Clomiphene Citrate (Clomid®, Serophene®)
Type of medication: a non-steroidal antiestrogen
How it works: tricks brain/pituitary into "thinking" that there is less estrogen around
How given: oral, started on day 3-5 of cycle
Typical dosage: 50-250 mg/day
Indications: infrequent or rare ovulation, luteal phase deficiency, to increase the numbers of eggs
Multiple pregnancies: 8%
Side Effects: hot flashes, breast tenderness, mood swings, visual problems. thick cervical mucus, luteal phase deficiency
Long-term safety: use for more than a year may increase the risk of ovarian cancer

Human Menopausal Gonadotropins (hMG)  (Menopur®, Repronex®)
Type of medication: pituitary peptide hormone, usually from the urine of menopausal women
How it works: directly stimulates the ovaries
How given: intramuscular or subcutaneous injection (1-2 times per day)
Typical dosage: 75-600 IU/day (1-8 ampules)
Indications: problems of the hypothalamus, unexplained infertility, endometriosis, ovarian stimulation for IVF.
Multiple pregnancies: 25%
Side Effects: mood swings, ovarian hyperstimulation
Long-term safety: potential risk of ovarian cancer is unclear

Follitropin (FSH)     (Bravelle®, Follistim®, Gonal-F®)
Type of medication: pituitary peptide hormone, from urine or though recombinant DNA technology
How it works: directly stimulates the ovaries
How given: subcutaneous injection via pen or syringe (1-2 times per day)
Typical dosage: 75-600 IU/day
Indications: anovulation, unexplained infertility, endometriosis, ovarian stimulation for IVF
Multiple pregnancies: 25%
Side Effects: mood swings, ovarian hyperstimulation
Long-term safety: potential risk of ovarian cancer is unclear

Human Chorionic Gonadotropin (hCG)  (Ovidrel®, Pregnyl®, Novarel®)
Type of medication: peptide hormone from urine of pregnant women
How it works: triggers ovulation
How given: intramuscular or subcutaneous injection before ovulation
Typical dosage: 5,000-10,000 IU or 250 mcg, less after ovulation
Indications: used in conjunction with hMG, FSH or clomiphene to force eggs to release
Multiple pregnancies: variable
Side Effects: cramping, hyperstimulation
Long-term safety: potential risk of ovarian cancer is unclear

Bromocriptine (Parlodel®) Cabergoline (Dostinex®)
Type of medication: a dopamine agonist (acts like a transmitting chemical in the brain)
How it works: suppresses prolactin hormone levels and allows return of menstrual function
How given: oral, vaginal
Typical dosage: 2.5 mg twice a day/ 0.5 mg twice a week
Indications: abnormal bleeding or infertility due to elevated prolactin levels
Multiple pregnancies: no increase
Side Effects: weakness on standing, nausea, nasal congestion
Long-term safety: appears safe, should be discontinued once pregnant

Progesterone (Crinone®, Prometrium®,Procheive®)
Type of medication: a steroid hormone produced by ovary and placenta
How it works: supplements levels of hormones naturally produced in last half of the menstrual cycle and in pregnancy
How given: oral (micronized), intramuscular (in oil), vaginal
Indications: luteal phase deficiency (deficiency in progesterone action), IVF
Multiple pregnancies: no increase
Side Effects: breast tenderness, tiredness, bloating
Long-term safety: appears safe, other progestin hormones have been associated with birth defects

GnRH (Factrel®, Lutrepulse®)
Type of medication: a hormone produced by the brain
How it works: replaces missing hormone and allows the pituitary gland to function
How given: infusion by pump with indwelling catheter
Indications: absent periods due improper function of the hypothalamus (part of the brain)
Multiple pregnancies: no increase
Side Effects: infection of the indwelling line
Long-term safety: appears safe

GnRH Agonist (Lupron®, Synarel®, Zoladex®)
Type of medication: an analog of GnRH produced by the brain
How it works: prevents premature release of eggs (daily form), turns off the pituitary gland (monthly form)
How given: daily injection or nasal spray, monthly injection or implant
Indications: to prevent premature release of eggs for IVF/GIFT or to induce a menopause-like state to suppress endometriosis or fibroids
Side Effects: headaches, hot flashes, bone loss
Long-term safety: safe for less than 6-9 months use, longer if estrogen is supplemented

GnRH Antagonist (Ganirelix, Cetrotide®)
Type of medication: an analog of GnRH produced by the brain
How it works: prevents premature LH surge and release of eggs
How given: daily or every 3rd day subcutaneous injection while on FSH or hMG
Indications: to prevent premature release of eggs for IVF or IUI
Side Effects: rare except those associated with FSH or hMG
Long-term safety: appears safe

Metformin (Glucophage®)
Type of medication: a diabetes medication
How it works: lowers insulin levels and improves insulin resistance
How given: oral
Typical dosage: 1500 mg per day
Indications: polycystic ovarian syndrome, diabetes
Side Effects: bloating, cramping, diarrhea, lactic acidosis
Long-term safety: appears safe

Patient Instructions for Injectable Fertility Drugs

Mixing Instructions for Injectable Fertility Drugs