Fertility pills: Clomid, Tamoxifen and Letrozole

By: Dr. Susan Wolf

Often taking fertility pills is one of the first options for treating couples with infertility, especially if you have irregular cycles. Sometimes you regular gynecologist will give you a prescription for 3 months of pills and have you see how it goes. If you are not pregnant in 3 months, they may then refer you to a fertility specialist.

Fertility pills are typically taken for 5 days of the month. They work by making your brain think that there is no estrogen around and so your brain sends increased signals to your ovary. If you don’t have regular periods, the idea is to develop an egg. The egg grows in a small cyst in the ovary called a follicle. If you are someone who does ovulate regularly, the oral fertility medications are given in the hopes to make a “better” follicle. This better follicle produces more hormones to help the lining prepare for implantation of an embryo. If you react to the medication by making more than one follicle, then you make conceive twins and rarely triplets.

In addition to the multiple births, the side effects from taking oral fertility medications include changes to the cervical mucus. That is why we most often combine the treatment with an intrauterine insemination (washing the sperm and inserting a thin tube into the uterine cavity). Urine ovulation kits tend not to be as accurate in women taking fertility pills. You may get a false positive or not pick up a true surge when you are on the medication. To time the insemination properly, we most often monitor patients with ultrasound and occasional blood testing. When a mature egg is identified, patients take one dose of an injection medication to insure the timing of ovulation (release of the egg) and insemination.