Fertility Medications
Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Nov 15, 2014
Medications Used in IVF & Infertility Treatments
Fertility drugs / medications are medications used in fertility treatments. As a leading fertility center that pushes the boundaries of fertility research and bring the results to clinical treatment, CHR has recently introduced two new fertility medications into fertility care. For more information on how DHEA and G-CSF (an experimental treatment with two clinical trials under way) may boost your chance of conceiving, please contact us.
Fertility Medication Types
Medications for Ovarian Stimulation (Ovulation Induction)
Clomiphene Citrate (Clomid or Serophene)
Many fertility experts use clomiphene citrate (commonly referred to as Clomid, one of its brand-names) when patients have trouble ovulating with no apparent reason. This popularity of Clomid is partially because it is an oral medication, while most other fertility medications are injectables. Other reasons are its relatively lower cost and the rarity of severe side effects.
At CHR, we view this approach to infertility treatment with suspicion. Using Clomid randomly, without first identifying the underlying cause of "unexplained infertility," just does not constitute good medical practice! Clomid may be cheaper than other fertility medications, but if a patient keeps trying Clomid for months, the cost does add up. Moreover, blindly using Clomid can delay pregnancy, which many women in their late 30s and early 40s cannot afford to do, with the so-called "biological clock" ticking away. You can learn more about aging, fertility treatments, and IVF after 40 here. Instead, CHR physicians use Clomid only if infertility tests confirm that Clomid use in IUI cycles makes sense for an individual patient.
Clomiphene citrate is used to stimulate the ovaries to produce eggs, primarily in IUI (intrauterine insemination, also called artificial insemination) cycles. With stimulation from Clomid, hypothalamus, a portion inside the brain, releases pulses of GnRH (gonadotropin releasing hormone). In turn, these pulses of GnRH stimulate the pituitary gland, another tiny part of the brain. Then, the pituitary gland produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones work together to encourage follicle development in the ovaries toward maturation and, eventually, ovulation.
Human Menopausal Gonadotropin (hMG)
Human menopausal gonadotropin (hMG) is a fertility medication that contains the two types of gonadotropins produced by the human body: FSH and LH. hMG contains natural FHS and LH, taken from menopausal women (which is where the name comes from). hMG does what FSH and LH do: it regulates ovulation, and encourage the growth of multiple eggs in the ovaries, in preparation for either IUI or IVF. In specific, FSH initiates the growth of follicles (fluid-filled sacks in the ovaries that contain eggs), and when these eggs in the follicles are mature, LH triggers ovulation.
hMG is taken as subcutaneous injections (injections under the skin). Patients who did not respond well to Clomid may start producing eggs with hMG stimulation, partially because it skips the intermediate step of GnRH production in the brain to produce FSH and LH. Major brand names of hMG include Repronex and Menopur.
Follicle Stimulating Hormone (FHS)
As described above, FSH is a gonadotropin secreted by the pituitary gland in the brain. FSH starts the maturation process of eggs in the ovaries. Taken as subcutaneous injections, FSH is used in IVF cycles to stimulate the ovaries so that the patient will have more than one mature egg at the time of egg retrieval. There are a number of brand names for FSH, among them Bravelle, Follistim and Gonal-f.
Medications to Prevent Premature Ovulation
Leuprolide Acetate (Lupron)
Leuprolide Acetate (often called Lupron, which is a brand name) is a medication in a category called gonadotropin releasing hormone agonists. As described above, gonadotropin releasing hormones (GnRHs) stimulate the release of FSH and LH. GnRH agonists, including Lupron, suppress the release of FSH and LH.
It may sound strange that in an IVF cycle, FSH and LH need to be suppressed, when they normally work together to prepare mature eggs for ovulation. However, suppression is necessary to prevent premature ovulation. The whole point of IVF is to encourage the patient's ovaries to grow many eggs, while making sure that they don't get released from the ovaries too soon. By precisely controlling the time of ovulation, fertility doctors can retrieve those eggs at just the right stage of maturity. Lupron is used for this purpose.
Just like most other fertility drugs, Lupron is taken as subcutaneous injections, just under the skin. Another major brand name for Leuprolide Acetate is Serophene.
Ganirelix Acetate (GnRH Antagonist)
GnRH antagonist is a class of compounds that suppress LH, which would normally let the ovaries to release the mature eggs in the process of ovulation. GnRH antagonists have a similar structure to GnRH (gonadotropin-releasing hormone), and bind to the GnRH receptor, thus preventing the release of LH (and FSH). GnRH antagonist, often called by its brand name Antagon, is used in IVF cycles to prevent premature ovulation during ovulation induction. Unlike Lupron, GnRH antagonists are injected toward the end of an IVF cycle, before the hCG injection. Other brand names for GnRH antagonists include Ganirelix and Cetrorelix.
Medications to Trigger Ovulation
Human Chorionic Gonadotropin (hCG)
hCG is similar to LH in function: hCG triggers ovulation. In assisted reproduction technologies like IUI and IVF, hCG is a one-time injection taken at a specific time. hCG injection is carefully timed by the physician, so that the eggs are released from the ovary (ovulation)when they are at just the right maturity. It is extremely important that you follow your physician or nurse's instruction as to when you should do the hCG injection.
hCG is taken as an intramuscular injection (injection into the muscle), and is sold under a few brand names, including Novarel, Pregnyl, Profasi and Ovidrel.
New Medications Introduced by CHR
Micronized DHEA • Developed at CHR!
CHR researchers brought DHEA into fertility care in 2005, revolutionizing the treatment of premature ovarian aging (POA). DHEA improves both the quantity and quality of eggs and embryos before the patient reaches early menopause. For more information about our innovative treatment protocol using DHEA for diminished ovarian reserve, please read our POA page. DHEA is taken as oral tablets, from at least six weeks before the start of an IVF cycle until a positive pregnancy test.
Granulocyte Colony-Stimulating Factor (G-CSF) • Experimental
Granulocyte colony-stimulating factor (G-CSF) is a medication that we are using for fertility treatment in exclusively experimental setting (G-CSF has been FDA-approved for another use). CHR physicians have come to think that G-CSF may improve thin endometrium that does not respond to conventional treatment, and we are currently conducting two clinical trials to test that hypothesis. For more information, read our preliminary case report.
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.