Fertility Drugs, Or Not?

Should you use fertility drugs as part of your attempt at pregnancy?  It depends. Depending on factors like your age, and whether or not you ovulate regularly, fertility drugs may be helpful. However they require careful monitoring because they may have side effects and are certainly associated with multiple pregnancy, usually twins.

Clomid (clomiphene citrate) is an oral medicine used to improve both the quality and timing of ovulation and to enhance implantation. It is helpful in many women who have menstrual cycle irregularities, who either do not ovulate or ovulate in a suboptimal way.

Though there are many potential side effects of Clomid, most women experience none or only a few. Since Clomid works in the brain, many of the side effects can include hot flashes, mood changes, irritability, insomnia or visual symptoms. In addition, ovulation can be associated with pelvic pressure or cramping, which can continue throughout the cycle. The incidence of birth defects, stillbirths, or even miscarriage is not increased with Clomid; and the overwhelming weight of evidence does not support any increased risk of cancer, early menopause, or pregnancy complication.

Injectable fertility medications (usually Gonal-F or Follistim) are sometimes used to stimulate the ovaries to develop multiple follicles (eggs) – these medications are often used with older women, who do not ovulate with Clomid. Additionally, they may be used in conjunction with IVF.

Because women respond to these injectable fertility medications at different rates, careful monitoring with vaginal ultrasound and blood estrogen testing is critical to achieve proper, individualized dosage. After several days of injections, additional ultrasound testing is performed, until the follicles are measured to be a precise size and the corresponding level of estrogen in your blood reaches a particular level. At this point, the eggs are felt to be mature.  An HCG shot may be given at this point to induce ovulation to occur 36 hours later, and intercourse or IUI can be timed accordingly.

Some side effects may include breast tenderness, mood swings, bloating, tiredness, and pelvic discomfort. Many women also form temporary cysts on their ovaries after ovulation. These cysts do not usually cause any problems other than some pelvic fullness, and they always eventually go away. Sometimes, however, these cysts will grow to considerable size and may cause significant abdominal bloating or pain. The resulting condition is referred to as hyperstimulation. There is no evidence that miscarriages or birth defects are more common with these drugs. There is also no evidence that these medications cause the development of earlier menopause or any other maternal complication such as the later development of ovarian cancer.

These drugs are associated with the increased possibility of multiple births. This incidence of multiple pregnancies is approximately 25%, usually in the form of twins. Less than 5% of the total pregnancies result in triplets, and less than 1 % are higher-order.


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