Fortunately, there are numerous fertility drugs available to treat many of the causes of female infertility. Unfortunately, there are very few medications shown effective for the treatment of male infertility resulting in improved pregnancy rates.
Many female fertility drugs are “ovulation inducing agents” meaning that they regulate or stimulate ovulation. The best known drug in this class is Clomid, which has enjoyed widespread clinical use for over three decades. Other ovulation inducing agents include FSH which is marketed as Gonal-F, Follistim, Bravelle, Menopur, and others.
The Assisted Fertility Program’s main infertility clinic office, located in North Florida, was the first fertility program established in 1985. Our offices are conveniently located across from the Lewis-Gale medical center, so infertile couples in Southwest Virginia may no longer need to travel outside of the area for specialized services.
Clomid works at the hypothalamus to “occupy or compete for” estrogen binding sites. The hypothalamus can be thought of as the “hormone regulator” reading the levels of various hormones and adjusting production accordingly.
In a normal ovulatory cycle, estrogen levels rise as the follicles mature leading to a decrease in Follicle Stimulating Hormone (FSH) production. FSH is the hormone responsible for the recruitment and development of the ovarian follicles each containing an egg. Since Clomid binds estrogen sites, the hypothalamus reads lower estrogen levels and signals the pituitary to continue production of FSH thus leading to follicular recruitment.
Once ovulation is occurring on Clomid (evidenced by increased progesterone levels and ultrasound), there is no advantage to increasing the dosage. Pregnancy is most likely to occur during the first three ovulatory cycles and therapy beyond 3-6 cycles is not recommended.
Continued use of Clomid is highly unlikely to succeed, is expensive, and can cause significant side effects. Unfortunately, we sometimes see women who have been on Clomid for a year or more, prescribed by her OB/GYN. Women 35 and older should seek infertility specialist care immediately and should not “waste” valuable time trying Clomid without a definitive diagnosis. Fertility can decline very rapidly in this age group.
Letrozole may be used as an alternative to clomid. Letrozole is an aromatase inhibitor which is traditionally used for treatment for breast cancer however it is also used to treat ovulation disorders as a part of infertility treatment. Letrozole causes the pituitary gland to secrete FSH by suppressing estrogen. Letrozole can be an effective treatment in women with Polycystic Ovary Syndrome (PCOS) as the rise in FSH can cause a mature follicle to grow.
In addition to Clomid and Letrozole, other fertility drugs are available including: