Fertility medication are drugs which enhance reproductive
fertilityFertility is the natural capability of producing offsprings. As a measure, "fertility rate" is the number of children born per couple, person or population. Fertility differs from fecundity, which is defined as the potential for reproduction...
. For women, fertility medication is used to stimulate
follicleOvarian follicles are the basic units of female reproductive biology, each of which is composed of roughly spherical aggregations of cells found in the ovary. They contain a single oocyte . These structures are periodically initiated to grow and develop, culminating in ovulation of usually a single...
development of the
ovaryThe ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
. There are currently very few fertility medication options available for men.
Agents that enhance ovarian activity can be classified as either Gonadotropin releasing hormone,
EstrogenEstrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
antagonistsA receptor antagonist is a type of receptor ligand or drug that does not provoke a biological response itself upon binding to a receptor, but blocks or dampens agonist-mediated responses...
or Gonadotropins.
Gonadotropin-releasing hormone
Either
Gonadotropin-releasing hormoneGonadotropin-releasing hormone , also known as Luteinizing-hormone-releasing hormone and luliberin, is a tropic peptide hormone responsible for the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. GnRH is synthesized and released from neurons within...
(GnRH) or any
Gonadotropin-releasing hormone agonistA gonadotropin-releasing hormone agonist is a synthetic peptide modeled after the hypothalamic neurohormone GnRH that interacts with the gonadotropin-releasing hormone receptor to elicit its biologic response, the release of the pituitary hormones FSH and LH.GnRH agonists are pregnancy category...
(i.e. Lupron) may be used. GnRH releases gonadotropins from the hypothalamus in the body.
Estrogen antagonists
Fertility medication inhibiting the effects of
estrogenEstrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
includes Clomiphene citrate and
Aromatase inhibitorAromatase inhibitors are a class of drugs used in the treatment of breast cancer and ovarian cancer in postmenopausal women. AIs may also be used off-label to treat or prevent gynaecomastia in men....
s.
Clomiphene citrate
Clomiphene citrate is a
selective estrogen receptor modulatorSelective Estrogen Receptor Modulators are a class of compounds that act on the estrogen receptor. A characteristic that distinguishes these substances from pure receptor agonists and antagonists is that their action is different in various tissues, thereby granting the possibility to selectively...
(SERM). It is used as an ovarian stimulator by inhibiting the negative feedback of estrogen.
Aromatase inhibitors
Although primarily a breast cancer treatment,
aromatase inhibitorAromatase inhibitors are a class of drugs used in the treatment of breast cancer and ovarian cancer in postmenopausal women. AIs may also be used off-label to treat or prevent gynaecomastia in men....
s can also work as fertility medication, probably through a mechanism similar to clomiphene citrate.
Gonadotropins
Gonadotropins are the hormones in the body that normally stimulate the gonads (testes and ovaries). For medication, they can be extracted from urine or by genetic modification.
For example, the so called
menotropinMenotropin is an active substance for the treatment of fertility disturbances. It consists of gonadotropins that are extracted from the urine of postmenopausal women, usually luteinizing hormone and follicle-stimulating hormone...
s consist of
LHLuteinizing hormone is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone , it stimulates Leydig cell...
and
FSHFollicle-stimulating hormone is a hormone found in humans and other animals. It is synthesized and secreted by gonadotrophs of the anterior pituitary gland. FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH and Luteinizing hormone act...
extracted from human
urineUrine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
from menopausal women.
There are also recombinant variants which are created by inserting the DNA coding for it into bacteriae. The bacterial DNA is then called
Recombinant DNARecombinant DNA molecules are DNA sequences that result from the use of laboratory methods to bring together genetic material from multiple sources, creating sequences that would not otherwise be found in biological organisms...
. Examples of recombinant FSH are Follistim and Gonal F, while Luveris is a recombinant LH.
Human chorionic gonadotropin
Human chorionic gonadotropin (hCG) is normally produced during pregnancy. However, it can also replace LH as an ovulation inducer.
Male
There currently are no effective medications to treat
oligospermiaOligospermia, also oligozoospermia, refers to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility...
, so other
assisted reproductive technologiesAssisted reproductive technology is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments. Some forms of ART are also used in fertile couples for genetic reasons...
are used.
Research in male fertility medication is currently ongoing. An study in Egypt assessed the efficacy of a combination of clomiphene citrate and
vitamin EVitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...
in improving sperm count and
sperm motilitySperm motility describes the ability of sperm to move properly towards an egg. This can also be thought of as the 'quality' of the sperm, which is a factor in successful pregnancies, as opposed to the 'quantity'. Sperm which do not properly 'swim', will not reach the egg in order to fertilize it...
in
male infertilityMale infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.-Pre-testicular...
.
Adverse effects
Estrogen antagonists and gonadotropins may stimulate multiple follicles and other ovarian hormones leading to
multiple birthA multiple birth occurs when more than one fetus is carried to term in a single pregnancy. Different names for multiple births are used, depending on the number of offspring. Common multiples are two and three, known as twins and triplets...
and possible
ovarian hyperstimulation syndromeOvarian hyperstimulation syndrome is a complication from some forms of fertility medication. Most cases are mild, but a small proportion are severe.-Causative medications:...
.
Clomid Side Effects:
See also
- Diethylstilbestrol
Diethylstilbestrol is a synthetic nonsteroidal estrogen that was first synthesized in 1938. Human exposure to DES occurred through diverse sources, such as dietary ingestion from supplemented cattle feed and medical treatment for certain conditions, including breast and prostate cancers...
Manufacturers:
- Ferring Pharmaceuticals
Ferring Pharmaceuticals is a pharmaceutical company that specializes in the development and marketing of drugs for use in human medicine.It was founded by Frederik Paulsen Sr in Malmö, Sweden, in 1950, initially as the Nordiska Hormon Laboratoriet, renamed Ferring in 1954. A ferring in Frisian is a...
- Organon International
Organon is a human pharmaceutical company headquartered in Oss, Netherlands. In November 2007 the company became a part of Schering-Plough Corporation, acquired Organon, active pharmaceutical ingredient producer Diosynth , and its veterinary pharmaceutical sister company Intervet from Akzo Nobel. ...
- EMD Serono