Reproduction is the process our bodies use to make babies. This happens via sexual intercourse (“sex”) when a sperm cell from male ejaculation meets a female egg and fertilizes it, usually in the fallopian tube (the tube connecting the ovaries, where eggs are produced, to the uterus, or “womb”). The fertilized egg attaches to the lining of the uterus, resulting in pregnancy. This is called conception. Infertility is the inability to become pregnant after one year of regular, unprotected sex. This may be due to an issue with the man’s or woman’s reproductive system. Worldwide, infertility is known to affect approximately 14% of the population, but it may affect up to 30-40% of the population in Africa, so it is a major public health concern. Fortunately, there are treatments available that can help a couple conceive a baby. The type of treatment will depend on the cause of infertility. There are also options available to help prevent unwanted pregnancies (“contraception”) or to improve sexual health and well-being. Often, non-medication treatments such as changes in diet, avoiding smoking and alcohol, changes in the frequency of sex, or other lifestyle changes are recommended before medication treatment. Medications used for the treatment of infertility and other reproductive issues are discussed below.
May be used alone or in combination with fertility procedures such as in-vitro fertilization to aid in conceiving a baby. It is important to remember that a full fertility workup with a reproductive specialist to determine the cause of infertility should be done before starting any of these medications, and more than one medication may need to be used before you may become pregnant. Sometimes these medications may be used in combination with each other.
Clomiphene is an oral medication often used as a first-line treatment for women who do not ovulate (release an egg from the ovary) normally. It works by increasing hormone levels to stimulate ovulation. These are to be taken on specific days of your menstrual cycle, for five days in a row. Usually, ovulation will occur one week after the last pill is taken. Doses may be increased up to a maximum dose if the medication is not effective initially. It is not recommended to continue clomiphene for longer than 6 months.
Gonadotropins are injected hormones that stimulate the ovaries to release more eggs, to promote growth of eggs in the ovaries, or stimulate the release of the egg(s) at ovulation. These are injected either under the skin (subcutaneous) or into a muscle (intramuscular/IM) in the stomach, buttocks, upper arm, or upper thigh, starting during the menstrual period, for 7-12 days. Examples of gonadotropins include human menopausal gonadotropins (hMG), follicle-stimulating hormone (FSH), synthetic human chorionic gonadotropin (hCG), and gonadotropin releasing hormone (GnRH).
GnRH Analogs/Antagonists are given to prevent early ovulation, usually in preparation for a procedure like in-vitro fertilization. They are given as injections or as a nasal spray for 3-4 days in a row during the cycle. Examples are leuprolide, gosarelin, nafarelin, and ganirelix acetate.
Progesterone is a hormone that thickens the lining of the uterus in preparation for a fertilized egg to implant. It is also needed to maintain pregnancy. It may be given as a pill, injection, or vaginal suppository in preparation for fertility procedures, or in early pregnancy to help prevent miscarriage.
Metformin is an oral diabetes medication used when insulin resistance is a suspected cause of infertility, particularly in a condition caused Polycystic Ovarian Syndrome (PCOS).
Bromocriptine and Cabergoline are oral medications that help treat ovulation problems due to high levels of a hormone called prolactin by reducing the release of prolactin by the pituitary gland.
Letrozole is an oral medication that works similarly to clomiphene, decreasing progesterone levels in the body, which increases FSH levels to stimulate ovulation.
There are fewer medication options to treat male infertility than female infertility, but there are medications to help treat specific causes of infertility, such as hormone imbalances (many of the same hormones needed for ovulation in women are needed for sperm production in men) and sexual intercourse issues such as maintaining an erection or premature ejaculation.
Hormone Therapy is used to treat male infertility when hormone imbalances cause low sperm count or problems with having sex. Testosterone is needed for sperm production. However, it is important to note that testosterone replacement itself can increase sex drive and help cure erectile dysfunction, however, it can decrease sperm count. Therefore, other hormone therapies are used to signal the body to make more testosterone or to prevent testosterone breakdown in the body and increase sperm count. Examples include clomiphene, anastrazole, bromocriptine, hCG, and hMG.
Erectile Dysfunction (ED) Medications are used when the inability to obtain and maintain an erection during sex contributes to male infertility. These medications work by increasing blood flow to the penis. Examples are sildenafil, tadalafil, and vardenafil.
Premature Ejaculation Medications may be used because premature ejaculation may result in low semen volume and low sperm content, which contributes to infertility. Erectile dysfunction medications or antidepressants such as dapoxetine, fluoxetine, sertraline, paroxetine, and citalopram may help improve premature ejaculation symptoms. Topical numbing agents may also be used on the penis to delay ejaculation, including lidocaine, prilocaine, and benzocaine.
Containing vitamins, minerals, herbs, and antioxidants such as coenzyme-Q10, folic acid, zinc, L-carnitine, selenium, vitamin C, vitamin D, vitamin E, ginseng, and saw palmetto are available. It is important to note that these supplements are not proven to increase fertility, but they may be a non-medication option. You should always let your doctor or pharmacist know if you are taking supplements, as they may interact with other medications or otherwise affect your health.
Are used when infection, particularly sexually transmitted diseases (STDs) such as chlamydia and gonorrhoea contribute to infertility. In females, there may be no symptoms of these diseases, but they still cause damage in the reproductive tract, so it is important to test for these infections regularly. Treatment includes the antibiotics doxycycline, azithromycin, levofloxacin, penicillin, and/or ceftriaxone.
Are used to prevent unwanted pregnancy. They are available as pills, shots, vaginal rings, implants, and intrauterine devices (IUDs). These contain hormones that can stop or reduce ovulation, thicken cervical mucus to prevent sperm from entering, and thin the lining of the uterus so a fertilized egg cannot attach to form a pregnancy. There are no current contraceptive medications available for men. It is important to remember that birth control medications do not protect you from sexually transmitted diseases.
There are several types of birth control pills. Combination pills contain forms of both oestrogen and progestin. Progestin-only pills (also called the “minipill”) only contain a form of progestin and are preferred for women who are breastfeeding or have a history of blood clots (because they shouldn’t take oestrogen). Birth control pills come in packs and are taken every day, usually starting on the first day of the menstrual cycle. There are 28-day regimens, which will cause a menstrual period every 28 days, during one week of “inactive” pills, or there are extended regimen packs that last 84 days, or even a year, which eliminate regular menstrual periods. There are many birth control pills available with different forms and doses of oestrogen and progestin. Your doctor can help you determine which one is the best for you.
The birth control shot contains medroxyprogesterone acetate, a progestin. It is given into the upper arm or buttocks muscle every three months.
The vaginal birth control ring contains ethinyl oestradiol and etonogestrel, an oestrogen and a progestin, and is inserted every month for three weeks at a time.
The birth control patch contains ethinyl oestradiol and norelgestromin, an oestrogen and a progestin. It is applied to the skin and changed weekly.
The birth control implant contains levonorgestrel, a progestin, and is inserted into the arm by a healthcare professional to provide protection against pregnancy for up to 3 years before removal.
Intrauterine Devices (IUDs) are a popular birth control choice in South Africa. A t-shaped device is inserted into the uterus through the vagina/cervix by a medical professional. IUDs are available as a copper IUD or hormone-containing device with levonorgestrel. Copper IUDs work by stopping sperm from reaching the fallopian tubes. IUDs containing levonorgestrel also prevent pregnancy by thickening cervical mucus and thinning the lining of the uterus, like birth control pills. Copper IUDs can be inserted and left for up to 10 years, and levonorgestrel-containing IUDs can be left in the uterus for 3-8 years, depending on the specific device.
Side effects that are expected and relatively common in people taking medications for fertility or contraception include:
Serious side effects and possible complications are discussed below.