FRS Fertility Drugs

Question 1

Fertility Drugs

Answer 1

• Clomiphene
• Used by women without primary ovarian failure who cannot get pregnant after 1 year of trying

These drugs act to stimualte follicle development and ovulation in functioning ovaries and are combined with human chorionic gonadotropin (HCG) to maintain follicles once ovulation has occured.

Primary ovarian insufficiency occurs when the ovaries stop functioning as they should before age 40

Question 2

Theraputic Action & Indications

Answer 2

• Directly by stimulating the hypothalamus to increase FSH & LH levels - ovarian follicle development & maturation of ova
• General Use- given in sequence with HCG to maintain follicle & hormone production
• Treatment for infertility in women with functioning ovaries
• Treatment for multiple follicle development for the harvesting of ova for invitro fertilization

Question 3

Types of Fertility Drugs

Answer 3

• Clomiphene (clomid) – commonly used oral agent that is also used for treatment of male infertility. Treatment of ovarian failure in patients with normal liver functions and normal endogenous estrogens.
• **Chorionic gonadotropin (chorex, pregnyl) **– injected drug used to stimulate ovulation by acting like GnRH and affecting FSH and LH release

* Chorionic gonadotropin alpha (ovidrel) – injected drug that stimulates final follicular development and ovulation in infertile women.

Question 4

Pharmacokinetics

Answer 4

• Drugs are well absorbed and are treated like endogenous hormones within the body.
• Undergo hepatic metabolism and renal excretion
• Should not be used during pregnancy or lactation – potential adverse hormonal effects on fetus or neonates.
• Route – PO
• Onset – 5 – 8 days
• Duration 6 weeks,
• T1/2 – 5 days with hepatic metabolism and excretion in the feces.

Question 5

Contraindications & Indications

Answer 5

• Contraindicated in the presence of primary ovarian failure
• thyroid & adrenal dysfunction (effects of hypothalamic- pituitary axis, ovarian cysts, serous fetal defects)
  Caution-
• In lactating women
• Those with thromboembolic diseases (risk of increase thrombus formation)
  Women with respiratory disease – alterations in fluid volume and blood flow.

Question 6

Adverse Effects

Answer 6

• Vasomotor flushing
• visual changes
• abdominal discomfort
• distention and bloating
• nausea & vomiting
• ovarian enlargement
• breast tenderness
• multiple pregnancies

Question 7

Nursing Implications

Answer 7

• Assess cause of dysfunction before beginning therapy (ensuring appropriate use of drug)
• Complete a pelvic examination before each cycle of drug therapy (to rule out ovarian enlargement, pregnancy and uterine problems
• Check urine estrogen and estradiol levels before beginning therapy (verify ovarian function)
• Administer with an appropriate dose of HCG as indicated (ensure beneficial effects).