Fertility Problems

Medication or hormone treatments are often the first steps in infertility treatment. They are also used for in vitro fertilization and other assisted reproductive technologies.

Medication Choices

Medications to stimulate ovulation

• Clomiphene citrate (Clomid) stimulates the release of hormones that trigger ovulation. Clomiphene is typically the first choice of treatment for unexplained lack of ovulation because of how easy it is to use—it's taken orally rather than injected, doesn't usually cause severe side effects, and doesn't usually require daily monitoring.
• If clomiphene does not work, your doctor might try hormone shots. These shots, called gonadotropins, directly stimulate the ovaries to produce mature eggs.
• If you have polycystic ovary syndrome, your doctor may suggest a medicine to help start ovulation and restore regular menstrual cycles by correcting insulin resistance.

Medications used for in vitro fertilization

• First, a hormone is used to "shut down" the pituitary, which puts the ovaries in a menopause-like state (menopausal symptoms are common). This is generally done using a gonadotropin-releasing hormone (GnRH) analogue.
• Then ovulation-stimulating gonadotropins are used to trigger ovulation on a schedule. This process is also used before some insemination procedures.

Other medications

• Gonadotropin-releasing hormone (GnRH) (for women and men with low levels of naturally produced gonadotropins) increases the body's production of hormones needed for egg and sperm production. A small pump worn by the user injects a tiny amount of this drug into the body. The drug stimulates the pituitary gland to produce hormones that trigger ovulation in women and sperm production in men.
• Bromocriptine and cabergoline (for women and men) reduces high prolactin levels. High prolactin levels can prevent ovulation in women and can prevent the release of testosterone and production of sperm in men.

What To Think About

Ask your doctor questions about medicines you are considering, including whether there are long-term effects, how long the treatment lasts, how often you must be tested while taking it, and whether there are any side effects that will affect your daily life.

Multiple pregnancy risk

If you have irregular or no ovulation, using medicine or hormones to stimulate ovulation will increase your chances of pregnancy. But these treatments increase your risk of multiple pregnancy, which poses health risks to both you and your fetuses. When considering an infertility treatment:

• Ask your doctor about your risk for having a multiple pregnancy and how to minimize the chance of conceiving more than one fetus.
• Think about how a high-risk multiple pregnancy, and the possibility of having multiple disabled children, might affect your life. For more information, see the topics Multiple Pregnancy: Twins or More, Preterm Labor, and Premature Infant.

Other rare complications—such as ovarian hyperstimulation syndrome—can result from hormone shots used to stimulate ovulation, usually for assisted reproductive technology such as IVF.