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Medications
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Clomiphene citrate (Clomid, Clostilbegid, Serophene, Serpefar) is a tablet taken orally that induces ovulation and stimulates follicle development. Clomiphene citrate induces ovulation by increasing the output of follicle stimulation hormone (FSH) from the pituitary gland. Side effects from clomophene are rare but can include: ovarian enlargement, hot flashes, breast tenderness, nausea, visual disturbance, light-headedness and others. The incdence of multiple births in patients receiving clomiphene is approximately 6%. In general, clomiphene should not be taken for more than 3 ovulatory cycles without further study. Clinical studies report that long-term administration of clomophene may negatively impact the ability to achieve pregnancy.Clomiphene, like all fertility medicines, should be administred by physicians familiar with its use. A reproductive endocrinologist is best equipped to administer and monitor clomophene. Aromatase inhibitor – AI (Arimidex, Femara) The aromatase inhibitors have the potential to replace CC from the so-called first line of treatment through induced ovulation. The application of AI involves reduction of the FSH dose, necessary to achieve optimum control of ovarian hyperstimulation (СОН), improvement of the ovarian response to gonadotropins in cases with unsatisfactory ovarian response, improvement of the ovarian response to СОН in endometriosis cases, improvement of the implantation rate in assisted reproduction technologies (ART), reduction of the estrogen levels and reduction of the risk of ovarian hyperstimulation syndrome (OHSS) in COH. Pergonal, Metrodin, Menogon, Humegon (urine-derived injectable FSH products) These compounds are human hormones produced by the pituitary gland (LH and FSH) and are used to stimulate ovarian follicular development. They are urinary, meaning they are extracted from the urine of postmenopausal women. These women have not ovarian function and produce high levels of the hormone FSH. This FSH is extracted, purified and made into a powder form. These drugs can’t be ingested orally, and are therefore administered by injection. Injections usually begin on day 2 or 3 of the menstrual cycle and continue for several days until the developing follicles are mature. Daily dosage, and the length of time needed for adequate stimulation, varies from patient to patient, and from cycle to cycle. These compounds are used in women who do not ovulate, who don’t ovulate on Clomophene Citrate, or to produce multiple follicles (eggs) needed for an ART procedure. These drugs can produce serious side effects and should only be given by a specialist trained in their use. When administered by a Reproductive Endocrinologist, who closely monitors the treatment cycle, the incidence of side effects is low. Dosage is adjusted based upon a myriad of factors, including the body’s response to treatment. Failure to adequately monitor and adjust dosage can lead to a very serious condition, ovarian hyperstimulation syndrome. This syndrome is characterized by ovarian enlargement, abdominal pain, abdominal distention, weight gain, circulatory problems, and often requires hospitalization. Other side effects can include: ovarian cysts, nausea, vomiting, diarrhea, and abdominal cramps, bloating. Multiple births occur about 25% of the time. The incidence may be lower when an experienced Reproductive Endocrinologist monitors the drug dosage. Puregon & Gonal-F (recombinant FSH injectable products: 100% pure FSH) These two products produce the same response, and have the same side effects, as the urinary products discussed below. The difference is that they are recombinant pure products. They are not extracted from urine but instead are made using genetic recombinant technology. Both can be administered subcutaneously. There appears to be little difference in the pregnancy rates for patients receiving recombinant FSH products compared to those receiving the urine-derived FSH products. Ultrasound and estradiol measurements will always be taken in patients receiving these injectable drugs. These measurements allow the Reproductive Endocrinologist to follow the development of the follicle and make appropriate dosage adjustments.  |
