Transcription:

Deborah Howell (Host): If growing your family is taking longer than expected, you may be considering fertility treatment to help you on your journey.

In this episode, Dr. Elie Hobeika, a board-certified reproductive endocrinology and fertility specialist at Fertility Centers of Illinois, will help explain how and why fertility medications are prescribed and what to expect when you take medication for this treatment.

This is The Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Welcome, Dr. Hobeika.

Dr. Elie Hobeika: Thank you for having me again, Deborah.

Deborah Howell (Host): Lovely to have you back. So let's dive right in. What are the most common medications for women during fertility treatment and do they differ based on what treatment you're getting?

Dr. Elie Hobeika: An easy way to group medications used in fertility treatment is to do so based on their purpose of use. There are medication used to stimulate the growth of follicles. Those can be oral pills, such as clomiphene citrate and aromatase inhibitors, or those can be injectables. And then, there are medication used to induce ovulation. Those are typically called triggers and we have two types, the hCG trigger and the lupron trigger, and both come in an injectable form. And there are female hormones used to modify, simulate or control a menstrual cycle. The two main hormones we're talking about are the estrogen and progesterone hormones. And also, those come in oral injectable and vaginal forms as well.

Deborah Howell (Host): And how do you determine what medication a patient should be taking?

Dr. Elie Hobeika: Medications that need to be taken will depend on what treatment we are administering. If it's, let's say, in vitro fertilization or intrauterine insemination, the reason of infertility and, of course, the patient's previous response to certain drugs. If that is favorable, you're more likely to prescribe the same medication. If not, then we consider changing agents.

Deborah Howell (Host): Got it. Now, do you use certain medications for specific diagnoses PCOS or unexplained infertility?

Dr. Elie Hobeika: Yes, definitely. Most women with PCOS have irregular menses due to the absence of ovulation. So our first choice to induce ovulation is aromatase inhibitors and the famous one is called letrozole. Whereas in other cases, such as in unexplained inferity, we have a preference to use clomiphene citrate, although we can also use both drugs.

Deborah Howell (Host): Okay. And are subcutaneous medications only used for IVF patients?

Dr. Elie Hobeika: Not necessarily. As we earlier mentioned, medication that induce growth of follicles can also come in injectable forms. And moreover, triggers that induce ovulation are widely used in insemination cycles. So to answer your question, subcutaneous medications can be used outside of an IVF cycle, but definitely at a much lower number of injections compared to IVF.

Deborah Howell (Host): Okay. I understand. Now, are there trainings on how to inject subcutaneous fertility medications?

Dr. Elie Hobeika: Of course. Patients have various resources. They can have a one-on-one teaching session with nurses in their clinic. They will be given links for video demonstrations on how to administer those injections. And they can also look up any questions they have on our website or on the manufacturer's website.

Deborah Howell (Host): All right. Now, let's talk about the typical medication protocol for an IVF cycle. In other words, what medication is needed at each stage of an IVF cycle and how long does the cycle last?

Dr. Elie Hobeika: A step that may or may not precede an IVF cycle is the pre-treatment phase. Most commonly used medication are birth control pills and/or estrogen patches. Now, the first main step in an IVF process is the growth of follicles that is achieved by giving daily injections of different medications, averaging two to three injections per day for nine to thirteen days, Then comes the ovulation trigger, which is a single injection. At this point, the patient presents to the office where they undergo an egg retrieval procedure. Now, after that phase in the setting of a fresh transfer, progesterone needs to be administered either intramuscularly, vaginally or sometimes in both routes until a pregnancy test is performed. So overall, from the start of the injectables to grow follicles until the pregnancy test, an IVF with a fresh transfer will last four weeks.

Deborah Howell (Host): Four weeks. Okay. Now, doctor, a lot of women wonder how fertility medications affect you physically and mentally, and what can be done to reduce any side effects.

Dr. Elie Hobeika: The side effects of fertility medications are mainly due to the hormonal shifts they induce. Those can be physical, such as headaches, nausea, abdominal tenderness, or mental, such as mood swings, irritability, and fatigue. Supportive treatment is the way to go to alleviate those symptoms most of the times.

Deborah Howell (Host): Fair enough. And can you tell us what ovarian hyperstimulation syndrome is and are there ways to prevent it?

Dr. Elie Hobeika: My IVF consultations, I tell patients that the enemy of good is better, and ovarian hyperstimulation syndrome represents this better. It is when we stimulate the growth of multiple follicles to the point that women get severely bloated and sick after the trigger shot. We can prevent ovarian hyperstimulation syndrome by having a moderate or a controlled growth follicles by triggering with a Lupron trigger as opposed to an hCG trigger, and freezing all embryos and avoiding transferring embryos in the same cycle. Other drugs can also be added to decrease the risk of ovarian hyperstimulation syndrome after the egg retrieval, such as injections of Ganirelix or Cetrotide and oral tablets of Cabergoline.

Deborah Howell (Host): Well, that's good to know. Now, are there other potential dangers of fertility medications like increased risk of cancer or birth defect?

Dr. Elie Hobeika: This is unlikely. Many studies have looked at that and there has been no correlation drawn in between fertility medication and increased risk of cancer or birth defects.

Deborah Howell (Host): Excellent. All right. Now, a big, big question is do fertility medications increase your chances of having multiples?

Dr. Elie Hobeika: So in the setting of insemination, the use of drugs does play a role in having multiples. So if we use injectable medication to grow follicles, then the chance of multiples is gonna be higher than using oral pills. However, in IVF, the chance of multiples is mostly dependent on the number of embryos that is transferred back in the uterus and not necessarily on the use of medication themselves.

Deborah Howell (Host): Okay. Now, Dr. Hobeika, what kind of monitoring is done for patients taking these medications?

Dr. Elie Hobeika: So the monitoring involves an ultrasound and blood work and the frequency would depend on what treatment we're doing and how close patients are from ovulating.

Deborah Howell (Host): And some couples would definitely like to know are there medications for men with infertility?

Dr. Elie Hobeika: Of course, and they are similar to the medication that are used for women. However, we use them at different doses and for different indications.

Deborah Howell (Host): You've given us a really good overview of these medications. Can your OB prescribe fertility medications, or do you need to see a reproductive endocrinologist for that?

Dr. Elie Hobeika: OBs can prescribe fertility drugs depending on their level of comfort doing so. But what patients gain mostly by seeing a productive endocrinologist is the monitoring that they obtain to see the effects of those medication on their follicles and on their lining.

Deborah Howell (Host): And how do patients go about ordering medication? Can they go through their regular pharmacy?

Dr. Elie Hobeika: Some of it is present at a local pharmacy, yes, and some you'd have to order from a specialty pharmacy. Medication coverage may differ from policy to another, so I encourage patients to check with their insurances before ordering those meds.

Deborah Howell (Host): Yes. Now, speaking of insurances, what costs associated with medication and are there resources to help with these costs?

Dr. Elie Hobeika: So, costs vary widely among fertility drugs from a copay of couple dollars for oral ovulation induction agents, to thousands of dollars when we're talking about injectables used in IVF. There are some non-for-profit organizations that help with cost. However, unfortunately, the service is provided only for a select group of women, those who have cancer and other underlying medical conditions

Deborah Howell (Host): Okay. Well, Dr. Hobeika, we can't thank you enough for being with us today and for letting us learn all about fertility medication.

Dr. Elie Hobeika: Thank you for having me.

Deborah Howell (Host): That was Dr. Elie Hobeika, a board-certified reproductive endocrinology and infertility specialist at Fertility Centers of Illinois. You can schedule an appointment to talk to a fertility specialist at 877-324-4483 or visit fcionline.com for more information. And if you enjoyed this podcast, you can find more like it in our podcast library, and be sure to give us a like, and a follow if you do.

This has been The Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Have yourself a terrific day.