Side Effects of Fertility Drugs
If you’re someone who is struggling with infertility, you might leave your doctor’s office with a handful of prescriptions to fill – and a lot of questions. I blindly trusted the people wearing white coats. I did whatever they said and took whatever they prescribed, without doing any research. Even though there was information readily available about the medications I was taking, I didn’t really understand exactly what I was putting into my body – through pills and injections. I had a one-track mind – which was solely focused on doing whatever it took to get pregnant and have a healthy baby.
Now that I’m on the other side of infertility, and have done years of research and interviews with the most renown fertility experts in the world – I now see so many ways I could be in more control of my infertility journey. That old saying “knowledge is power” – is especially true when you are faced with medical challenges. Had I done my research ahead of the many procedures I went through, it would have been a much easier, much shorter and less costly experience. I might have also realized it’s not one-size-fits-all when it comes to treating infertility.
You have to be your own advocate – and that means arming yourself with as much information as you can when you walk into your doctor’s office. You need to learn as much as you can about your body, your medical history, and the options you have for treatment. I felt like things were moving so fast – I didn’t want to stop and wait another minute, because I was racing against my biological clock. But, I didn’t understand that when you take the time to educate yourself – it will save you so much more in the long run.
Whether you need to take medications to improve fertility, trigger ovulation or you are about to go through IUI or IVF (link to definition page) – being prepared is key. You should know what the fertility drugs are, what they are supposed to do and if there are any potential side effects. Your doctor, nurse or fertility specialist may go over this information with you in their office – but there is often so much information you are getting all at once, that you may not remember it all by the time you get home. Figuring out the right way to take the medications is challenging enough! Sometimes I felt like an uneducated scientist in a lab – with my shaky fingers – mixing up the powders and liquids before injecting them.
Crown Fertility is here to offer the support and information you need on your fertility journey. We’ll get into some of the amazing fertility supplements they offer later. But first, let’s start with a guide to the most common medications you might be prescribed:
Clomid or Serophene
Clomiphene citrate has been around for several decades. The two most common brand names for this drug are Clomid and Serophene. This medication is a pill that is usually prescribed to help ovulation. Clomiphene is used to block estrogen, basically causing your brain to release hormones that tells your ovaries to produce and then release eggs – or ovulate.
Clomid is typically the fertility drug that many doctors will try first, before moving on to other treatment. Clomiphene should be taken under the guidance of a doctor, or natural fertility specialist, who will prescribe the dosage that is right for your specific case. Your doctor might have you take Clomid, monitor your body temperature, cervix position – and then try to conceive naturally. Your fertility specialist might prescribe Clomid before doing a procedure, like artificial insemination or IUI. This medication is not recommended for long term use – usually no more than six cycles.
Some of the side effects of taking Clomiphene include an upset stomach, bloating, getting headaches, or feeling dizzy. Another potential side effect is a change in your vision – like seeing spots, flashes or blurry.
Another possible side effect to watch out for is Ovarian Hyperstimulation Syndrome (OHSS). In extreme cases, OHSS will cause fluid to build up in the stomach, chest and heart areas. If you feel severe pain, have swelling in lower abdomen or legs, nausea/vomiting, diarrhea, chest pain – contact your doctor right away.
It’s important to know that Clomid does increase your chances of getting pregnant with multiples, because more than one egg may be released from the ovary and fertilized.
If Clomid doesn’t work, your fertility specialist may recommend you start hormone therapy, medications you take by injecting them. This treatment is designed to regulate and stimulate the production of your own hormones or to trigger ovulation. You can expect to be prescribed these medications when you use assisted reproductive technology (ART) – like Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), or oocyte cryopreservation (egg freezing). Here is a breakdown of the main injectable hormones:
Human Chorionic Gonadotropin (hCG)
HCG is a naturally produced hormone by the cells in the placenta during pregnancy. This is the hormone that pregnancy tests can detect in your blood or urine between 11 and 14 days after conception. The levels will increase as a healthy pregnancy develops.
But in the case of fertility treatments – hCG is an injectable hormone with brand names that include Pregnyl and Novarel. HCG is typically used to cause women’s ovaries to release a mature egg. The hormone might also be prescribed to improve male fertility with the goal of increasing sperm production.
Some of the side effects from taking the hCG injectable hormone include headaches, fatigue and depression. These are things you might already be experiencing from battling infertility. But if these feelings increase after using hCG or any other medications, you should let your doctor know. Other side effects to look out for swelling include swelling of your feet, legs, hands and/or ankles. In some cases, this drug could cause blood clots, allergic reactions or painful swelling or even rupture of the ovaries. These are serious and you should be seen by a doctor right away.
Do not take the hCG hormone if there’s a chance could already be pregnant, or if you have prostate cancer or another cancer. Always be sure to let your doctor know of other medical conditions you have –because it could impact your treatment – and make you at higher risk for complications from taking the medication.
Follicle-Stimulating Hormone (FSH)
FSH is the hormone that both men and women’s bodies naturally produce. Your pituitary gland, which is just below your brain, produces FSH into your bloodstream. In women, FSH helps women produce and release their eggs. In men, it allows men to make sperm. Now, if you’re trying to get pregnant, especially if you are a woman over the age of 35, your doctor might test this level in your blood pretty early on, to determine how much of this hormone your body is making. Because if you don’t have enough, or you have too much of this hormone, it can potentially make it more difficult to get pregnant. Your doctor will weigh these test results with others to offer a prognosis and a plan for treatment.
The synthetic or man-made version of FSH is an injectable hormone with brand names which include Follistim, Gonal-F and Bravelle. Your ovaries develop follicles each month, and they produce estrogen and progesterone – and then release an egg during ovulation. Well, FSH is used to stimulate the growth and development of those follicles – which could potentially produce multiple eggs. FSH is usually with hCG to treat infertility in women who can’t ovulate or as a way to produce multiple eggs for retrieval for procedures like IVF or egg freezing. FSH is not helpful for women to have primary ovarian failure – which means they can’t produce eggs.
The FSH injectable hormone has the same side effects as hCG – including depression and risk of Ovarian Hyperstimulation Syndrome (OHSS) – which is when your ovaries get too large from the medications.
Human Menopausal Gonadotropins (hMG)
HMG is an injectable medication that has both FSH – the follicle-stimulating hormone and luteinizing hormone (LH). LH is the hormone that is made in the pituitary gland and supports the reproductive system – the woman’s ovaries and man’s testes. When you are trying to get pregnant – or you are going through ART, your doctor may test your LH levels several times – to find out exactly when your body is going to ovulate. Because the amount of LH in your blood increases with ovulation.
HMG is prescribed with brand names that include Menopur, Pergonal, Repronex and Metrodin. When using this injectable medication, the goal is to help a woman’s ovarian follicles mature and be able to produce multiple eggs in one cycle. In men, hMG may be used to stimulate sperm production.
Why would you want to produce multiple eggs? In the case of IVF, or egg freezing, once the follicles have matured and hopefully produced multiple eggs, the doctor would retrieve those eggs through an outpatient procedure. The mature eggs would then be fertilized and the embryo would be observed for approximately 5 days to assess viability for either implantation or freezing.
Side Effects from taking hMGare the same as FSH and hCG, listed above.
Gonadotropin-Releasing Hormone agonists (GnRH agonist)
GnRH is naturally produced in the part of the brain called the hypothalamus. GnRH signals the pituitary to create the FSH and LH hormones. GnRH agonist is sold with brand names including Lupron and Synarel. GnRH agonists cause an initial surge of FSH and LH, then will cause the body to shut down normal production of those hormones because it senses that too much is being made. At that point, a doctor can have control over the egg development during fertility treatments. When used during IVF, or to prepare for egg retrieval, other drugs, gonadotropins, are used at the same time to stimulate follicle growth. By suppressing the production of the LH hormone, ovulation won’t happen before the fertility specialist is ready to retrieve the mature eggs. At that point, the doctor will use an hCG “trigger” shot, typically the day before the retrieval procedure.
Side Effects – The side effects of Lupron are similar to what you might have when going through menopause, but will typically go away once your treatment is completed. Some women will experience hot flashes, headaches, mood swings and depression, nausea and acne breakouts.
Gonadotropin-Releasing Hormone Antagonist (GnRH Antagonists)
Now this medication is similar to the GnRH agonist. But this injectable medication, with brand names including Ganirelix, Antagon and Cetrotide, skips the initial surge of FSH and LH, and starts by shutting down the release of those hormones right away. This protocol may mean less injections and a shorter amount of time. Meaning you would start taking this medication after you start the IVF protocol. With the agonists, like Lupron, the additional step of the hormone surge, then the shutdown, means starting that medication sooner.
There is a debate in the medical community over which protocol is best for IVF – using antagonists or agonists (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442989/). While the side effects are pretty much the same, some people prefer going the antagonist route, because it means less time taking the medication. Also, antagonists are approved by the FDA for IVF treatment. GnRH agonists are not FDA approved for that purpose, but some doctors prefer to use it for IVF.
*Always be sure to read the complete list of drug interactions and side effects that come with any prescription medication. We don’t have all of the side effect listed here – and we also don’t list all of the medications you might be prescribed. So, if you have any questions contact your doctor or pharmacist.
Some of these injectable medications are injected beneath the skin, others are injected into a muscle- typically in the abdomen, upper arm, upper thigh or your backside. One thing that really helped me with the discomfort of the injections was using an ice pack or ice cube to numb the area right before doing the injection.
Now, about Crown Fertility, the reason we are all here. While you are going through fertility treatments – taking medications -whether orally or through injections – you should also be taking care of your body. You can do that many ways, through lifestyle changes including- not smoking, eating a variety of vegetables, cutting down on junk food – like sugar and processed foods. You should also consider including supplements into your daily routine, to complement and support your healthy eating plan. Please consult your doctor before starting to take any supplements – so you can be sure nothing you take will interfere with your fertility medications.
Supplements can improve your overall health – while you are preparing or undergoing ART treatments. If you have a male partner – their health is just as important as yours. There are fertility supplements for men, women and for women with PCOS available. I know that I wanted all the help I could become as healthy as possible – inside and out. Taking supplements offered a peace of mind that any nutrients I was missing would be filled.
July 22, 2019