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 Promote follicular maturation Stimulate ovulation Stimulate ovulation Prevent premature stimulation of ovulation by endogenous hormones 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 Hot flashes Gastrointestinal: nausea, bloating Gastrointestinal: nausea, bloating Abdominal discomfort Abdominal discomfort Breast engorgement Breast engorgement Visual disturbances: blurred vision Visual disturbances: blurred vision Multiple births Multiple births Ovarian hyperstimulation (very rare) 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 Ovarian hyperstimulation syndrome Multiple births 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 Promotes follicular maturation and ovulation  Adverse effects Ovarian hyperstimulation syndrome Ovarian hyperstimulation syndrome Edema Edema Injection site pain Injection site pain Central nervous system disturbances 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 Nausea Headache Headache Dizziness Dizziness Orthostatic hypotension 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 Nausea Headache Headache Dizziness Dizziness Fatigue Fatigue Abdominal cramps Abdominal cramps Orthostatic hypotension 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 Endometriosis Uterine fibroids Uterine fibroids Central precocious puberty Central precocious puberty Advanced prostate cancer 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 Hot flushes Vaginal dryness Vaginal dryness Nasal irritation Nasal irritation Decreased libido Decreased libido Bone loss Bone loss Mood changes Mood changes Headache 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 Acne Deepening of the voice Deepening of the voice Growth of facial hair Growth of facial hair Edema Edema Thrombotic events Thrombotic events Hepatotoxicity Hepatotoxicity Intensifies effects of warfarin Intensifies effects of warfarin