Medications: Medication Risks

Taking medications to stimulate growth of multiple follicles is associated with several risks. Please understand these risks completely before taking any medications.

Your physician can discuss these in more detail as needed.

Most of the drugs are grouped together based on their effects.

Lupron

Since Lupron blocks the normal hormone function of the ovary by blocking follicular growth, it essentially blocks the production of estrogen. Lupron can induce a low estrogen environment (hypoestrogenism) that is a lot like menopause.

Patients can experience hot flashes, vaginal dryness, headaches, and less commonly changes in emotions.

Used over longer periods of time than those experienced in infertility treatment, Lupron can lead to loss of bone minerals. Decreased bone mineral density can increase a woman's risk of developing fractures.

Lupron treatment is often limited to six month intervals or combined with estrogen therapy for the treatment of endometriosis and some cases of uterine fibroids.

Gonadotropins

Medications that stimulate the growth of multiple follicles have the following risks:

• Ovarian Hyperstimulation Syndrome (OHSS): This is a collection of signs and symptoms that includes enlargement of the ovaries, accumulation of fluid into the abdomen, abdominal pain, nausea, dehydration, and potentially, renal failure, pulmonary edema (fluid in the lungs), and venous thrombosis (blood clots).
  
  This can be a very severe complication of treatment. Stimulation cycles are sometimes canceled to reduce the risk of this worsening. This risk is not an all or nothing phenomenon and it is likely that many women feel some of the effects of hyperstimulaton.
• Multiple gestation: The occurrence of twins in women not taking gonadotropins is about 1 to 2 percent whereas the risk of multiple pregnancies with gonadotropins can be as high as 20 percent or more.
  
  Limiting the number of embryos transferred can help reduce this risk in vitro fertilization (IVF) cycles. There is no way to control the number of follicles fertilized in a controlled ovarian hyperstimulation (COH) cycle. With COH cycles the number of gestations is does not increase proportional to the number of follicles present according to a review of our data.
  
  Some patients consider selective reduction procedures to reduce the number of pregnancies and increase the chances of the remaining pregnancies to survive without complications. This issue is best discussed ahead of time between both partners.
• Ectopic (tubal) pregnancies: There is a minimal increase in the risk of ectopic pregnancy seen with ovarian stimulation. This is also possible with in vitro fertilization as the embryos can become implanted in the fallopian tube rather than the uterus. This may require medical or surgical intervention.
• Adnexal torsion: Adnexal torsion is the twisting of an ovary in such a way that it blocks the blood supply to the ovary. Ovaries that have been enlarged from the follicles that are stimulated by these medications are at increased risk of twisting. The pain associated with ovarian torsion is usually on one side of the pelvis and is quite severe.
  
  Torsion usually requires surgery to correct the problem or remove the ovary. Fortunately, ovarian torsion is very uncommon (less than 1 percent).
• Birth defects: Taking these medications does not alter the genetics of the eggs and the rate of birth defects does not appear to be any higher that that of the general population.
• Ovarian cancer: There is not conclusive evidence supporting or denying the risk of ovarian cancer caused by taking gonadotropins. There is an association with the number of times a woman ovulates and ovarian cancer. That is to say women who have early onset of ovulation (and menstrual periods -- menarche) and those with delayed menopause, have an increased risk of developing ovarian cancer.
  
  Women taking birth control pills, as well as women who breastfeed, have a decreased risk of breast cancer. These risks were measured in years and may not apply to a single month with multiple follicles.
• Allergic reactions: Due to the size of follicle stimulating hormone (FSH) and luteinizing hormone (LH) and since they are produced by the body, they do not produce an allergic reaction. Patients may develop allergic reactions to the carriers or chemicals in the medications.
  
  Often switching the type of medication will alleviate the problem. Inflammation at the site of the injection can be a localized infection known as cellulitis. Most of these are self-limiting and do not require treatment unless it is worsening. Bruising is also not considered an allergic reaction.

Clomid

While Clomid is usually not considered as potent as the injectable gonadotropins it carries the same potential risks. The side effects are seen less commonly but can be just as severe.