additional fertility medications

These drugs are sometimes used alone or in combination with other medications to treat infertility.

• insulin sensitizing agents
• thyroid hormone replacement
• anti-androgens or estrogens
• GnRH analogues
• human chorionic gonadotropin (hCG)

insulin sensitizing agents

It is becoming more common for doctors to add insulin-sensitizing drugs to the menu of drugs used to treat infertility, especially in women with polycystic ovarian syndrome.

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thyroid hormone replacement

Some women may have problems with their thyroid gland, which impacts their ability to ovulate. Replacing the thyroid hormone will generally correct this. Many anovulatory (not properly producing eggs each month) and oligoovulatory (ovulating irregularly) women are screened for abnormal prolactin or thyroid levels during their initial evaluation.

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anti-androgens or estrogens

Some women produce high levels of androgens (male sex hormone) from their adrenal glands. After a thorough evaluation to rule out more serious adrenal problems, these women may be given medications to lower their adrenal androgen production. The lower androgen levels will enable ovulatory cycles to resume for some women. For other women, it will improve their response to other forms of ovulation induction. Women with symptoms of excess androgen production (masculine hair growth patterns, acne, etc.) can be screened to see if they might benefit from this type of treatment.

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gnrh analogues

Some women undergoing controlled ovarian stimulation with injectable gonadotropins will have a spontaneous mid-cycle LH surge before the developing follicles are mature and can result in the need to cancel the IVF cycle. This premature LH surge may be prevented by the use of medications called GnRH analogues. These medications suppress the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary. Therefore, all of the FSH needed to stimulate the follicles during the cycle comes from the injectable gonadotropins.

There are two types of GnRH analogues commonly used: GnRH agonist and GnRH antagonist. GnRH agonist must be given for two or three weeks prior to initiation of infertility treatment. Whereas, the GnRH antagonists can be given only for an average of five days of treatment to prevent a premature LH surge.

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human chorionic gonadotropin (hcg)

Human Chorionic Gonadotropin is a glycoprotein, a peptide framework (the building blocks of proteins), to which carbohydrate side chains are attached. It consists of two subunits (alpha and beta). Unique biologic activity as well as radioimmunoassay characteristics are attributed to the beta subunit.

In the treatment of female infertility, hCG is used mid-cycle to induce the final maturation of the oocyte and trigger ovulation by mimicking the normal LH surge following gonadotropin stimulation. An ultrasound scan will be done to document that ovulation has occurred following hCG administration. The success of hCG in inducing ovulation is dependent upon the effectiveness of the preceding follicular stimulation and the correct timing of administration. Side effects of gonadotropins include multiple pregnancies and ovarian hyperstimulation syndrome.

In male infertility, hCG is used for the treatment of prepubertal cryptorchidism (undescended testicles) not due to anatomical obstruction. Human Chorionic Gonadotropin is also used to treat secondary hypogonadism.

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