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Clomiphene (Clomid, Serophene, Milophene)

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Clomiphene is oral medication commonly used in the treatment of infertility that stimulates ovulation. It is a type of drug called a SERM (selective estrogen receptor modulator) and is related to others SERMs such as Tamoxifen (Novaladex) which is used to treat breast cancer and Raloxifene (Evista) which is used to treat postmenopausal osteoporosis. Clomiphene works by blocking estrogen receptors in the brain and pituitary gland, "tricking" the pituitary gland to secrete more FSH and LH which in turn stimulates the ovary to produce eggs. Unfortunately, clomiphene also blocks estrogens effects at the cervix and endometrium (the lining of the uterus). This can cause the cervical mucus and the endometrium to thin out making it more difficult for sperm to reach the eggs and more difficult for an embryo to implant in the uterus. Overall, though, the fertility benefits outweigh the negatives.

Understanding how clomiphene works (blocking estrogen and stimulating ovulation), makes it easier to understand its side effects:

  • Mulitple pregnancies (about 8% overall)
  • Hot flashes
  • Mood swings
  • Headaches
  • Reduced cervical mucus
  • Possible increased risk of ovarian cancer with long term use

Letrozole (Femara)

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Femara is a relatively new drug used in fertility treatment. It a type of drug called an aromatase inhibitor which is usually used to treat breast cancer. It is not a chemotherapy drug, but rather works by blocking the enzyme (aromatase) that turns testosterone into estrogen. The lower estrogen level causes the pituitary gland to produce more of the hormones that stimulate egg growth. The side effects of Femara are similar to those of Clomid but are generally less severe. It does not harm the cervical mucus or the lining of the uterus, and appears to be less likely to cause multiple births than Clomid.

Clomiphene Instructions for Princeton IVF patients

  • Please start the clomid on day 3 of your cycle. Day 3 is the third day of red flow. If you are delayed, it is OK to start as late as day 5.
  • Please schedule an ultrasound and bloodwork for day 12 or 13 of your cycle unless we ask you to come in earlier, and that any referrals/precertifications are in place.
  • If you are planning to do intrauterine insemination (IUI), please be sure to have your Ovidrel injection on hand before the ultrasound. If you are using donor sperm from a sperm bank, please be sure the sample has arrives prior to your ultrasound appointment.
  • Based on the results of the ultrasound we will give you timing instructions for intercourse and/or IUI, have your return for an additional ultrasound or change around your dose.
  • You will be asked to come in for a progesterone blood test one week after ovulation
  • If treatment is not working after a few cycles, please set up a consultation to discuss the next step. As long term use may raise the risk of ovarian cancer, we want to limit the amount of time you are on clomiphene.

Letrozole (Femara) Instructions for Princeton IVF patients

  • Please start the femara on day 3 of your cycle. Day 3 is the third day of red flow. If you are delayed, it is OK to start as late as day 5.
  • Please check a pregnancy test (home urine test or office blood test) to be sure you are not pregnant any time you start Femara even if you had a normal period.
  • Please schedule an ultrasound and bloodwork for day 12 or 13 of your cycle unless we ask you to come in earlier, and that any referrals/precertifications are in place.
  • If you are planning to do intrauterine insemination (IUI), please be sure to have your Ovidrel injection on hand before the ultrasound. If you are using donor sperm from a sperm bank, please be sure the sample has arrives prior to your ultrasound appointment.
  • Based on the results of the ultrasound we will give you timing instructions for intercourse and/or IUI, have your return for an additional ultrasound or change around your dose.
  • You will be asked to come in for a progesterone blood test one week after ovulation
  • If treatment is not working after a few cycles, please set up a consultation to discuss the next step. As long term use of clomid may raise the risk of ovarian cancer, we want to limit the amount of time you are on femara.