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Fertility Medications

Eggs develop in ovarian follicle under stimulatory influence of hormones: FSH or the Follicle Stimulating Hormone makes the follicle grow and LH or Luteinizing Hormone makes the follicle release the egg in the process of ovulation.  Both hormones, called collectively, gonadotropins, are produced in the pituitary. The ovary contains many actively growing ovarian follicles which produce estrogen. The rise of estrogen is a signal to the pituitary to diminish the amount of FSH released.  FSH becomes so scarce that only one follicle can continue to grow.  In some women that one single surviving follicle does not receive enough FSH to survive and when that last follicle dies off (atresia), ovulation does not happen leading to an infertility condition called anovulation. Infertility medications are designed to increase the amount of FSH delivered to the ovary in order to sustain growth of at least one follicle and to reach the stage of ovulation.  Typically more than one follicle survives and several eggs may be released which increases the chance of conception but it may also lead to multiple pregnancies.  There are 3 types of medications available.

CLOMIPHENE CITRATE (better known under old brand name as CLOMID)

This is an old and traditional medication that has been available for many decades. It is an oral pill taken for 5 days at the beginning of the menstrual cycle (on the 3rd or 5th day of menstrual bleeding) as an anti-estrogen, it forces the pituitary to maintain a higher level of FSH production: more FSH in the ovary, more follicles can develop. As an anti-estrogen it may, in some women, impair the development of the uterine lining (endometrium) and/or the production of the cervical mucus; both may lower reproductive success. Therefore, we recommend close monitoring of the treatment cycle. Clomid may also lead to hot flushes and visual disturbance. If conception does not occur after 6 cycles of Clomid, we advise the patient to change the strategy.


This medication is designed to inhibit estrogen production in the ovarian follicle. Low level of circulating estrogen leads to higher production of FSH in the pituitary and follicles can grow to full ovulatory stage. It comes in simple oral pill taken for 5 days at the beginning of the menstrual cycle (on the 3rd or 5th day of menstrual bleeding). Femara is designed to stop estrogen production in survivors of estrogen dependent breast cancer.  It is not FDA approved for ovulation induction/enhancement but it works very well. However, by lowering availability of estrogen it can interfere with development of the uterine lining (endometrium) and/or cervical mucus production. Therefore, we recommend close monitoring of the treatment cycle. If conception does not occur after 6 cycles of Femara, we advise the patient to change the strategy.


This class of fertility meds contain FSH alone or FSH+LH.  As protein hormones, these meds must be injected (taken orally they would be digested). There are two sources of these hormones:

  • Human Menopausal Gonadotropin (HMG, Menopur, Repronex) is obtained from urine of menopausal women who produce large amounts of pituitary hormones.  The medication is sold in form of dissolvable powder and contains both FSH & LH; if LH is removed and the vial contains FSH only, it’s called Bravelle
  • Recombinant FSH, follitropin alpha & beta, (Follistim, Gonal-F); both are genetically engineered proteins produced based on the human gene, DNA sequence, for FSH; both come in solutions readily available for subcutaneous injection using a convenient injection pen.

Gonadotropins are physiological, meaning non-synthetic medications.  They have to be used with care by an experienced physician who closely monitors ovarian response.  If too many follicles develop, not only can multiple pregnancy can occur, but the woman can develop Ovarian Hyper-Stimulation Syndrome.  This condition is associated with enlarged ovaries, abdominal fullness and distension, accumulation of free fluid in abdominal cavity, swelling of peripheral tissues. Some patients may require hospitalization. Even with close monitoring and reduction in the dose of medication injected, this syndrome may develop.


In men, fertility is treated with:

  • Surgery, if the cause is a varicoele (widening of the veins in the scrotum) or a blockage in the vas deferens, tubes that carry sperm.
  • Antibiotics to treat infections in the reproductive organs.
  • Medications and counseling to treat problems with erections or ejaculation.
  • Hormone treatments if the problem is a low or high level of certain hormones.


In women, infertility is treated with:

  • Fertility drugs and hormones to help the woman ovulate or restore levels of hormones
  • Surgery to remove tissue that is blocking fertility (such as endometriosis) or to open blocked fallopian tubes
  • Infertility in men and woman can also be treated with assisted reproductive technology, or ART. There are several types of ART:
  • IUI (intrauterine insemination): Sperm is collected and then placed directly inside the woman's uterus while she is ovulating.
  • GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer): The sperm and egg are collected, brought together in a lab, and quickly placed in a fallopian tube.

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