DISCLAIMER: The following post is not intended to act as medical advice. As always, please consult your doctor with any questions about fertility.
Clomid, letrozole, trigger shots. Are you familiar with these terms? If you’re well into your fertility journey, you probably know exactly what they are. But if you’re new to a fertility journey, you may not know the difference between them or why one would be used over another. They can be an incredibly important part of your fertility journey, and each has its own purpose. It is helpful and important to understand what they are and why they’re used, depending on each person’s situation.
Our friends from Michigan Center for Fertility and Women’s Health are here to support you on your fertility journey. You might have caught their Fertility Friday series over on our IG page–quick videos to answer common questions and provide information. Below, they’re sharing information about the types of medications you may take during your fertility journey, including oral and injectable medications.
Oral Medications
There are typically two common oral medications that are used as part of our fertility treatment that may be used to help induce ovulation. Those two medications are clomid and letrozole (clomid you may also hear called clomiphene citrate, and letrozole is also known as femara). They’re usually relatively cost-effective options. They can be used in multiple situations for patients who may not be ovulating or who may not be ovulating in a predictable manner to try to help induce ovulation.
We also use them for patients who have regular ovulation but may still benefit from the medication to allow us to have better accuracy with timing. How we determine which oral medication and dose is best for you usually comes from our workup and your history. Some patients might be better suited for one versus the other.
Side Effects of Oral Fertility Medications
Clomid does tend to, at times, have a few more side effects than letrozole. You may see a slightly higher incidence of mood swings, hot flashes, and possibly a thin uterine lining. Clomid is an “antiestrogen” which is why it is possible to experience these side effects a bit more. However, each individual experience varies and generally both medications are very well tolerated. There are some less common side effects that we discuss with patients prior to starting medications, and we advise them to let us know if they are experiencing any.
Letrozole tends to have a few less side effects, and it has a shorter half-life. It’s an aromatase inhibitor, which has to do with what happens on a pituitary level to allow the hormones to be altered and induce ovulation.
Both clomid and letrozole are great options and are used commonly in practice. You may also see them being used at your OBGYN office. We will help you determine if they are a good option for you. We can help you figure out which one is best and again, what dose and protocol is most suitable.
These oral medications are typically used for our less aggressive treatment options, like timed intercourse or insemination. They may also be used in conjunction with some specific IVF protocols.
Injectable Medications
Injectable medications are the hormones that our body produces–FSH and LH–in injectable form. They are typically subcutaneous injections given in the abdomen. We typically produce enough of those hormones (if ovulation is happening regularly) to produce one dominant mature follicle each month. We use these medications when the goal is to produce more follicles (for example, with IVF) or if the oral medications are not inducing ovulation on their own. They typically are stronger and do produce more of a response. However, this can vary per patient based on their background, history, age, etc.
Generally speaking, the success rate between using the oral medications and injectables is not statistically significantly higher for injectables when combined with timed intercourse or insemination, assuming a patient is responding appropriately to both options.
We do take a cautious approach when using injectables for timed intercourse or insemination. This is due to a potentially higher risk of multiple pregnancy. Our goal is, of course, to get you pregnant. However, the safety of our patient and their pregnancy is also of utmost importance.
Injectable Medications + IVF
Injectable medications are the primary medications used during IVF. IVF allows us to grow more follicles in a safer manner, of course while always keeping hyperstimulation in mind and taking necessary precautions. We typically use these medications at higher doses during IVF to stimulate more follicles to grow in preparation for the egg retrieval.
Once the eggs are retrieved and embryos are created, we can safely elect to transfer 1-2 embryos based on the patient’s history and background. Typically, a single embryo transfer is advised. However, there are some scenarios where more than one may be recommended; this is determined by your health care provider.
Injectable medications can be a useful tool in your fertility journey and treatment plan. It is important that your provider talks to you about when they are needed, when they are going to benefit your success rate, and what some of the safety aspects are as well.
Trigger Shots
Another medication commonly discussed and used during fertility treatment is the “trigger shot.” The trigger shot helps induce an LH surge. This is what triggers our follicles to get them ready to ovulate or release. We use the trigger shot in almost all of our treatment cycles–whether we are doing timed intercourse, insemination, or IVF. The type of “trigger shot” and specific timing of administration is dependent on your treatment plan.
