Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Chapter 63

Drug Therapy of Infertility

2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drug Therapy of Infertility

Infertility Decrease in the ability to reproduce

Sterility Complete absence of reproductive ability

3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Causes of Female Infertility

Female infertility Anovulation and failure of follicular maturation Unfavorable cervical mucus Hyperprolactinemia Endometriosis Polycystic ovary syndrome

4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Causes of Male Infertility

Male infertility Hypogonadotropic hypogonadism Erectile dysfunction Idiopathic male infertility

5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs Used to Treat Female Infertility

Drugs for controlled ovarian stimulation Facilitation of follicular maturation and ovulation Fertilization can be natural or assisted

reproduction Mechanisms of action

• Promote follicular maturation• Stimulate ovulation• Prevent premature stimulation of ovulation by

endogenous hormones

6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs Used to Treat Female Infertility

Clomiphene (Clomid, Milophene, Serophene) Used to promote follicular maturation and

ovulation Blocks receptors for estrogen Adverse effects

• Hot flashes• Gastrointestinal: nausea, bloating• Abdominal discomfort• Breast engorgement• Visual disturbances: blurred vision• Multiple births• Ovarian hyperstimulation (very rare)

7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs Used to Treat Female Infertility

Menotropins (Pergonal, Repronex, Menopur) Used in conjunction with human chorionic

gonadotropin (hCG) to promote follicular maturation and ovulation in anovulatory patients

Adverse effects• Ovarian hyperstimulation syndrome• Multiple births

Follitropins Urofollitropin, follitropin alfa, follitropin beta

8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs Used to Treat Female Infertility

Human chorionic gonadotropin (hCG) A polypeptide hormone produced by the placenta Therapeutic use

• Promotes follicular maturation and ovulation Adverse effects

• Ovarian hyperstimulation syndrome• Edema• Injection site pain• Central nervous system disturbances

Headache, irritability, restlessness, fatigue

9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs Used to Treat Female Infertility

Lutropin alfa (Luveris) Choriogonadotropin alfa Gonadotropin-releasing hormone antagonists

10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Dopamine Agonists for Hyperprolactinemia

Cabergoline (Dostinex) Used to correct amenorrhea and infertility Activates dopamine receptors Adverse effects

• Nausea• Headache• Dizziness• Orthostatic hypotension

11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Dopamine Agonists for Hyperprolactinemia

Bromocriptine (Parlodel) Used to correct amenorrhea, galactorrhea, and

infertility Activates dopamine receptors Adverse effects

• Nausea• Headache• Dizziness• Fatigue• Abdominal cramps• Orthostatic hypotension

12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs for Endometriosis

Leuprolide (Lupron Depot, Eligard) Synthetic analog of gonadotropin-releasing

hormone (GnRH) Suppresses ovarian hormone production Therapeutic uses

• Endometriosis• Uterine fibroids• Central precocious puberty• Advanced prostate cancer

13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs for Endometriosis

Leuprolide (Lupron Depot, Eligard) (cont’d) Adverse effects

• Hot flushes• Vaginal dryness• Nasal irritation• Decreased libido• Bone loss• Mood changes• Headache

14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Drugs for Endometriosis

Danazol (Danocrine) Used to improve symptoms of endometriosis, but

does not increase fertility Induces regression of endometrial implants Adverse effects

• Acne• Deepening of the voice• Growth of facial hair• Edema• Thrombotic events• Hepatotoxicity• Intensifies effects of warfarin