Wish there was a magic pill that could instantly sprout you an infant? It’s never that simple, but modern medicine has given us some pretty effective fertility drugs that work to help many people conceive.
Which fertility drugs are right for you will depend on a number of things, starting with the results of all those fertility tests your doc does when you start your fertility journey. Knowing the root cause of any trouble conceiving—even knowing that it’s “unexplained”—will help you and the doctor make the right choices in fertility drugs.
“Some infertility is treated by medications; other conditions are managed surgically and still others require a combination of both,” says David Diaz, MD, reproductive endocrinologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “No two patients are exactly alike. Furthermore, pre-existing medical problems like diabetes, hypertension, thyroid problems must also be considered when choosing a treatment protocol.”
Here’s the lowdown on some of the most common fertility drugs for women.
Let’s get this ovulation party started
Sometimes a woman’s body just needs a little extra push to develop and release an egg. Yep, we’re talking about ovulation. If this is the case for you, you might get prescribed one of these:
Clomid (a.k.a. clomiphene or seraphine) blocks estrogen receptors in a woman’s body, which causes a release of FSH (follicle stimulating hormone). FSH is what spurs a woman’s egg-containing follicles to start developing in anticipation of releasing those eggs.
- It may be prescribed if… you have unexplained fertility, you’re not ovulating or not ovulating regularly, you have PCOS or you’re undergoing IUI (intrauterine insemination).
- How it’s taken: Clomid is typically a 50 mg pill taken on the third, fourth or fifth day of the menstrual cycle.
- Side effects: Mild side effects include bloating, sore breasts, upset stomach, headaches, vaginal dryness, thinned uterine lining, hot flashes and mood swings. More serious potential side effects include abnormal bleeding, blurred vision and other vision problems, yellow eyes and skin, depression and stomach or pelvic pain. There’s also a higher risk of having twins or other multiples.
Femara (a.k.a. letrozole) started out as a breast cancer drug but has been increasingly used as an alternative to clomid. It lowers estrogen levels so that FSH is released, says Dr. Diaz.
- It may be prescribed if…you have unexplained fertility, you’re not ovulating or not ovulating regularly, you have PCOS or you’re undergoing IUI (intrauterine insemination). You might also get prescribed femara if clomid didn’t work for you in the past and/or caused side effects for you. Femara may also be prescribed to patients with breast cancer who are doing IVF or who are freezing their eggs, says Dr. Diaz.
- How it’s taken: Femara is typically a 2.5 mg pill it taken once a day for five days, usually beginning on day three of your period.
- Side effects: Femara is known to have fewer or less serious side effects than clomid can. But it can cause fatigue, weight gain, headache, bone or muscle pain and/or hot flashes. There’s a risk of conceiving multiples with Femara as well, though it’s slightly lower than with clomid.
Here’s a quick and painless health lesson: Women with PCOS tend to have trouble with ovulation. They also have insulin resistance, which makes them at higher risk for type 2 diabetes. Metformin is a medication typically given to people with diabetes, to lower their blood sugar. If given to a woman with PCOS and type 2 diabetes, it can help them ovulate (woohoo!).
- It may be prescribed if… you have PCOS and type 2 diabetes. It may be taken instead of clomid or in addition to clomid, especially if clomid alone didn’t work for you in the past.
- How it’s taken: Metformin can come in regular pill form, which should be taken twice a day. There’s also an extended release tablet, which is a once-a-day thing. Dosage varies from person to person.
- Side effects: Common side effects to metformin include stomach discomfort, decrease in appetite, diarrhea, shallow or quick breathing, cough, fever, pain in the lower back or side, muscle cramps, painful urination, drowsiness. Less common side effects include blurred vision, confusion, nervousness or anxiety, seizures, shortness of breath, slurred speech and tightness in the chest. Keep your doctor posted if you experience any of these or any other side effects.
Gonadotropins—not a particularly fun word to say and not a particularly fun type of fertility drug to take. You’ll have to be injected with these bad boys. To put it simply, gonadotropins get your body ready to ovulate using hormones.
Gonadotropins carry a small risk of conceiving multiple babies. There’s also a risk of ovarian hyperstimulation syndrome (OHSS), which can be life threatening if severe, so keep your doctor posted on any symptoms or side effects you experience after getting trigger shots.
A few common gonadotropins are:
Talk about direct! There are FSH or follicle stimulating hormone shots that can be injected right into the bod to spur ovulation. Name brands of FSH include Gonal-F, Follistim AQ, Bravelle and Ganirelix.
- It may be prescribed if… you’re not or may not be ovulating, you have PCOS or you hope to release more than one egg in a month (like if you’re doing egg retrieval for IVF).
- How it’s taken: You’ll probably get the shot once a day for around 10 days to hopefully get those ovaries on their egg-developing way.
- Side effects: Side effects of FSH shots include mood swings, headaches, ovarian hyperstimulation syndrome and possible increased risk of ovarian cancer.
hMg stands for human menopausal gonadotropin. You may hear the brand names Menopur or Repronex. As the very long name suggests, hMg is the real deal. It’s FSH and LH (luteinizing hormone) extracted from the urine of actual menopausal women. (Again, purified.) And it can help a woman release more than one egg in a cycle.
- It may be prescribed if… you’re doing IVF.
- How it’s taken: hMg is a self-administered shot. Your doctor or nurse will show you how do it.
- Side effects: These are basically the same as FSH: mood swings, headaches, and possible increased risk of ovarian cancer.
Synthetic human chorionic gonadotropin—say that five times fast. hCG is a hormone produced in a pregnant woman’s body. It can help the egg follicles mature and get released, and it may even help the embryo implant in the uterus after conception. You may see hCG under the name Pregnyl, Ovidrel, Novarel or Profasi.
- It may be prescribed if… you’re already taking something else to trigger ovulation. Think of hCG as a helper fertility drug. It is sometimes prescribed during IVF treatment too, in hopes that the woman releases more than one egg for an egg retrieval.
- How it’s taken: hCG is given through subcutaneous or intramuscular injection. Your doc will tell you which day and exact time to inject, depending on your hormone levels. Then you’ll need to have sex (or IUI) when you’re ovulating.
- Side effects: With an hCG shot, you may have some bloating or cramping, says Diaz. Less common side effects include indigestion, stomach pain, nausea, vomiting, diarrhea, shortness or breath, swelling in the feet or lower legs and sudden weight gain, according to the Mayo Clinic.
Here’s another hormone to know: Prolactin. According to the Society for Endocrinology, it does a whole bunch of things within the body, but most important to female fertility is its role in menstruation. Too much prolactin can mess with your period and prevent ovulation. If your doc finds your body is producing too much prolactin, you might get prescribed one of these:
Bromocriptine (a.k.a. Cycloset or Parlodel) blocks the release of prolactin to hopefully help you ovulate.
- It may be prescribed if… your doctor has found your body’s over-producing prolactin and it’s messing with your ovulation.
- How it’s taken: Bromocriptine may be available in a tablet or capsule. Your doctor will advise you on how much you should take, but it will probably be two or three times a day, since bromocriptine has a short half-life, says Dr. Diaz.
- Side effects: You may experience nausea, vomiting, a stuffy nose, headache, dizziness and even fainting because of bromocriptine. It can also cause blood pressure to lower.
Dostinex is otherwise known as cabergoline. (Don’t you love how every fertility drug has at least two names?) Like bromocriptine, dostinex is used to stop an overproduction of prolactin, so ovulation can occur.
- It may be prescribed if… your doctor has found that your body’s over-producing prolactin and it’s messing with your ovulation. (Sound familiar?) Bromocriptine is considered the “gold standard,” for this issue, says Dr. Diaz. But your doctor may choose Dostinex since it is generally better tolerated (i.e. less likely to cause side effects) and is more convenient, since it doesn’t need to be taken nearly as often.
- How it’s taken: Dostinex is a tablet that you might only need to take twice a week (in a dose of around 0.125 to 1.0 mg), says Dr. Diaz.
- Side effects: Dostinex can cause nausea, constipation, headache, dizziness and more.
Other potential meds
Depending on your own unique medical history, your doctor could prescribe some other meds that could get you on your way to conception. This may include:
- Aspirin: An anti-inflammatory, aspirin may be prescribed in a low dose to women with chronic inflammation who are having difficulty conceiving or who have had a previous miscarriage.
- Heparin: Heparin is an anticoagulant, meaning it prevents blood clotting, but sometimes it also helps women to conceive. Some doctors believe it can prep the uterus for implantation and fetal growth. Lovenox is a similar drug.
- Progesterone: This hormone may be prescribed to women with a history of miscarriage or who are undergoing IUI and IVF. It’s available in a shot and sometimes, as a vaginal capsule, says Diaz.
- Estrogen: Low levels of the hormone estrogen can prevent ovulation, so sometimes doctors will supplement injections with doses of estrogen.
- Leuprolide: Also known as Lupron, Eligard or Viadur, this injected hormone can help women with endometriosis conceive by lowering estrogen levels, which, if too high, can inhibit conception, according to the Mayo Clinic. It can also trigger ovulation during an IVF cycle.
There’s no one-size-fits all fertility drug plan for women trying to conceive. In fact, there may be a bit of trial and error, or you might take a few fertility drugs to help make conception happen.
“Inducing ovulation for example, can be managed by using clomid, injectables or a combination of both,” says Dr. Diaz. “These may be combined with metformin, thyroid medication, DHEA and many others.”
What’s most important is that you follow doctors’ orders and keep them in the loop about any side effects or issues. After all, if you’re going to be pregnant (eeep, we said it), you’re going to have to be healthy.