In general, infertility drugs work by releasing the hormones that either initiate ovulation or regulate it. Some are taken by mouth, others are injected, and some are taken vaginally.
For the injectable drugs, some are given beneath the skin (subcutaneously), and others are injected into the muscle (intramuscular). They are usually injected in the abdomen, upper arm, upper thigh, or buttocks. The injections are usually started on the second or third day of a cycle (with the first day being the first day you see bright red blood) and continued for 7-12 consecutive days.
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Clomiphene Citrate (Clomid®, Serophene®) is an anti-estrogen that acts on the brain to stimulate release of more hormones to induce ovulation. Patients take clomiphene citrate tablets by mouth during the early part of a cycle. The American Society for Reproductive Medicine (ASRM) recommends that patients use this medication for no more than six months.
Letrozole is an aromatase inhibitor that decreases estrogen initially, then allows for follicular growth. Patients take the pill for several days in the early part of the cycle to promote ovulation.
Human Menopausal Gonadotropin or hMG (Menopur®) contains luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones stimulate the ovaries to produce more follicles, thus increasing the number of eggs. This can be injected just below the skin (subcutaneously — SQ).
Follicle Stimulating Hormone or FSH (Gonal-F®, Follistim®, Bravelle®) stimulates ovaries to produce more follicles, thus increasing the number of eggs.
Human Chronic Gonadotropin or hCG (Ovidrel®, Pregnyl®) is a hormone that matures the developing follicles and triggers release of an egg from its follicle. In men, hCG may be used to enhance sperm production. It is taken as an intramuscular (IM) injection or subcutaneous (SQ) injection.
Testosterone is a hormone, often given by a patch, that may increase the response of the ovary to gonadotropins. This is not used when a woman may be pregnant.
Estrogen is a hormone that is helpful to improve the uterine lining or support a pregnancy.
Human growth hormone (HGH)
Human Growth Hormone (HGH) is a hormone given by subcutaneous injection. HGH may improve pregnancy rates when used during an IVF treatment, especially for women with lower quality eggs.
Progesterone is a hormone that helps prepare the endometrium (the lining of the uterus) for the arrival and implantation of an embryo. Progesterone is delivered by intramuscular injection or vaginal suppository, capsule, or gel. Certain formulations can be taken orally.
Leuprolide Acetate (Lupron®) acts on the brain to initially stimulate and then to suppress the body’s own hormone production, thus preventing follicle development and egg release. Doctors use it in combination with other medications to improve the stimulation cycle. It is also used to trigger the final maturation off the eggs in an IVF cycle.
GnRH Antagonist (Antagon®, Cetrotide®) acts on the brain to suppress the body’s own hormone production, thus preventing egg release. It is used in combination with other medications to allow for growth of more follicles without premature ovulation.