Washington Center for Reproductive Medicine

Fertility Drugs Overview

Many fertility drugs are now available to help couples conceive. Most of these medications stimulate ovulation in the female and include fertility drugs, such as follicle stimulating hormone FSH (Gonal-F, Follistim, Repronex, Menopur)Clomid, and Glucophage (corrects insulin imbalance). Other fertility drugs correct hormonal imbalances, such as Parlodel, which lowers the level of the hormone prolactin.

The Ovulatory Cycle

In order to understand how fertility drugs exert their actions, it is necessary to have a basic understanding of the ovulatory cycle. Every month the normal fertile female undergoes hormonal changes (the hypothalamic-pituitary-adrenal axis) associated with egg recruitment, development, ovulation, fertilization and embryo implantation.

The hypothalamus is a gland located at the base of the brain responsible for regulating hormone levels, much like a thermostat. During the first few days of the ovulatory cycle, the hypothalamus signals the pituitary to produce follicle-stimulating hormone (FSH). This "signal" is sent by gonadotropin releasing hormone (GnRH). Increasing levels of GnRH causes increased production of FSH.

FSH directly stimulates the follicles on the ovary, each one of which contains an egg. As healthy follicles develop, they begin to produce estrogen. The hypothalamus "measures" the levels of estrogen and adjusts the production of FSH accordingly. Once the follicles are mature, the hypothalamus signals the pituitary gland to produce a surge of luteinizing hormone (LH), which stimulates ovulation.

The follicular structure remaining after ovulation is known as the corpus luteum and it begins to produce Progesterone. Estrogen and Progesterone stimulate the growth and development of the lining of the uterus (endometrium). The endometrium must thicken and become more vascular to accept the developing embryo. Once the embryo has implanted, the placenta begins to produce additional Progesterone.

Fertility drugs affect one or more of these ovulatory cycle processes.

Unfortunately, there are few fertility medications proven effective in the male. Medications are rarely effective unless there are specific hormone abnormalities, which is very infrequent.

Mild male infertility is effectively treated using intrauterine insemination (IUI) and moderate to severe male factor is treated with in vitro fertilization and intracytoplasmic sperm injection.







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