Clomid (Clomiphene Citrate)
Clomid is often effective in regulating ovulation. It is usually started on cycle day 3, 4, or 5 and continued for five days. The dose varies based upon the cause of infertility, previous treatment results, and other factors. The usual starting dose is 50 mg. and if ovulation does not occur the dose can be increased up to 150 mg. per day.
In general, Clomid should not be used for more than 6 ovulatory cycles. Fertility can decrease rapidly in older women and FSH may be the appropriate treatment depending upon ovarian reserve.
Femara is effective in regulating ovulation and does not have some of the side-effects seen with Clomid, such as decreased cervical mucus, thinning of the endometrial lining or emotional irritability. The incidence of twins is 2-3% with Femara compared to 10% with Clomid. Letrozole can be useful in inducing ovulation in PCOS patients.
Metformin is in a class of fertility drugs known as anti hyperglycemics and it is used to treat Type II diabetes and PCOS. PCOS patients often have chronically elevated insulin levels (hyperinsulinemia) leading to overproduction of androgens and, increased LH production.
Metformin does not directly stimulate ovulation; rather, it corrects a physiologically abnormal condition (chronic hyperinsulinemia) thus allowing natural ovulation to occur. The usual dose of Metformin is 850 mg. twice a day or 500 mg. 3 or 4 times a day.
Repronex, Gonal-F, Follistim, Bravelle, Menopur (Follicle Stimulating Hormone, FSH)
The active ingredient in these medications is FSH. Repronex, Bravelle and Menopur are urinary (naturally) derived products while Gonal-F and Follistim are manufactured using genetic recombinant technology.
FSH stimulates the recruitment and development of many eggs, is sometimes used in IUI, and it is always used in IVF. FSH is administered by injection. Dosages are individualized for each patient during treatment based upon the results of follicular ultrasound scans and estradiol hormone measurements.
Ovidrel, Profasi, Novarel, Luveris (Human Chorionic Gonadotropin, hCG, LH)
Once the follicles mature, an injection of human chorionic gonadotropin (hCG) is given to stimulate ovulation and the release of the mature eggs. Luveris is a genetically produced product that is identical to the body’s hCG. Pregnyl, Novarel and Profasi are natural products that stimulate ovulation at about half the cost. Ovidrel is pure LH made using genetic recombinant technology. Ovidrel is sometimes uses to trigger ovulation or in ovulation induction protocols, however it is expensive.
Lupron (GnRH Agonists), Ganirelix, Cetrotide (GnRH Antagonists)
Lupron, Ganirelix, and Cetrotide work by interfering with the production of gonadotropin releasing hormone (GnRH). Lupron inhibits GnRH production while Ganirelix and Cetrotide block production. These drugs allow the infertility specialist to control the ovulatory cycle insuring ovulation does not occur prior to egg maturity.
In some ovulation induction protocols, they will cause a greater increase in the body’s production of FSH thus augmenting FSH injections. An injection of hCG must be given to stimulate ovulation when these drugs are used.
Prometrium, Prochieve, Crinone, Endometrin, Injectable Progesterone
Progesterone is necessary for the proper development of the endometrium, which is the lining of the uterus. During the first half of the ovulatory cycle, estrogen stimulates the endometrium to thicken and become more vascular. Progesterone is produced after ovulation causing the endometrium to undergo final maturation preparing it for the implantation of an embryo.
Progesterone is always given in IVF cycles because the drugs used to control ovulation inhibit progesterone production, which can lead to poor endometrial development.