said, because letrozole is taken early in the menstrual cycle—before conception takes place—most doctors consider it safe when used for fertility purposes.
Gonadotropins: Ovulation Stimulation via Injectable Drugs
Gonadotropins are the strongest ovulation-stimulating drugs. They contain biologically similar follicle stimulation hormone (FSH), luteinizing hormone (LH) or a combination of the two. In female reproduction, these are the hormones that stimulate the ovaries to mature and release eggs.
These drugs are taken via injection, usually into the fatty tissue (also known as subcutaneous injections.)
Gonadotropins can be used alone or alongside other medications with timed sexual intercourse at home. They are also often used during IUI or IVF treatments.
The most common side effects of gonadotropins include headache, nausea, bloating, breast tenderness, mood swings, and irritation at the injection site.
The risk of conceiving twins, triplets, or higher order multiples is significantly higher with gonadotropins than with oral drugs like Clomiphene citrate. The risk of developing ovarian hyperstimulation syndrome is also much higher.
While gonadotropins are used primarily in women, men with hypogonadotrophic hypogonadism may be prescribed injectable fertility drugs to improve testosterone levels and improve semen health.
Follitropin beta and Follitropin alpha : These drugs mimic the hormone FSH in your body. They are created in a lab using recombinant DNA technology, which makes them bio-similar to your natural hormones.
Choriogonadotropin alpha : These drugs are made of hCG, the pregnancy hormone. The hormone hCG is similar to LH in the body.
Lutropin alpha : This is LH hormone, created in a lab using recombinant DNA technology.
Drugs Used to Control or Suppress Ovulation During IVF Treatment
Some medications used during fertility treatment suppress ovulation.
Why? Two primary reasons:
- During IVF treatment, to prevent ovulation before the eggs can be retrieved surgically. Once the eggs are ovulated into the body, they cannot be found or used for IVF.
- To coordinate cycles with a potential egg donor or surrogate.
Birth control pills: These may be prescribed for the month before IVF treatment.
Birth control may also be used therapeutically.
For example, women with PCOS who don’t respond to clomiphene citrate may have a better response to the drug if they take birth control pills for two months prior to treatment.
Ganirelix acetate and Cetrorelix acetate:These fertility drugs are GnRH antagonists. This means that they work against the hormones LH and FSH in the body, suppressing ovulation. They are taken via injection.
The most common side effects include abdominal discomfort, headache, and injection side pain.
Medications to Treat Other Fertility Problems
Fertility drugs are medications intended to stimulate the ovaries. However, these aren’t the only medications your doctor may prescribe during fertility treatment.
Aspirin or heparin: If you’ve experienced recurrent miscarriage, or you’re diagnosed with a blood thrombophilia disorder (a situation where tiny blood clots can lead to pregnancy loss), your doctor may prescribe a daily baby aspirin or injections of the blood-thinning drug heparin.
Progesterone: Your doctor may prescribe progesterone supplementation, either as a vaginal suppository or via injections.
Vaginal progesterone suppositories may be suggested if you’re experiencing recurrent miscarriage or have a suspected luteal phase defect. Injectable progesterone is most frequently used during IVF treatment.
Estrogen: Your doctor may prescribe estrogen vaginal suppositories if your endometrial lining is too thin, if you experience vaginal dryness or pain during sexual intercourse, or to improve the quality of your cervical mucus.
A possible side effect of Clomiphene citrate use is thicker cervical mucus, which can interfere with conception. Extended Clomiphene citrate use can also lead to a thinner endometrial lining. Estrogen may help with these issues.
Medications to Treat Underlying Medical Conditions
Sometimes, an underlying medical condition may be decreasing your fertility. In these cases, that issue must be treated first.
Treating the underlying issue may be enough to improve your fertility. After treatment, you may be able to conceive on your own.
However, in other cases, a combination of solutions is required. You may need to have treatment for the medical issue in addition to fertility drugs or surgical interventions.
Metformin: Metformin is a diabetes drug, intended to treat those with insulin resistance. Women with PCOS are frequently diagnosed with insulin resistance.
Some research has shown that metformin treatment may help restart or regulate ovulation in women with PCOS. Other studies have found that it may reduce the miscarriage rate and help Clomiphene citrate work in women who were unable to ovulate on Clomiphene alone.
Antibiotics: Infection of the reproductive tract can reduce fertility in both men and women. In some cases, an infection can lead to scarring. This scarring may prevent the egg and sperm from meeting.
As long as there’s no scarring, antibiotics alone may be enough to improve fertility. However, if the fallopian tubes are blocked or filled with fluid, surgery or IVF treatment be also be required.
Cabergoline: Cabergoline is a dopamine agonist. It may be prescribed in hyperprolactinemia.
Hyperprolactinemia is a condition where hormone levels of prolactin are abnormally high. Prolactin is the hormone responsible for breast development and lactation. High prolactin levels can cause irregular or absent ovulation in women and cause low sperm counts in men.
Cabergoline can lower prolactin levels. Possible side effects include headache, nasal congestion, headache, and dizziness. There’s no increased risk of conceiving twins with these medications unless a fertility drug like Clomiphene citrate is used alongside treatment.
Sometimes, this can bring back ovulation or normal sperm production. In other cases, surgery or additional fertility treatments are needed.
Thyroid regulating medications for hypothyroidism or hyperthyroidism: An under or over functioning thyroid can cause fertility problems in men and women.
Women may have irregular cycles, while men may have low sperm counts. Thyroid deregulation can also cause fatigue and weight gain. Obesity can further impact fertility.