When women are given these ovulation induction medications, it is important to monitor how they are responding in terms of egg development. This is best done with a combination of frequent ultrasounds and hormonal bloodwork. At ISIS, such monitoring is provided seven days a week in the morning period. This allows time for your physician to make adjustments in dosage as needed or to provide specific counseling on a daily basis to patients.
Clomiphene Citrate
The most common fertility drug used for this treatment is a pill called Clomiphene Citrate.
Clomiphene is given to women who do not ovulate regularly on their own or to women who have regular ovulation but desire more than one egg to mature each month to increase the opportunity that one may be fertilized. It is prescribed for five days, starting in the early part of the menstrual cycle. Indirectly, this medication stimulates the pituitary gland to release more follicle stimulating hormone (FSH) with the hope that this will result in recruitment of a follicle or follicles and thus lead to ovulation.
Clomiphene has common side effects, including headaches, nausea, hot flashes, blurry vision and mood swings. Clomiphene can also occasionally cause the development of a thin endometrial lining that can only be detected with ultrasound. It has been suggested that the development of a thin lining may not provide the best opportunity for the establishment of a pregnancy. Clomiphene can also lead to multiple gestation in approximately 8-10% of patients, This is most commonly twins and rarely triplets or more.
Injectable Gonadotropins (FSH)
There is a second group of fertility drugs that are prescribed for ovulation induction. They are given by injection. They are composed of FSH and/or LH in various types of combinations or singly as purified agents. These drugs are given in various combinations and doses, by daily injections, usually starting on the third day of the menstrual cycle. These hormones directly stimulate the ovaries to increase the number of developing follicles.
FSH
FSH is follicle-stimulating hormone. It is a hormone that comes from the brain and goes to the ovaries to help promote egg development. FSH is supplied to you in the form of injection to provide FSH in a higher amount that what your brain will do naturally. FSH preparations available in Canada are known as:
o Puregon, Gonal-F, Repronex, Menopur and others
o Collectively known as Gonadotropins
FSH may be given to help women who do not make eggs well on their own or to improve the number of eggs that a woman may make on her own. It is injected under the skin, usually in the lower abdomen or thigh. FSH injections start on the third day of the cycle and continue until the developing eggs are mature and ready to ovulate.
The use of FSH is associated with some risks. One is the risk of multiple pregnancy (twins, triplets or quadruplets, or more). The risk of multiple pregnancy is 20-30%. The majority of these are twins. Triplets and quadruplets occur in less than 1% of pregnancies. The physician will advise you of your risk based on the number of developing eggs seen on ultrasound. If too many eggs develop at once, the physician may advise you to not take any more FSH and not to have intercourse as the risk of multiple pregnancy is too high.
There is a risk of ovarian hyperstimulation with FSH. This is where too many eggs develop at once and your hormones in your blood become too high. Sometimes this condition does not develop until after your eggs have ovulated. This can occur most commonly when the HCG injection is given. If your doctor determines that you are at risk of developing ovarian hyperstimulation, they may advise you to stop or reduce the amount of FSH you are taking to attempt to limit the chance of the condition developing or worsening. This condition will resolve itself with time.
Pain or swelling at the site of injection is common. This may be relieved by applying ice to the site of injection. Less commonly, you may also have bruising or welts at the injection site. The risk of birth defects is not higher than in women who are not taking FSH. FSH injections do not increase your chance of ovarian or other types of cancer.
For women who are taking FSH because they have unexplained infertility (no cause of the infertility has been found) or the couple has mild male factor infertility, may have pregnancy rates of up to 18% per cycle. This is when the FSH injections are combined with an intrauterine insemination. This rate may be less when women are older than 38 years. Chance of achieving a pregnancy is related to the age of the woman and her cause of infertility when taking FSH injections.
For women who are taking FSH because they don’t make eggs on their own (polycystic ovary syndrome), may have higher rates of pregnancy per cycle. The chance of pregnancy in these women may be as high as 20-30% per cycle.
Several treatment cycles may be required to gain a pregnancy.
When women take FSH for a treatment cycle, the typical cost is $1000-$2,000 per cycle. The more FSH you take, the higher the cost.
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