Fertility Medications are used to Regulate Hormones, Stimulate the Ovaries and Produce Eggs for procedures like IVF.
Many medications are used in the treatment of infertility. Below is a list of the most common prescription drugs and a description of their use.
Obtaining Your Medications
It is very important to be familiar with your insurance coverage for fertility medications. Contact your prescription insurance company and have them go over your coverage details explaining any requirements, such as if you are required to use a specific pharmacy, if an authorization is required, or if you have a life time maximum limit.
If you have coverage for your infertility medications, please be aware that it could take some time to obtain the necessary authorization and determine which pharmacy your insurance company requires you to use. Some insurance companies, such as Aetna, require an authorization for refills. Before filling your prescription please contact your insurance company or our Authorizations Department.
If you do not have insurance coverage for your medication please beware that prices vary from pharmacy to pharmacy and are subject to change. We suggest that you confirm the cost of the medication with the pharmacy and do a price comparison with other pharmacies prior to having your prescription filled. Please contact our Authorizations Department if you have any questions.
This is an antibiotic in the erythromycin family. It has multiple uses in medicine. In fertility treatment, it may be prescribed prior to a uterine procedure or before initiating IUI therapy. We choose to treat all patients undergoing a fertility evaluation with a Z Pack as it is both cheaper and more cost effective than culturing the cervix for infectious diseases and treating patients who have a positive result. You may take this medication with or without food. Possible side effects include abdominal pain, nausea/vomiting, or diarrhea.
Birth control pills (Desogen®, etc.)
These pills (containing a progestin plus a small dose of estrogen) have many uses in fertility treatment. They may be used in as a contraceptive agent prior to surgery or to prevent ovarian cyst formation and synchronize egg development in IVF. Some side effects that can occur include: breakthrough bleeding, nausea, fluid retention, and mood changes.
This is a gonadotropin releasing hormone antagonist. It helps to prevent premature ovulation in gonadotropin cycles or in IVF treatment, allowing more time for egg maturation. It is given as a subcutaneous injection, typically for 3-5 days.Possible side effects include local irritation, headache, and nausea.
Clomid® (Serophene®, clomiphene citrate)
This medication causes eggs to mature and ovulate in women who ordinarily do not ovulate on their own. It is typically given daily from menstrual cycle days 3-7, 4-8, or 5-9. The response to Clomid may be monitored with ultrasound and/or ovulation predictor kit (OPK) testing. Clomid can cause a false positive response on an OPK, and so it is recommended to start OPK testing no earlier than 4 days after the last Clomid pill. If a woman does not respond to the initial dose of Clomid (50mg), the dose may be increased in subsequent cycles – up to a maximum dose of 250 mg/day for five days. Once ovulation is achieved, there is no benefit to using a higher dose of Clomid (and higher clomid doses can cause undesired effects on the uterine lining). Possible side effects of Clomid include: hot flashes, headache, nausea, bloating, breast tenderness, and mood changes. If you experience severe headaches or visual changes with this medication, please notify your doctor or nurse promptly. Fertilization in patients taking Clomid may be achieved with either intercourse or intrauterine insemination (IUI).
This is an antibiotic in the tetracycline family. It has many different indications for use. In fertility treatment, it may be prescribed prior to a uterine procedure or IUI therapy. It is also used after an egg retrieval in IVF. It is recommended to take this medication with a full glass of water. You should not drink milk while taking this medication, although you should consider taking doxycycline with food to prevent stomach upset. To prevent irritation of the esophagus (the swallowing tube), do not lie down for 30 minutes after taking this medication. Do not take vitamins or antacids within 2 hours of this medication. You should also avoid alcohol or excess sun exposure while taking this medication. Potential side effects include abdominal pain, nausea/vomiting, diarrhea, or yeast infection.
Estrace®: (micronized estradiol)
This is a form of estrogen that is commonly used to thicken the lining of the uterus. Possible side effects include mood changes, headache, and vaginal spotting.
Gonadotropins (Gonal F®, Follistim®, Menopur®, Luveris®)
These medications help to stimulate the growth of ovarian follicles. They are given subcutaneously (underneath the skin) with very thin/short needles. The response to these medications is monitored by both ultrasound and blood work. Typically, a patient will use these medications daily over a 9-13 day period, though some patients may need a shorter or longer time on the medication. Once the ovarian follicles are thought to be mature, a final trigger shot (Ovidrel) will be administered to cause the egg(s) to be released. We recommend combining the gonadotropins with IUI rather than intercourse in order to maximize pregnancy rates, as many studies have shown significantly higher pregnancy rates with IUI. Use of this medication is associated with a higher multiple pregnancy rate. Ovarian hyperstimulation syndrome (OHSS) is also a possible significant side effect of this medication. In this condition, the ovaries can become enlarged, and there can be temporary kidney, blood clotting, and fluid problems. Women who are at higher risk for OHSS are those who are younger and those who have PCOS. Side effects of these medications include: abdominal bloating, headache, local irritation, nausea, and breast enlargement.
This is a gonadotropin-releasing hormone agonist. It helps to prevent premature ovulation in gonadotropin cycles or in IVF treatment, allowing more time for egg maturation. It may also be used in cases of severe endometriosis or in pre-surgical treatment of large fibroids. It is given as an injection – daily, monthly, or every 3 months depending on the scenario. Possible side effects include: hot flashes, headache, nausea, and mood changes. In addition, the long lasting (depot) formulation of this medication can cause some loss of bone mineral density (osteopenia or even osteoporosis). In order to prevent this (as well as to block the hot flashes), we typically administer Aygestin (an oral progesterone pill) daily while patients are taking Depot Lupron.
This is a steroid medication used in IVF which can help pregnancy success in cases of day 3 embryo transfer. It is started on the 2nd day following retrieval and continued for 4 days. Because this is short term use of a small dose of steroid, side effects are negligible.
This is a medication which can be used in patients with pre-diabetes (“insulin resistance”) to both help regulate blood sugar and allow ovulation to occur. Typically, these patients also have polycystic ovarian syndrome (PCOS). Usually the medication dosage is increased over a number of weeks to minimize side effects. Possible side effects to this medication include: nausea, vomiting, diarrhea, and abdominal pain.
This medication is used to cause the final steps of oocyte maturation to occur and to trigger ovulation. Ovidrel is actually a recombinant (made in the laboratory) form of human chorionic gonadotropin or hCG – the pregnancy hormone. If you take a pregnancy test within 9-10 days after taking this medication, you may have a false positive result. Ovidrel is given as a subcutaneous shot. Possible side effects include: local irritation or nausea.
Progesterone: (Crinone®, vaginal suppositories, intramuscular injection)
This medication is used to either supplement the luteal phase (the 2nd half of the menstrual cycle) or to help maintain an early pregnancy. Progesterone is naturally produced by the follicle that releases the egg, and most patients do not need supplemental progesterone in natural cycles or even if they are taking Clomid. Most patients who are taking the gonadotropins combined with IUI and all patients undergoing IVF or frozen embryo transfer will be given extra progesterone. Possible side effects of progesterone include constipation, fatigue, nausea, breast tenderness, mood effects, irregular bleeding, and headache.
Provera® (medroxyprogesterone acetate)
This medication is often used to bring on a period for women who do not menstruate regularly. It may also be used to thin the uterine lining before a hysteroscopy procedure to enable the surgeon to more clearly see the entire uterine cavity. It is usually administered for 10 days in a row, and a period is expected approximately 3-4 days after finishing the last pill. Possible side effects are similar to other progestins and include constipation, fatigue, nausea, breast tenderness, mood effects, and irregular bleeding.