Managing Your Fertility Drugs

If you’re experiencing problems getting pregnant, chances are that at some point in your fertility treatment you’ll be prescribed one of these five common medications.

There are five main types of fertility drugs, and most work by helping the ovarian follicles (which contain immature eggs) to grow and mature, or by promoting the release of an egg (ovulation), explains Edmond Confino, M.D., professor of reproductive endocrinology and infertility at Northwestern University in Chicago. If your doctor decides to put you on fertility medication, you may receive a single drug, or you may be prescribed a combination—especially if you’re preparing for in vitro fertilization (IVF).

As with any drugs, fertility meds come with the risk of side effects. Most can be managed pretty easily: You may be able to head off stomach upset, for example, by taking oral medicines with food, and applying heat can soothe the sore spot of an injection site. (But if you experience any of the more serious side effects specially flagged below, don’t hesitate to call your doctor.) You should know, too, that most doctors believe that over the long term, fertility drugs appear to be safe. “There is no evidence that use of fertility drugs increases a woman’s risk of developing ovarian or breast cancer later in life,” says Beth W. Rackow, M.D., assistant professor of obstetrics and gynecology at the Yale University School of Medicine in New Haven, Connecticut.

Clomiphene Citrate

Common names: Clomid, Serophene

How this fertility drug works
Clomiphene citrate, often used as a fertility “starter” drug, was discovered by chance. It was developed about 40 years ago to treat polycystic ovary syndrome (PCOS) and other conditions in which a woman doesn’t ovulate, and was later used for breast cancer. “But women who were prescribed the drug started getting pregnant, so it was a serendipitous discovery,” says Dr. Confino. Clomiphene citrate essentially tricks the body into thinking estrogen levels are low, which in turn stimulates the production of follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones are essential for conception: FSH causes follicles in the ovaries to ripen, and LH triggers the release of an egg(s).

Possible side effects
These can include vaginal dryness, hot flashes, breast tenderness, nausea, vomiting, moodiness, and irritability—in short, what women typically experience during menopause, says Dr. Confino. Women taking clomiphene citrate are also more likely to conceive multiples: Between 4 and 10 percent of women who use clomiphene citrate become pregnant with twins and up to 1 percent conceive triplets, according to Dr. Confino. One side effect that requires immediate attention: Call your doctor right away if you experience headaches or visual disturbances, especially “floaters” that cloud your vision.

How this fertility drug works
Follicle stimulating hormone (FSH) is a natural hormone that helps eggs mature, but the drug is a synthetic version. You’re a good candidate for synthetic FSH if your ovaries produce follicles (usually each follicle holds an undeveloped egg), but your body doesn’t make enough FSH to ripen them. The drug is also used to stimulate the development of multiple eggs for IVF.

Possible side effects
Headaches, irritability, breast tenderness, and muscle aches top the list for synthetic FSH. But the big concern is ovarian hyperstimulation syndrome (OHSS), says Dr. Rackow, in which the ovaries become very enlarged. OHSS typically occurs seven to 10 days after starting treatment and affects 5 to 10 percent of women taking this injectable medication, though less than 1 percent will experience severe OHSS. The syndrome ranges from bloating, discomfort, and nausea in its mildest form, to pelvic pain, swelling of the hands or legs, shortness of breath, reduced urination, diarrhea, vomiting, and in the most severe cases, blood clots and kidney dysfunction. If you experience any symptoms, tell your doctor immediately. She may recommend that you avoid intercourse and get plenty of bed rest; if symptoms are severe, close monitoring, including ultrasounds, daily weight measurements, and blood work may be necessary. Usually, though, OHSS goes away on its own, without complications, and treatment may be nothing more than an oral pain reliever.