You decided you are ready to get pregnant and you thought it would be easy! Unfortunately, many women find they can’t conceive right away and they eventually turn to their doctors for help. If this describes you, you are not alone: about 12% of women in the United States have trouble getting pregnant.
If you’ve been trying to conceive for 6 to 12 months without success, infertility treatments may help. Sometimes, medicines (fertility drugs) can be prescribed to help you get pregnant. The medicines work by regulating the hormones that control the growth and release of an egg from your ovary—a necessary part of getting pregnant. Fertility drugs can be used on their own or, sometimes, as part of other methods such as in vitro fertilization or artificial insemination.
The choice among fertility treatments—and the choice to use them at all—will depend on your age, how long you’ve been trying to conceive, and your personal history and preferences. Fertility is a complex process and may involve financial, emotional, and physical investments. No one treatment is right for every woman who is trying to conceive.
Clomiphene citrate
One of the oldest and most common fertility drugs is called clomiphene citrate. (Its brand names are Clomid and Serophene.) It helps you ovulate normally by essentially blocking the release of estrogen and causing the hypothalamus and pituitary gland in your brain to release hormones that control ovulation and your menstrual cycle.
Clomiphene is available as a tablet that you swallow. The usual dose of clomiphene is 50 mg daily for 5 days. You will usually start taking clomiphene a few days after you start your period. Your body will usually ovulate about 7 days after the last dose. If you still don’t ovulate normally, your doctor may increase the dose of clomiphene every month until you are ovulating normally.
Most women (up to 80%) who take clomiphene will start to ovulate normally. Of those, about half will get pregnant—usually within 3 months. If you have been taking clomiphene for 6 months and still not gotten pregnant, your doctor will probably want to help you choose a new method or medication to help you conceive.
Clomiphene can cause hormone-related side effects such as hot flashes, blurry vision, nausea, bloating, and headache. Changes in mood may also happen while taking clomiphene. Most of these side effects are generally mild and the medicine is well tolerated by most women.
Clomiphene also decreases the consistency of cervical mucus and thins the lining of the uterus. These changes can actually make it harder to know when you are most likely to get pregnant and it may stop sperm from getting to your uterus. Clomiphene increases the chances of having multiple births: most multiple births will be twins.
Clomiphene will probably not help you ovulate and get pregnant if you have ovarian failure, high levels of prolactin, thyroid problems, or problems with the hypothalamus (a region of the brain that is critical in regulating hormones).
Hormones
If clomiphene does not help you conceive, there are hormones that can trigger ovulation and increase your chances of getting pregnant. Unlike clomiphene, these medicines are not taken orally; instead, they are injected as shots and the doses will vary, depending on when and how they are used.
Several hormone fertility treatments are available. Human chorionic gonadotropin (Novarel, Ovidrel, Pregnyl, and Profasi) triggers ovulation. Follicle-stimulating hormone (Bravelle, Fertinex, Follistim, and Gonal-F) triggers the growth of eggs in your ovaries. Human menopausal gonadotropin (Menopur, Metrodin, Pergonal, and Repronex) is a combination of 2 hormones that regulate the growth and release of eggs. Gonadotropin-releasing hormone agonists (Lupron, Synarel, Zoladex) and antagonists (Antagon and Cetrotide) control the timing of ovulation, as well as other aspects of your menstrual cycle.
Your doctor will usually start administering fertility hormones a few days after your period starts. You will take them for 7 to 12 days. Your doctor may recommend using hormones and clomiphene at the same time.
These hormones have about the same success rate as clomiphene—about half the women who ovulate will get pregnant. Side effects of fertility hormones are mild. The injections can cause tenderness or pain at the injection site and your ovaries may become overstimulated and tender. Like clomiphene, hormones increase the chance of multiple births.
Other medicines
If hormones do not help you get pregnant, a few other drugs are available. Metformin (Glucophage) is usually used as a treatment for type 2 diabetes. It can be used when problems with how the body uses insulin are affecting ovulation. Women who have polycystic ovary syndrome and are overweight may particularly benefit from this medicine. Even though it is used to help women ovulate, metformin is not FDA-approved for this use.
Letrozole (Femara) is usually used as part of breast cancer treatment. It triggers ovulation in a similar way to clomiphene. It has not been well studied as a fertility drug, however, and is not used very often. Most importantly, it is not FDA approved as a fertility drug.
Bromocriptine (Cycloset) can be used when your body produces extra prolactin, which can cause problems with ovulation. Bromocriptine is safe and effective at restoring ovulation for most women with high prolactin levels.
The best option for you
You and your partner will likely undergo several tests to determine if there are causes to your infertility. Depending on the cause, lifestyle modifications, surgery, or medications may be appropriate and can help increase your chances of getting pregnant. For about 1 in 10 women who have fertility problems, there is no known cause and fertility treatments may or may not help. Not all causes of infertility can be fixed with medicines, and you should talk to your doctor about all options available to you to help your chances of getting pregnant.
