Fertility Drugs 101

I have received feedback from my post about the Octuplets, and how dare I be so judgmental because after all, the woman who had the eight babies most likely used Clomid.

Because I am all about being fair I think it’s important to understand the drugs that are used in ART.

Clomid is the brand name for the fertility drug clomiphene citrate. Clomiphene citrate may also be sold under the brand name Serophene. Whether you’re taking the brand name Clomid, Serophene, or a generic version of clomiphene citrate, it’s all the same drug. (Think of Clomid in the same way that we use Kleenex® to refer to facial tissues.)

Clomid is the most well-known fertility drug, probably because it is the most commonly used. And with good reason. About 25% of female factor infertility involves a problem with ovulation, and clomiphene citrate, as a fertility drug, is easy to use (taken as a pill, not an injection), with not too many side effects, is pretty inexpensive compared to other fertility drugs, and is effective in stimulating ovulation 80% of the time.

Clomid is used when there are problems with ovulation, but no problems with blocked fallopian tubes. (We know the woman with the octuplets had blocked tubes so she wouldn't have been a candidate for Clomid - In that case, stimulating ovulation would be pointless –- the egg and sperm can’t meet if the tubes are blocked. And furthermore reports are this woman had embryos transferred back into her uterus.) If a woman has irregular cycles, or anovulatory cycles (menstruation without ovulation), Clomid may be tried first.

Clomid is often used in the treatment of polycystic ovarian syndrome (PCOS) related infertility. It may also be used in cases of unexplained infertility, or when a couple prefers not to use the more expensive and invasive fertility treatments, like IVF.

The side effect you’re probably most familiar with is the risk of multiples. You have a 10% chance of having twins when taking Clomid, but triplets or multiples of more are rare, happening less than 1% of the time.

If Clomid on its own isn't successful, your doctor may recommend injectable hormones to stimulate ovulation. Some of the types are referred to as the big guns:

* Human Chorionic Gonadotropin (hCG), such as Pregnyl, Novarel, Ovidrel, and Profasi. This drug is usually used along with other fertility drugs to trigger the ovaries to release the mature egg or eggs.
* Follicle Stimulating Hormone (FSH), such as Follistim, Fertinex, Bravelle, and Gonal-F – These are the drugs that create many many follicles, not just two or three depending on ovarian response.
* Human Menopausal Gonadotropin (hMG), such as Pergonal, Repronex, and Metrodin. This drug combines both FSH and LH. – Another powerful drug which is commonly referred to as a “stim drug” for mass ovulation.
* Gonadotropin Releasing Hormone (Gn-RH), such as Factrel and Lutrepulse. This hormone stimulates the release of FSH and LH from the pituitary gland. These hormones are rarely prescribed in the U.S.
* Gonadotropin Releasing Hormone Agonist (GnRH agonist), such as Lupron, Zoladex, and Synarel
* Gonadotropin Releasing Hormone Antagonist (GnRH antagonist), such as Antagon and Cetrotide.

The scary part about all of this is that someone screwed up, and I think the screw-ups were on many levels.

If this was an IVF transfer, shame on the doctor for even suggesting or allowing that many embryos to be transferred into this woman. Shame on the mother for allowing it to happen in the first place.

If this was an injectable cycle, IUI cycle that went wrong, I am still shaking my head in disbelief at the irresponsibility that has taken place.