This fertility drug treatment protocol is a combination of both the oral ovulation induction drug, Clomid, and a subcutaneously injected medication called gonadotropins (Follicle Stimulating Hormone- brand names Follistim or Gonal-F; or Follicle Stimulating Hormone/Luteinizing Hormone combination- brand name Repronex or Bravelle.)
These fertility drugs increase the number of eggs ovulated each cycle resulting in enhanced chances for pregnancy. The fertility drug hCG (human chorionic gonadotropin) is administered by injection after the ovaries have been properly stimulated, which will cause ovulation to occur. Clomid and/or gonadotropins (Follistim, Gonal-F, Repronex, Bravelle, and Menopur) are often combined with intrauterine insemination (IUI). When combined with IUI, for empiric therapy for couples who have infertility of unexplained origin, this fertility drug protocol has approximately a 13% pregnancy rate.
Clomid side effects can include headache, abdominal fullness or bloating, hot flashes, and blurred vision. Clomid is tolerated well by most patients and if side effects occur, they are usually temporary. Gonadotropins can have some of the same side effects as Clomid but tend to be better tolerated, overall. Local inflammation can occur at the injection sites.
Clomid and gonadotropin therapy are associated with three major clinical events including ovarian enlargement, multiple pregnancy, and ovarian hyperstimulation syndrome (OHSS). Multiple pregnancies are approximately 5-8% of “Clomid only” conceptions, and almost all are twins. This rate may be slightly higher for combined Clomid and gonadotropins. Approximately 10% of women who are treated with Clomid will develop ovarian enlargement from a cyst. Again, this is probably somewhat higher with the addition of gonadotropins.
For this reason, a pelvic examination is performed at the end of the fertility drug treatment cycle, around the time of the menstrual period. If ovarian enlargement is detected, treatment is withheld during the following cycle and the cyst usually resolves. Complications of cyst formation can include discomfort, cyst rupture or ovarian torsion (twisting of the ovary cutting off the blood supply). If they occur then surgery may be required but this is very rare.
Ovarian hyperstimulation syndrome (OHSS) is a rare condition (<1% of treated patients). In this condition, the ovaries enlarge and may create a significant illness with loss of body fluid into the abdomen or chest and there is an increased risk of vascular thrombosis (blood clot formation in a vein or artery). This condition may require hospitalization and is potentially serious. There is a slightly higher risk of ectopic pregnancy when gonadotropins are used. There is a large amount of information suggesting that babies born as a product of this therapy are at a normal risk for birth defects- not higher or lower. Clomid with gonadotropins has been in clinical use for over 25 years.
One risk that should be addressed is whether treatment with Clomid or gonadotropins may increase the long-term risk of developing ovarian cancer. There are research studies that show no risk, while others have shown increased risk with long-term use of these fertility drugs, such as 12 or more cycles of Clomid. Ovarian cancer is a complex disease with many known risk factors and it has been difficult to isolate the effect of these medications alone. The answer is unsettled at this time.
Please discuss any of the issues further with your fertility specialist if you have any questions or concerns.
