Fertility Pills

There are many different fertility treatment options available to you. Depending on your particular situation, your doctor may recommend that you start off by taking fertility pills.

This is what you need to know.

The first day of your menstrual cycle is called “cycle day #1.” Cycle day #3 is 2 days after cycle day #1. You don’t have to still be bleeding to call the third day of your cycle, “cycle day #3.”

Our ovaries pick the eggs that we are going to ovulate by cycle day #3.  Studies done comparing various start dates for the fertility pills seem to show that starting on cycle day 3 will give you your highest chance of pregnancy.

If you are someone who doesn’t get their period, your doctor will induce your period with a form of progesterone. You can also jump start a cycle by taking the birth control pill for a number of days (your doc will tell you how many).

You take the fertility pills every night for 5 nights of your cycle starting on cycle day #3 (cycle days 3-7).

I recommend that you start checking for ovulation using an ovulation predictor kit (OPK) starting cycle day #10. Fancy digital kits will only make things difficult and confusing so buy the cheapest litmus based kit that you can find. You will find the best deals through online retailers. As an example, you can buy 30 sticks for $50 through target.com.

Start having intercourse every other day starting cycle day #10.

If you have a +OPK before cycle day #14, ask your doctor for an ultrasound that day. If you don’t have a +OPK by cycle day #14, you will come in that day for an ultrasound.

Things to do:

1. Let your doctor know when your period starts so they can make a calendar for you
2. Order your fertility pills: either Femara (or similar drug to femara) or Clomid
3. Order your ovulation predictor kit online if you haven’t already
4. Make sure you get a specimen cup for the semen sample in preparation for your IUI (intrauterine insemination)
5. Tentatively make your ultrasound appointment for cycle day #14 and IUI appointment for cycle day #16
6. Have your doctor’s office order your trigger shot (HCG injection) for you so you can bring it in. The cost will be %50 less if you do it this way. For example, ordering this shot online is approximately $40. When dispensed from your doctor’s office the cost is >$80.
7. Ask your doctor if you need to take progesterone 72 hours after your trigger shot. If you are a candidate for progesterone, find out which progesterone your insurance covers. There are 3 different brand names: endometrin, prometrium, and crinone. Every insurance plan is different. If your insurance does not cover progesterone, mail order pharmacies will provide the cheapest medication for you.
8. Ask your doctor if you should be taking estradiol to thicken your lining. This may be prescribed to you if your lining is thin at the time of your ultrasound.
9. Ask your doctor if you should be taking a baby aspirin. This also may be prescribed to you if your lining is thin at the time of your ultrasound.
10. Have you had a test to make sure your tubes are open before exposing your body to fertility medications? May be a good idea to check before embarking on this path because no one wants to waste time, emotions and money when you should be concentrating your efforts elsewhere (IVF).

Clomid and Femara are generally the two fertility pills prescribed by fertility specialists.

What you should know about Clomid:

Clomid is generally prescribed in doses of 50 mg. I rarely prescribe a dose above 50 mg. You should not take clomid if you have problems with your mood. Clomid may exacerbate symptoms of depression. You should not take clomid if you have endometriosis because it may worsen your disease.

Clomid is a pill that makes your body think that there is no estrogen around. Imagine how that would make you feel……like someone who is going through menopause. Most patients experience hot flashes, night sweats, vaginal dryness and moodiness. Clomid causes bloating so if you feel particularly full in your abdominal area – it is likely due to the clomid. You should notify your doctor immediately if you have headaches or visual disturbances while taking the Clomid. If you do have severe headaches or problems with your vision, stop taking your Clomid. Don’t wait until you hear from your doctor’s office.

Clomid has an anti-fertility side effect that not many patients learn about until after they start taking the medication. It can thin out the lining of your uterus which may make pregnancy harder to achieve and increase your chance of miscarriage.

Clomid does not increase your risk of birth defects. Clomid lasts in your system for less than a week.

Clomid is cheap relative to other fertility drugs. If clomid isn’t covered by your insurance, ask your doctor to call your prescription into: Walmart, Costco or Sam’s Club. You will get each tablet for around $3-4. Your Clomid prescription should not cost more than $30.
Chances of pregnancy with Clomid are in the 8-10% range. If you do get pregnant with clomid, your chance of twins is around 8-10%. Risk of having more than twins is very very small but it isn’t 0.

What you should know about Femara:

Femara is generally prescribed at a dose of 5 mg. It is also prescribed starting on cycle day #3. It comes in 2.5 mg tablets, so you have to take 2 tablets nightly starting day #3. If you are overweight or haven’t had success on 2 tablets, your doctor may suggest that you take 3 tablets.

Femara does not work in the same way as Clomid so it doesn’t cause the symptoms described above. You may feel lower leg cramping while on Femara. Femara is in your system for less than 3 days so after the last tablet taken, by cycle day #9/10, your body won’t have any femara left circulating inside.

Femara is FDA approved for breast cancer prevention. In the clinical trials, researchers found that Femara caused women to make follicles on their ovaries so fertility doctors starting using it to induce ovulation.

Femara costs more than Clomid – from a wholesale pharmacy, you may pay between $10-13 per tablet for a total cost of about $130 for a supply for one month.

The pregnancy rate with Femara and twin rate with Femara is similar to Clomid.

It does not increase your chance of birth defects.

Now that you’ve reviewed the above information, you should know that you have a choice in terms of how you will be monitored with these fertility drugs:

Option #1: no monitoring. Just use an ovulation predictor kit. Time intercourse by having intercourse every other day starting cycle day #10 until 48-72 hours after your +OPK. Check for pregnancy 14 days after your +OPK and hope for the best.

Option #2: Ultrasound when you have a +OPK or cycle day #14 so that you can receive a trigger shot. The trigger shot will help you ovulate all the eggs that you have grown for this month.

Option #3: Ultrasound and an IUI (intrauterine insemination). Your highest chance of pregnancy is if you time your IUI 36 hrs after your trigger shot. Many clinics don’t do ultrasounds or IUIs on the weekend. Find out if your clinic is one of those clinics. Your doctor may create your fertility plan around their own schedule – which may not be in your ovaries’ best interest.

No one should feel that they are required to have an ultrasound or do an IUI. This is a personal choice that you and your partner will make.

Your doctor may want to check a progesterone level 8 days after your surge (+OPK)  to see that you have responded to the fertility pills. This is something to consider if you go with monitoring option #1. I tend to prescribe progesterone to everyone who goes through fertility treatments.

Frequently asked questions by patients taking fertility pills:
1. Is this IVF? No. IVF is more involved and includes a procedure done to remove eggs and make embryos followed by transferring the embryos into your uterus.

2. Are there any long term health effects on my body from taking fertility pills? No. There have been studies looking at the long term health effects, especially risk of ovarian cancer in women who take fertility pills. There was one study that showed an increased risk of a form of ovarian cancer but many of the women who were included in the study never had a pregnancy and we know that women who never have a pregnancy are at increased risk of ovarian cancer. In general, most infertility docs limit a patients’ exposure to fertility pills to 6 months and no more than that.

3. Will taking fertility pills put me into menopause sooner? Will I run out of eggs faster? The answer to this question is no. On average a woman will ovulate between 1-2 eggs when taking fertility pills. Some women ovulate more eggs. We all have a set number of eggs that we could possibly ovulate in any given cycle. We ovulate 1 and the rest die – you can never use them again. So fertility drugs don’t make you run out sooner.

4. Will these medications increase my risk of birth defects? No. Ask your doctor what your risk is of having a baby with a birth defect. The risks tend to be age related. Your doctor will know if you have any other medical problems that may put you in a higher risk category.

5. Why do I need the trigger shot? The trigger shot is the hormone HCG which mimics the hormone LH that our body makes when we ovulate. It’s easier to take HCG than LH – that’s why we give it. Taking HCG just gives your body a little boost in hormones that could give you a higher chance of pregnancy. Ask your doctor if this would be the case for you. Don’t check for pregnancy within 7 days of taking this shot because you will have a positive pregnancy test. It isn’t because you’re pregnant (not quite yet).

6. How many times do I do this treatment before becoming more aggressive? This is a personal choice. Statistically speaking, any given treatment should work within the first 3-4 cycles. Consider trying something different if it hasn’t worked by try #4. Or consider trying just a couple more cycles (up to 6) before moving to another approach.

7. What is involved in an insemination? If you are producing a sample at home, your doctor will tell you when to have the sample in the lab for processing. Processing times vary from clinic to clinic. The processing time in my lab is 30 minutes. You will have two appointments: time to drop off the sample, and time for the IUI. The IUI is similar to a PAP smear except a catheter goes through your uterus and you lie down for 10-30 minutes (depends on the clinic) after the procedure.

8. How much will an ultrasound and insemination cost? Depending on your clinic and insurance coverage, this treatment plan may cost (including medications) around $900. Ask ahead of time so there are no surprises.

I hope that reading this helps you decide on the best treatment plan for you and makes the process less overwhelming.