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If you’ve been struggling with infertility and have been trying to conceive, you know how disappointing it feels when you get your period at that time of the month; especially when you “had a feeling” that you were pregnant.
Overall, infertility (typically defined as the inability to get pregnant after having unprotected sex for one year) can be a very isolating experience—but know that you’re not alone—and that there are treatments available that may help you get pregnant. In fact, about 12.7% of women seek treatment for infertility each year (Carson, 2021).
One of those treatment options is the use of fertility drugs. Let’s learn a bit more about these medications and when they might help someone conceive.
What are fertility drugs?
Thanks to advances in medicine, there are many ways to achieve a pregnancy, even if you haven’t been able to do so naturally through sex. One of these options is to take fertility drugs: medications that are used to increase the chance of achieving a pregnancy.
Before we get into the details, let’s cover a few general facts to keep in mind about fertility drugs (Walker, 2021):
- There are no over-the-counter fertility drugs that are approved by the Food and Drug Administration (FDA). A healthcare provider’s prescription is required to obtain fertility medications.
- Fertility drugs can be expensive, and health insurance doesn’t always cover the costs.
- Some fertility drugs can increase the odds that you’ll conceive twins or triplets.
- Fertility drugs can either be used alone or in combination with assisted reproductive technology, such as in vitro fertilization (IVF).
Read on for an overview of common fertility drugs. For personalized medical advice, talk to a healthcare provider.
Fertility drugs for women
A variety of fertility drugs are available for women. Some of them come as pills that you swallow, while others are injectable.
Clomid (clomiphene citrate) is a popular fertility drug to start treatment with because it’s an inexpensive, easy-to-take pill that can be used before other, more expensive treatments. Clomiphene works by telling your body to produce more luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This hormone boost tells your ovaries to release an egg (ovulate) (DailyMed, 2021).
Clomiphene citrate is well-tolerated by most, but some women have swollen ovaries, hot flashes, belly pain, bloating, nausea, or vomiting.
Ovulation usually occurs 5 to 10 days after a course of clomiphene. If you don’t get pregnant after the first cycle, your doctor may increase your dosage. About 30% to 40% of women who take clomiphene become pregnant within three cycles (Seli, 2021).
Your healthcare provider will likely suggest moving on to a different fertility drug if you don’t have success after three to six rounds of clomiphene (DailyMed, 2021).
Letrozole (Femara) was originally developed as a breast cancer medication. It was later discovered that the drug could stimulate ovulation and is used off-label for this purpose (Walker, 2021).
Here are some fast facts about letrozole (DailyMed, 2022; Walker, 2021):
- Brand name: Femara
- Form: Oral tablet
- Drug classification: Aromatase inhibitor
- Common side effects: Hot flashes, joint pain, fluid retention, headache, dizziness, excessive sweating
Ovulation usually occurs five days after a course of letrozole. If you don’t get pregnant after the first cycle, your doctor may increase your dosage (Walker, 2021).
According to the American College of Obstetrics and Gynecology, letrozole may be a better and safer choice than clomiphene for women with polycystic ovarian syndrome (PCOS) and obesity (a body mass index greater than 30) (ACOG, 2018).
Gonadotropins are two hormones—luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—that the pituitary gland naturally produces. These hormones tell your body when it’s time to ovulate.
Gonadotropin fertility drugs are designed to mimic these natural hormones. Given as injections, they’re often used in different combinations as part of a protocol for assisted reproductive technology (ART), such as intrauterine insemination (IUI) (Copperman, 2013; Walker, 2021). These protocols require close monitoring by your healthcare provider, who can give you more details about this.
Here is a list of common gonadotropin medications (Walker, 2021; FDA, n.d.; ASRM, 2020):
- Human chorionic gonadotropin (hCG): hCG is a hormone the body naturally produces during pregnancy. Forms of hCG are also used as fertility drugs. It stimulates the release of an egg (ovulation) within 24 to 36 hours. Common hCG drugs include Novarel, Ovidrel, and Pregnyl.
- Human menopausal gonadotropin (hMG): hMG (brand name: Menopur) is a combination of LH and FSH. You inject it daily for 7 to 20 days. It works to help an ovule (egg) grow and mature. Then, another drug, usually hCG, is given to stimulate the release of the egg once it’s ready (FDA, 2014).
- Follicle-stimulating hormone (FSH): The drug form of FSH acts like the natural FSH made by your body. You inject it daily for 5 to 14 days. It works to help an ovule (egg) grow and mature until it’s ready, then another drug may be given to signal its release. Common FSH drugs include Bravelle, Follistim AQ, and Gonal-F.
- Gonadotropin-releasing hormone (GnRH) antagonists: It may sound strange compared to other fertility drugs, but GnRH antagonists drugs are used to block ovulation. This is because, in some cases, ovulation occurs too early, before an egg is fully mature. These drugs ensure that eggs reach their full maturity before an ART procedure like IVF. GnRH antagonist drugs include ganirelix and cetrorelix (Copperman, 2013).
Other fertility pills
Healthcare providers sometimes prescribe the following oral medications off-label to improve fertility in women:
- Metformin (brands: Fortamet, Glucophage, Glumetza): Metformin is a diabetes medication. It may also increase the chance of pregnancy in women with PCOS (Chang, 2021).
- Bromocriptine (brand name: Parlodel) and cabergoline (formerly available as the brand Dostinex): These drugs are used to treat hyperprolactinemia, a less common cause of infertility. With this condition, high levels of the hormone prolactin cause you not to ovulate (Walker, 2021).
Fertility drugs for men
Compared to female infertility, there are not as many drugs that can help with male infertility. That’s because male infertility can have causes that are only treated surgically, and medications won’t help. However, when male fertility has to do with hormone imbalances, certain medications pills can change a man’s hormones and get your fertility back on track—for example, by increasing the amount of testosterone.
Some of the drugs originally developed for female infertility have also been used in males. However, the evidence that they work in males isn’t as strong, and some experts don’t recommend these drugs for male infertility (Leslie, 2021).
Clomiphene for men
Clomiphene oral tablets may be used off-label in men to help improve sperm production. Clomid basically tricks your brain into thinking there’s too little testosterone in your system. As a result, your body ramps up the natural production of testosterone. Among the most common side effects of clomiphene are headache, mood changes, and chest tenderness (Krzastek, 2019).
Gonadotropins for men
Various combinations of gonadotropins, such as hCG, FSH, and hMG, have been successfully used to treat male infertility in some situations. This drug is typically a last resort treatment because it requires two to three injections per week (For more details about gonadotropins, see the section above regarding fertility drugs for women.) (Leslie, 2021).
Medications for non-testicular male infertility
For some men, the cause of infertility is non-testicular, meaning problems with their sperm or testicles are not causing their infertility. Instead, issues may be related to things like erectile dysfunction, lack of libido, or ejaculation problems (Leslie, 2021).
Several medications are available to treat erectile dysfunction, such as (ASRM, 2018; FDA, n.d.):
- Avanafil (brand name Stendra)
- Sildenafil (brand name Viagra; see Important Safety Information)
- Tadalafil (brand name Cialis; see Important Safety Information)
- Vardenafil (brand names Levitra, Staxyn)
In some cases, doctors may prescribe medications off-label for premature ejaculation, such as paroxetine (Shrestha, 2021).
Lifestyle changes like quitting smoking or avoiding alcohol may also help (Leslie, 2021). But, the first step in finding the right treatment is to talk to a healthcare provider. They will likely check your blood work and analyze a sperm sample to find any underlying causes of infertility. If they can’t determine a cause that’s treatable with a drug, they’ll likely recommend assisted reproductive technology (ASRM, 2018).
Bottom line: talk with a healthcare provider
Besides fertility drugs, there are many ways to become a parent. Talk with a healthcare provider to learn more about fertility treatments, including the fertility drugs above and assisted reproductive technologies.
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
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Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.