Having trouble conceiving? About 25 percent of all women with fertility challenges have ovulation issues — and for those who are trying to conceive, especially if you’re under 35 years of age and it’s been longer than a year, fertility medications might be the solution.
Fertility drugs prompt ovulation (which happens when the ovaries produce and release an egg) by acting like two of the natural hormones in your body, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). And if you need help producing better eggs or more of them, fertility medications or hormone shots might be the next step in your conception journey.
But if you’re wondering if fertility pills really work — or how long fertility medications actually take before you see results, the science is on your side. Several oral medications and hormone shots that your doctor might recommend have good success rates and relatively mild, temporary side effects.
If you’re ready to consider fertility medications to jumpstart your ovulation and move forward on your getting pregnant quest, here’s a roundup of the different drugs that may be part of your treatment.
Clomid
Clomid is the brand name for the medication clomiphene citrate. This oral pill stimulates your ovaries to release an egg (or eggs), helping to correct irregular ovulation or working to induce ovulation if you’re not ovulating at all.
How does Clomid work?
When you take Clomid, your body becomes convinced your estrogen levels are low, and in response, it kicks into high gear to produce more FSH (follicle-stimulating hormone) and a subsequent surge in LH (luteinizing hormone). Both hormones stimulate the follicles in your ovaries to develop and mature.
The maturation of the follicles and the eggs contained in them causes your body to produce more estrogen, which also (in some women) leads to the production of better-quality cervical mucus. Better-quality mucus creates a fertility-enhanced environment for sperm, helping them reach Destination Egg faster. Some women on Clomid, however, find that their cervical mucus becomes dry and sticky instead.
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Another byproduct of the increase in maturing eggs: more progesterone production, which builds a strong uterine lining for that fertilized egg to burrow into.
Most women start with 50 milligrams of Clomid per day for five days, beginning on day two, three, four or five of their cycle.
If necessary, the dose can be increased by 50 mg per day each month up to 150 mg, 200 mg, or even 250 mg (depending on your doctor’s protocol). Your doctor will monitor you through blood tests and ultrasounds to check your ovulation progress and you’ll hopefully hit the baby jackpot either the old-fashioned way through sex, or through intrauterine insemination (IUI).
If after 6 months on Clomid you’re still trying to get pregnant, you’ll likely move on to hormone shots and/or in vitro fertilization (IVF).
What are the potential side effects of Clomid?
Some women on Clomid experience bloating, nausea, headaches, hot flashes, breast pain, mood swings, vaginal dryness and in rare cases, ovarian cysts. Happily, these side effects are only temporary.
However, if you experience vision changes while on Clomid, it's recommended that you stop taking it.
How successful is Clomid?
The success rates for Clomid are encouraging. If failure to ovulate is the only problem, approximately 80 percent of healthy women will ovulate, and 30 percent will become pregnant within three months of treatment.
There’s also a 5 to 8 percent chance of conceiving twins on Clomid (the natural rate of twins is only 1 percent) because Clomid ups the odds that more than one egg will be released.
How much does fertility treatment with Clomid cost?
Clomid itself is relatively inexpensive, at least as infertility treatments go. But without insurance, you may have to pay about $100 a month for the pills.
Be aware that other medical costs (for bloodwork, monitoring and ultrasounds) will also factor into the full price per cycle — depending on your doctor and your region, the treatment could cost anywhere from $500 to $2,000 per month.
Some insurance plans will cover all aspects of infertility treatments (including the cost of the medication, the monitoring and the bloodwork), while other insurance plans don’t. You’ll want to call your insurance company to find out if Clomid is covered by your plan.
Femara
Femara is the brand name for letrozole — one of the class of drugs called aromatase inhibitors. This oral pill stimulates your ovaries to release an egg (or eggs), helping to correct irregular ovulation or working to induce ovulation if you’re not ovulating at all.
How does Femara work?
Femara works in a similar way to Clomid, suppressing estrogen leading to an increase in FSH production, which stimulates the ovarian follicles to mature and triggers ovulation.
You’ll take 2.5 mg of Femara per day on days five through nine of your cycle (though some fertility specialists give a higher dose — 5 mg or 7.5 mg per day).
Women who haven’t had ovulation luck using Clomid may find more success with Femara, especially if they have polycystic ovarian syndrome (PCOS).
Many doctors are finding significant success with Femara, and prefer to use it over Clomid because it has a lower risk of side effects and a reduced chance of conceiving multiples.
What are the potential side effects of Femara?
Some women experience mild dizziness and fatigue on Femara, but compared to Clomid, most women experience fewer side effects such as hot flashes.
How successful is Femara?
Studies show that the success rate of Femara is higher than Clomid for women with PCOS. One study found that while 19.1 percent of women with PCOS who took Clomid had a successful pregnancy within five cycles, 27.5 percent of women with PCOS who took Femara had a successful pregnancy within five cycles.
How much does fertility treatment with Femara cost?
The cost of Femara is comparable to Clomid per cycle, with a month's worth of pills running around $120. Similarly, your insurance may or may not cover Femara as an infertility treatment.
Your best bet: Give your insurance plan a call to find out what is or isn’t covered.
Hormone shots (gonadotropins)
If you’re not responding to oral fertility medications such as Clomid or Femara and still want to try to conceive with IUI, your doctor may decide to up your fertility game with hormone shots (called gonadotropins) that you’ll inject at home.
You’ll be given low doses, increasing the dose every four to seven days until the ovaries start to respond, with the goal of producing only one to two mature eggs at a time.
However, hormone shots can often cause the production of too many eggs, upping the chance of "high-order multiples" (triplets or more). For this reason, many practitioners will recommend IVF instead.
Hormone shots will still be the first step if you’re undergoing IVF. With IVF, you’ll aim for 10 to 15 eggs per egg-retrieval cycle, which means your dose of hormone shots will be higher (but not too high).
How do hormone shots work?
Hormone shots do the same thing as the oral medications, but at higher concentrations.
What might be on tap for you if you’re using hormone shots? Every woman’s cocktail of shots will be different — a lot will depend on your situation, on your doctor’s preference and on how your body responds to the hormones.
You might be prescribed only one of these hormones, or perhaps two of these shots, or maybe even most of them. It may also take several cycles (and several adjustments) before you hit your optimal fertility prescription.
Remember: Every woman’s fertility needs are different, and that means no two women’s fertility treatment plans will be the same.
Some of the hormone shots that you may be prescribed:
- Follicle-stimulating hormone (FSH). FSH shots, with brand names like Follistim and Gonal-f, are subcutaneous (under the skin) shots that act in the same way as your natural FSH to stimulate the growth and maturation of your eggs. FSH shots usually start on day two to four of your cycle. You’ll need to inject the shot once or twice a day.
- Human menopausal gonadotropin (hMG). The brand names of this hormone is Menopur. These subcutaneous shots include both FSH and LH —hormones that stimulate the development of follicles and the maturation of eggs. You’ll inject yourself with hMG once or twice a day for about seven to 12 days, starting on day two to four of your cycle.
- Human chorionic gonadotropin (hCG). These shots (brand names Ovidrel, Novarel and Pregnyl) are used alongside FSH and hMG injections (sometimes even in conjunction with Clomid) to help trigger ovulation. You may have heard this injection referred to as the “trigger shot,” given when one or more follicles is just about ready to release an egg. The shot mimics your natural LH surge, and it allows the follicle(s) to rupture and release the egg(s). Ovulation will usually occur 36 to 40 hours after the injection.
- Gonadotropin-releasing hormone (GnRH) agonist. Occasionally, FSH or hMG shots work too well, stimulating the release of eggs before they are mature. GnRH agonists (such as Zoladex or Lupron) help prevent immature eggs from being released too soon by preventing the LH surge, which triggers ovulation. Using this hormone enables more high-quality eggs to develop. This shot is used only in an IVF cycle, and you’ll inject it subcutaneously before FSH and hMG shots are started.
- Gonadotropin-releasing hormone (GnRH) antagonist. Brand names of this hormone injection include Ganirelix and Cetrotide. Also used only in IVF cycles, GnRH antagonists prevent a too-early LH surge, ensuring that the eggs aren’t released too soon and only when they are mature. Because GnRH antagonists work much faster than GnRH agonists, they are started at least five to seven days after starting FSH and hMG shots. These subcutaneous shots might be used in women who aren’t responding well to FSH and hMG, or in women who are responding too well, as a way to prevent ovarian hyperstimulation syndrome.
- Progesterone. The hormone progesterone isn’t a fertility drug the same way all these other shots are, but it does help maintain a newly conceived pregnancy and prevent miscarriage. This injection is especially important in an IVF cycle, when GnRH agonists and antagonists prevent the ovaries from making progesterone. In IVF pregnancies, supplementary progesterone picks up the baby-sustaining work until the placenta is ready to assume the job, at around two months.
What are the potential side effects of hormone shots?
While not all women taking hormone shots have side effects, those who do may notice breast tenderness, mood swings, headache, abdominal pain and nausea.
In rare cases, these shots could induce ovarian hyperstimulation syndrome. In most cases, women taking hormone shots notice more cervical mucus.
How successful are hormone shots?
Many variables come into play when looking at success rates of these hormonal medications, including the woman’s age, her BMI, the reason for the fertility challenges and so on.
Some estimate that the odds for a successful pregnancy and birth for a woman under age 35 after using fertility injections with IUI are 5 to 15 percent per cycle, and with IVF about 50 percent per cycle.
How much does fertility treatment with hormone shots cost?
Fertility hormonal shots don’t come cheap, and your insurance may or may not cover them.
Your personal cost will depend entirely on how many and what kind of shots you’ll need, but estimates for a full IVF cycle run to $30,000 (which includes the treatment, the drugs and additional costs such as monitoring and bloodwork).
Bromocriptine
Known by the brand name Parlodel, this drug is designed to correct a hormone imbalance call hyperprolactinemia, which means that there’s too much prolactin in your blood.
How does bromocriptine work?
By acting like the neurotransmitter dopamine, which is a natural substance in the brain, this drug targets the pituitary gland and works to prevent excess prolactin and lower its production. It can also treat a lack of menstrual periods and nipple discharge.
This medication may be prescribed as an oral tablet that’s usually taken daily with food or in capsule form to be inserted in the vagina. After a few months on bromocriptine, prolactin levels should be back to normal and ovulation can begin again.
What are the potential side effects of bromocriptine?
The side effects of bromocriptine can include dizziness, drowsiness, headache, insomnia, dry mouth, a stuffy nose, stomach pain, loss of appetite, constipation and diarrhea.
How successful is bromocriptine?
Success rates for this fertility medication are good among women who have high prolactin levels: According to one study, bromocriptine normalizes prolactin levels in blood serum for 80 percent of women, and there is a subsequent pregnancy rate of 60 to 80 percent, if there are no other fertility issues.
How much does fertility treatment with bromocriptine cost?
This drug may be covered by insurance and has a range of pricing, though it generally costs about $175 for 30 tablets or capsules (though it can go as low as around $120 for a generic version of the drug and as high as around $220).
Cabergoline
Cabergoline is marketed under the brand name Dostinex and like bromocriptine, it’s a dopamine receptor agonist (a drug that activates certain brain receptors) that’s used to treat hyperprolactinemia.
How does cabergoline work?
Cabergoline targets prolactin to reduce too-high levels in the body and comes in a tablet that’s taken orally a couple of times a week.
This medication is newer to the market than bromocriptine, but it works as effectively and may be prescribed if you don’t respond well to bromocriptine or you experience adverse effects while taking it.
What are the potential side effects of cabergoline?
You might have nausea, vomiting, heartburn, constipation, fatigue, dizziness, painful breasts or periods and occasional numbness or tingling in the arms, hands or feet while taking cabergoline.
How successful is cabergoline?
Cabergoline has been shown to help women ovulate regularly, and a small study found that for women treated with this fertility drug, approximately 85 percent had successful conceptions.
How much does fertility treatment with cabergoline cost?
This drug is likely covered by most insurance plans, so check with your doctor. Average prices for cabergoline are about $177 for eight doses but can run as high as $230 to $240.
The world of fertility drugs may seem complicated. But know that with your doctor's guidance, many of these oral medications and hormone shots have an excellent track record of helping couples who are trying to conceive go on to have healthy babies.
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