Fertility Medications

Clomiphene Citrate, or "Clomid" is often referred to as the "fertility pill". It is used to treat infertile women who have an ovulation problem. It works by helping the pituitary gland (located at the base of the brain) improve the stimulation of developing follicles (eggs) in the ovaries. Clomiphene is most often prescribed to those patients who have been found to have an abnormality with their cycle, though combined with intrauterine insemination, it may be useful in the treatment of unexplained infertility.

Clomiphene is usually prescribed for five days each cycle, usually beginning on day three or five. Of all women treated with clomiphene 60% to 80% will ovulate normally. Nearly 10% of women treated with Clomiphene may experience side mild side effects, including hot flashes, blurred vision, nausea, bloating sensation, and headaches. Serious side effects are rarely seen with clomiphene therapy. The frequency of twins occurring in women who conceive while taking clomiphene has been reported to be as high as 10%. In addition, new studies suggest that long-term use of clomiphene for more than 12 cycles may place patients at an increased risk of developing ovarian cancer.

A number of studies have confirmed a significantly improved pregnancy rate with injectable medications that stimulate "superovulation". This improvement in pregnancy rate is due primarily to the increased number of eggs produced. "Fertility drugs," including Pergonal, Humegon, Metrodin, Gonal-F, and Follistim are administered beginning on the second or third cycle day and given for six to nine consecutive days. Response to these drugs is monitored by frequent vaginal ultrasounds and blood estrogen determinations. At a time in the cycle when the ovarian follicles reach a designated size, and estrogen levels are appropriate, an injection of the hormone HCG is given to trigger ovulation. Ovulation usually occurs 36-48 hours after the HCG injection. Thus, intercourse or insemination should be timed accordingly.

Performing intrauterine insemination may result in an increase in the number of sperm at the site of fertilization in the fallopian tube. Generally only 1 of 2000 sperm ejaculated into the vagina make can later be found in the fallopian tube. Therefore, adding insemination to stimulated cycles may further improve the pregnancy rate. A possible side effect of the injectable fertility drugs is ovarian hyperstimulation, a condition in which the ovaries are tender and enlarged. In severe cases, a woman may have swelling from retaining excessive amounts of body fluid in the tissues. Fortunately, severe hyperstimulation is rare, occurring in less than one percent of treatment cycles.