Fertility drugs have played very important role in millions of successful pregnancies, and have been a great part of modern day fertility treatment. For most patients seeking medical aids for their fertility, chances are high that they will encounter one or more fertility medications over the course of their treatment. At times, these drugs are administered on their own, as a non-surgical fertility treatment, or they can be used in conjunction with intrauterine insemination (IUI). They are also applied as a part of in vitro fertilization (IVF).
These drugs are widely very safe, but like any medical intervention, they do carry some risks and side effects. Whether you undergo any of these effects will depend on which medications you are taking, the dosage, and how your body reacts. While the side effects and risks of fertility medication are popularly mild, it is good to be fully informed about all of the possibilities so that you can help your physician keep an eye out for trouble. However, these lists are not exhaustive, and it is important to remember that this information is offered purely as educational material, and not as medical advice. Your own fertility specialist will be able to help you understand the likely outcome.
OVERVIEW OF COMMON IVF FERTILITY DRUGS
There are three medications that are commonly used in an IVF cycle. Some are administered as pills and some are injected. Each has its part to play in the process of Controlled Ovarian Hyperstimulation (COH). COH is the reason of the fertility drugs as it pertains to IVF: the drugs are administered to aid your ovaries produce and mature as many eggs as possible in one cycle, so that they can be obtained and used to create embryos in the laboratory.
These are a few specific medications you are likely to encounter in this process: CLOMIPHENE CITRATE Known more popularly by the brand names Clomid and Siphene, this is a course of pills given to women who are not ovulating normally. Ovulation may not be regular or not happening at all (a condition known as anovulation). This is often the case for women who are dealing with Polycystic Ovarian Syndrome (PCOS). Clomiphene is a form of medication known as a selective estrogen receptor modulator (SERM). Its’ mode of action is by making the brain think that the body is short of estrogen. In response, the brain sends the message to relay a beneficial flood of three fertility-related hormones:
- GnRH (gonadotropin releasing hormone)
- FSH (follicle stimulating hormone)
- LH (luteinizing hormone)
These hormones incite the ovaries to produce eggs and ovulate.
SIDE EFFECTS OF CLOMIPHENE: Side effects are generally mild. The most commonly described issues are:
- Hot flashes, blurred vision, nausea, bloating, and headache.
- Changes in the cervical mucus.
- Increased chance of multiple births (exceedingly rare).
GONADOTROPINS: These types of hormonal medication have many different brand names. Some of the most popular are Gonal-F, Follistim, Menopur, and Luveris. They vary in terms of which hormones are included in the dose, which may be one or a mixture of the following:
- GnRH (gonadotropin releasing hormone)
- FSH (follicle stimulating hormone)
- LH (luteinizing hormone)
- hMG (human menopausal gonadotropin)
SIDE EFFECTS OF GONADOTROPINS: Most side effects are mild, although in rare cases some potentially dangerous complications may arise, and they include:
- Tenderness, swelling, or bruising at the injection site.
- Infection or blood blisters at the injection site.
- Risk of ovarian hyperstimulation (OHSS). This condition is when the ovaries respond too strongly to the medication. It may cause abdominal bloating and discomfort. Most mild cases resolve on their own in few days. In rare cases, faintness or breathing problems can occur. If you are determined to be at higher risk of OHSS (some women with PCOS may be more prone to developing it), you will receive extra monitoring and may be given a lower dose of medication.
- Increased ectopic pregnancy (exceedingly rare).
- Increased chance of multiple births (exceedingly rare).
hCG Injection: Sometimes referred to as a “trigger shot” the hCG (human chorionic gonadotropin) injection is known by several brand names, including Novarel, Ovidrel, and Pregnyl. As you can tell by the name, it is related to the gonadotropins mentioned above, but it works differently. It is used to stimulate the final maturation and release of eggs from the ovarian follicles. It is generally injected 35 to 36 hours before your egg retrieval procedure.
SIDE EFFECTS OFhCG: Again, the side effects are usually mild, but if anything worries you, you should contact your physician immediately, and they include:
- Tenderness, swelling, or bruising at the injection site.
- Hot flashes, blurred vision, vomit, bloating, and headache.
- Irritability, restlessness.
- Breast tenderness or swelling.
- Risk of ovarian hyperstimulation (OHSS).
How to Reduce Fertility Drug Side Effects and Risks
- It’s impossible to completely avoid all side effects. However, there are some things you or your doctor can do to reduce your risks.
- Some side effects may be avoided or reduced by taking the medication at night or with food. Always talk to your doctor about the best time and way to take your medications.
- Your doctor should also use the lowest effective dose. This is why it’s almost always better to start at a lower dose, and then increase the dosage if it doesn’t work, rather than start high.
- Let your doctor know if your side effects are bad, even if they are mood-related side effects (which many people keep from their doctors.) There may be an alternative drug.
- To reduce your risk of conceiving twins or multiples, close monitoring of your cycle is important. With gonadotropins or Clomid, ultrasound can be used to determine how many potential follicles are developing. Every follicle is a potential baby, if you conceive.
- Your doctor may cancel your cycle if he/she thinks your risk of multiples is high. You may be asked to avoid sexual intercourse. Listen to your doctor. Remember that a multiple pregnancy puts you and your future babies’ health (and even life) at risk.
- With IVF treatment, your risk of multiples can be reduced with single embryo transfer (SET), though this isn’t appropriate for every couple. Talk to your doctor about your options.
- Beware of fertility clinics that are overly aggressive in their treatment of infertility. On the one hand, it may feel good to have a doctor promising you success and starting with the “best” or strongest treatments first. On the other hand, jumping up the ladder too quickly might lead to a premature fall.
- Of course, even with careful monitoring and a responsible doctor, you still may develop OHSS or get pregnant with twins or more. In that case, the best thing to do is to follow your doctor’s treatment advice and take care of yourself.
- Good prenatal care can lower the risks that come with multiple pregnancies. With early detection and treatment, OHSS is rarely severe and usually can be dealt with at home.
Coping with Fertility Drugs Side Effects: What can you do to relieve or reduce the discomfort of side effects? You should always talk to your doctor about this first. Let them know what you’re experiencing. That said, here’s some general advice.
- Paracetamol is best for headaches or cramps:
Communicate with your doctor first, of course, but commonly acetaminophen is the pain reliever of choice during fertility treatment. You should not take ibuprofen (Advil, Motrin) or naproxen (Aleve, Midol) because there is some concern these drugs can interfere with ovulation and embryo implantation.
- Dress in layers if you’re experiencing hot flashes:
You may also want to avoid drinking hot drinks, which might trigger a hot flash. If you dress in layers, and you’re suddenly “burning up,” being able to strip (a bit) might help.
- Make use of your yoga pants:
You may also use your sweatpants, or a long flowing summer dress—whatever will fit comfortably around your waist when you’re bloated.
- Seek for support and be forgiving of yourself:
Infertility and fertility treatment alone are likely to have you feeling vulnerable and emotional. Add in some mood swings—thanks to the side effects of some hormones—and you’ll likely be crying after a touching tire replacement commercial. Let your support circle know what you’re going through and how they can help.
