A leading cause of infertility in reproductive-age women is an ovulatory disorder that interferes with normal ovulation. Endocrine disorders, insulin problems, abnormal levels of thyroid hormones and pituitary gland disorders are frequently diagnosed types of ovulatory disorders. Failure to ovulate may also be due to fluctuations in the production of follicle stimulating hormone (FSH), sex hormone binding globulin (SHBG), androgens and estrogen.
Ovulation and Infertility
Ovulation is defined as the release of a mature egg from an ovary. The egg then travels down a fallopian tube where it may be fertilized by sperm. If fertilization does not occur, women menstruate by shedding the lining of the uterus. Various hormones play essential roles in regulating the process of ovulation and conception. When an ovulatory disorder interferes with hormone levels and the ovulation process, infertility may affect women trying to get pregnant.
Fertility Drug Therapy Explained
Also known as ovulation-inducing drugs”, fertility drugs are medications that restore hormone balance to promote normal ovulation and egg release. Before you are prescribed a fertility drug, you will undergo a series of tests to determine exactly what is causing your infertility. In addition to an ovulatory disorder, infertility may also be caused by tubal diseases, endometriosis, cervical factors, and other medical problems. Your partner will also need to have a semen analysis performed before your doctor begins fertility drug therapy.
By stimulating the release of pituitary gland hormones needed to support normal ovulation, Letrozole is taken orally in five-day cycles. In most women, Letrozole instigates ovulation within 5 to 10 days of beginning treatment. Women on Letrozole can use ovulation kits, basal body temperatures or pelvic ultrasounds to determine when they should have intercourse or have an assisted reproductive technology performed. Fertility doctors have been prescribing Letrozole as an ovarian stimulator for nearly 20 years because it causes fewer side effects than Clomid. Women using Letrozole also have less chance of multiple gestations than women taking other fertility drugs.
Fatigue, joint pain, insomnia, and hot flashes are the most common side effects of Letrozole.
Clomiphene (brand names Serophene and Clomid) is prescribed to more women with ovulatory disorders than any other fertility drug. Like Letrozole, Clomiphene stimulates release of pituitary gland hormones essential for ovulation. Clomiphene is also prescribed to women experiencing infertility for unexplained reasons. In cases of unexplained infertility, Clomiphene is frequently used to improve success rates of intrauterine insemination.
Clomiphene initiates ovarian follicle growth, steroidogenesis (production of steroid hormones) and increases circulating levels of estradiol. After ovulation occurs, estradiol and progesterone levels rise and fall just like they do during a normal ovulatory cycle.
Fertility drug therapy with Clomid or Serophene involves women taking low dosage tablets for five days. Within 5 to 10 days of beginning Clomiphene therapy, most women will ovulate. Dosage amounts may need increasing when women fail to ovulate.
Side effects of Clomiphene include abdominal bloating/tenderness, nausea/vomiting, headache, and breast tenderness.
Instead of stimulating release of pituitary hormones, gonadotropins stimulate ovaries to produce and release multiple eggs. Gonadotropins are injected instead of taken orally. Your fertility doctor will show you how to inject these fertility drugs at home.
Luteinizing hormone [LH] and follicle-stimulating hormone [FSH]) are gonadotropins frequently prescribed to women who have previously used Clomiphene unsuccessfully to achieve pregnancy. Treatment cycles with gonadotropins are monitored by your fertility doctor. Ultrasounds and blood tests provide information to fertility doctors to help them determine timing of ovulation and if dosage requires adjustment to minimize side effects.
Women taking gonadotropins have an increased risk of multiple pregnancy compared to using other fertility drugs. Other side effects of gonadotropins include ovarian enlargement (ovarian hyperstimulation syndrome) and, more rarely ovary torsion (twisting).
Are Fertility Drugs Available for Men?
Approximately two percent of men experiencing infertility are diagnosed with secondary hypogonadism, a condition affecting the pituitary gland or hypothalamus. When one of these two glands are not producing hormones properly, men may suffer reduced testosterone levels and low sperm count. Hypogonadism is the only male infertility condition that may be treated with fertility drugs for men.
Viera Fertility Center offers fertility drug therapy and many types of assisted reproductive technologies to help women and men experiencing infertility. Call today to schedule an appointment with our fertility physician.