Many couples who struggle with infertility jump right to the conclusion that they need in vitro fertilization (IVF). In most cases, there are several other treatment stops along the fertility treatment rail line. In fact, because of the costs involved, IVF is typically the last stop on the journey.
A Brief Overview of Oral and Injectable Fertility Medications
If you and your partner are having problems conceiving, a heart-to-heart with your OB/GYN is typically the first step. If you are in your 20s or early thirties (approaching 35), odds are she will recommend you try naturally for at least a year before jumping to the conclusion that one or both of you has fertility issues. If you are 35-years or older, you only want to wait about six months because time is unarguably of the essence.
Once it is determined that you may, indeed, be experiencing fertility issues, there are several routes you can take. We always recommend getting a complete fertility workup. There is no point in spending time, energy and/or money on fertility treatments that may not work – depending on your condition. Knowing what the hurdles are will create a more concrete plan of action for your fertile future.
Two of the most common fertility treatments only require a prescription and assistance/monitoring by your doctor. These include oral and injectable fertility medications.
The most common oral fertility medications are clomiphene citrate (Clomid) and letrozole (Femara). Both work to enhance the production of follicle-stimulating hormone (FSH), which induces and/or improves the maturation and release of your egg(s). If this is a fertility treatment you pursue, your OB/GYN will write a prescription and you will take the pills orally for five days in a row, early in your menstrual cycle. In some cases you will be sent home to have intercourse as usual. In other cases, your doctor may monitor things more carefully and suggest timed sex to increase your chances of conceiving.
Because this is a hormone-based treatment, and it alters your body’s natural hormone production, side effects can range from headaches and mood swings to ovarian cysts and visual disturbances. Also, because oral fertility medications have the potential to stimulate more than one egg release at a time, the risk for twins is slightly higher (10% to 15%) than normal.
In most cases, if oral fertility meds are going to work, a woman will conceive within her first few ovulation cycles using the medication. Some couples opt to combine oral fertility medications with Intrauterine Insemination (IUI) to increase their odds even further.
If oral fertility meds aren’t effective within three ovulatory cycles, you may be referred to a fertility specialist.
Injectable fertility medications are the next stop on the fertility treatment journey. Clinically called gonadotropin therapy, the injectable commercial names include Gonal-F, Follistim, Menopur and Bravelle. These injectable meds use follicle-stimulating hormone (FSH) or lutenizing hormone (LH). Injectable fertility meds are usually prescribed if it’s determined that you don’t ovulate on your own or if clomiphene citrate didn’t work for you.
Not surprisingly, injectable fertility meds are more potent than their oral counterparts. They are administered by you or a partner (your doctor may give you the first one and teach you how to administer the shots for yourself thereafter), either under the skin (subcutaneously) or into the muscle tissues (intramuscular). Once you start the injections, you will be monitored carefully via ultrasounds and blood work to evaluate follicular development. Since this is not a “starting point” for most couples, and the side effects are more powerful, injectable fertility meds are almost always paired with IUI to increase the chances of conception ASAP, thereby limiting the amount of time a woman undergoes the injections.
Side effects can be slightly more dramatic than those experienced with oral fertility medications. They include ovarian enlargement, abdominal bloating and ovarian hyperstimulation syndrome. Injectable fertility meds often trigger the release of more than one egg, and this increases the chances of multiple births. For this reason, conscientious fertility clinics often stop a cycle of gonadotropin therapy if it is thought that triplets or higher orders of multiple births are a possibility. Multiple birth pregnancies are considered high-risk, and our goal is to produce healthy, full-term singleton births.