"I need fertility medication," is not an uncommon request doctors get from patients who are having trouble conceiving. We have medicine for nearly every ailment out there - for when we can't sleep, for when we have a headache, or even if we are anxious. With all that we can treat today, it makes perfect sense that women struggling to get pregnant believe that there is medication out there to help them.
Dr. Don Aptekar says it's not uncommon for patients to come in and ask for fertility drugs without a proper diagnosis. He says that, "some even get angry with me when I say no. I understand that it can be incredibly stressful and frustrating when not getting pregnant, but there are a lot of misconceptions out there about fertility drugs."
Since it's important to understand how the medication works, who they work for, and the risks that are involved, we met with Dr. Aptekar for a Fertility Drug 101.
Who needs fertility drugs?
Nearly all the fertility drugs for women stimulate ovulation or make women ovulate more predictably.
There is a common misconception about fertility drugs; many women believe they need fertility medication to enhance their fertility. Fertility drugs, however, will not enhance fertility unless you have an ovulation problem. If you do not have an ovulation problem, then fertility drugs will not help you.
The medication currently available helps women who have viable eggs but don't ovulate or who don't ovulate predictably. For example, a woman with PCOS (to learn more about PCOS click here).
How do you determine who needs fertility drugs?
There is a sequence of questions I ask to determine who needs fertility drugs:
What is the problem?
What are the signs and symptoms?
What is the diagnosis?
What is the therapy?
These are essential to ask and understand before starting fertility drugs. What if you are ovulating but simply missing your fertile window each month? Or what if we find that your husband's sperm is the problem, not your ovulation cycle?
How to find when Ovulation Happens when Trying to Conceive
What are the fertility drugs used?
The general go to drugs are clomiphene (clomid) and gonadotropins. Both are ovulation induction agents. They basically fool the pituitary gland that body is not producing enough of the hormones that are released during a menstrual cycle to stimulate the ovaries to release an egg.
What are the risks with Clomid and gonatropins?
The biggest risk is multiple births. Clomid increases the chance of having twins by 3 to 4 fold. Other risks include side effects such as hot flashes, mood swings, pelvic pain and nausea. For more information on the side effects check out this article.
Having twins is a high risk pregnancy. When I say there is a risk of having multiples, some patients ask if they can just use it anyway and say they wouldn't mind having twins. Well, you could end up with twins at 27 weeks and all the complications that come with having premature infants.
But if have you PCOS, for example, and don't ovulate, you may get pregnant in the first month or two and therefore Clomid was a good choice.
What if Clomid or gonatropins do not work?
Neither drug should be used for long periods of time. So if after 2 or 3 months and it doesn't work, we need to go back to the drawing board and evaluate if releasing eggs is really the problem. We may need to look at seeing if you have enough eggs or, if age is a factor, if you may be perimenopausal.
The second step tends to be combining clomid with hGC to help release eggs. hGC will enhance egg release. Some will use that combination in conjunction with IUI to factor out other potential issues such as thick cervical mucus.
Then you get into higher levels of ovulation of induction. A doctor may use FSH to stimulate many eggs. Superovulation is for a woman who doesn't have good egg develop and this makes them release 10 or 12 eggs. Then you jump to IVF which usually uses ovulation stimulating agents as well.
What are the negative sides to taking fertility drugs:
Multiples which is a high risk for prematurity. We aren't talking about only twins here, but triplets as well.
Side effects such as nausea, mood swings, pelvic pain, bloating.
A condition called ovarian hyperstimulation syndrome from superovulation medication. Ovaries get huge and it can be life threatening.
Clomid has been questioned for leading to ovarian cancer. The is not a direct cause and effect however. A slight increase risk for ovarian cancer could be due to the fact that there was an issue in the first place.