Do fertility drugs work?

Infertility affects around 7.3 million US women and their partners according to the American Society for Reproductive Medicine – that’s around 12 percent of those who are childbearing age. Fertility drugs can help to jumpstart ovulation, either by stimulating the production of brain hormones that trigger your ovaries to produce eggs, or working directly on your ovaries to regulate egg production.

These drugs are safe – in fact, newly published research has found little association between fertility drugs and ovarian cancer, which had long been a concern for many women. They also can be highly effective – but using them does raise your risk of conceiving more than one baby and encountering possible complications (such as miscarriage and/or pre-term labor) as well as needing a cesarean section to deliver if you’re carrying twins or multiples.

Oral fertility drugs

Clomiphene (Clomid, Serophene) has proven successful over more than 25 years of use and is used in women who aren’t ovulating and in men with a low sperm count or more sperm motility (movement) due to hormonal imbalances. Clomiphene often is used alongside IVF techniques and artificial insemination.

How do they work?
Clomiphene comes in pill form and is taken across five days of your menstrual cycle. It triggers the release of follicle-stimulating hormone (FSH) by the brain to stimulate the ovaries to produce eggs. After you finish taking the drug, your brain then releases luteinizing hormone (LH), which stimulates release of the egg into the fallopian tube.

How successful are they?
Typically, clomiphene causes ovulation within about seven to 12 days of taking the final dose, but if you don’t ovulate the dose can be increased. About 60 to 80 percent of women on clomiphene do ovulate, and about half of them get pregnant as a result (normally within three menstrual cycles). The live birth rate is thought to be between 30 and 60 percent. If you don’t become pregnant with six months, your doctor will likely switch you to an alternative drug, as clomiphene doesn’t improve your chances the longer it’s taken.

Are there any side effects?
It’s common to experience mild side effects from taking clomiphene, including hot flashes, blurred vision, nausea and headaches. Rarely it can thicken cervical mucus to the extent that sperm are not able to enter the uterus. Clomiphene is thought to be less likely to result in multiple births than some other fertility drugs.

How much does it cost?
One cycle of clomiphene costs around $50 and you’ll also have to factor in your doctor’s fee, ultrasound scans of your ovaries and any other follow-up procedures. Depending on the terms of your policy, your health insurer may cover some or all of the treatment.

Injectable fertility drugs

These include human chorionic gonadotropin/HCG) (Pregnyl, Novarel), FSH (Follistim, Fertinex) and a combination FSH and LH option (Pergonal, Repronex). They can be used alongside clomiphene and also given to men with a low sperm count or poor sperm motility.

How do they work?
The injections (FSH or combined FSH/LH) are usually started on the second or third day of your cycle (with the first day being the first day of bleeding) and given for a week to 12 days. Your doctor will show you how to inject yourself or demonstrate the technique to your partner. You also may be prescribed clomiphene. The drugs boost FSH levels in order to trigger production of several eggs.

Your doctor will monitor your progress via ultrasound and your eggs are mature you’ll be given a shot of HCG, which will promote ovulation within 24 to 36 hours. Hopefully you can conceive the old-fashioned way; alternately your doctor can schedule you for artificial insemination.

How successful are they?
Injectable hormones have a high success rate in promoting ovulation and 20 to 60 percent of women who take them conceive, typically within three to six cycles. The live birth rate for injectables is around 70 to 80 percent. As with clomiphene, staying on these drugs long-term doesn’t improve your chances of pregnancy so if you don’t conceive within six cycles your doctor may suggest another approach.

Are there any side effects?
You may experience abdominal tenderness and bloating, along with swelling and bruising at the injection sight but side effects usually are mild. Injectables are more likely to result in the release of more than one egg, raising the risk of conceiving twins or multiples.

Rarely a condition called ovarian hyperstimulation syndrome (OHSS) can result, causing the ovaries to swell to a potentially harmful size (if bloating seems excessive, alert your doctor). Keep in mind that this is a very time-intensive procedure, involving many visits to your doctor’s office for monitoring.

How much does it cost?
Treatment is expensive, at up to $5,000 per cycle (including the drugs and ongoing follow-up). Depending on the terms of your policy, your health insurer may cover some or all of the treatment.

Natural fertility treatments

Some vitamins (for example, zinc, and vitamins C and E, which are claimed to strengthen sperm count and motility) and herbs are reputed to help boost fertility if you’re having problems conceiving but there is little scientific evidence that they work. Nutritional supplements and herbs can be potent and may interact with conventional fertility drugs as well as any other medications you may take. Check with your doctor before using them.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.

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Last Modified: 01/03/2009

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