Infertility

Fertility Drugs

Initial treatment often includes the use of fertility drugs to stimulate egg production, especially in women with polycystic ovaries. These are prescribed if there is a problem with ovulation (the release of an egg each month). Common fertility medicines include:

clomifene – encourages the monthly release of an egg (ovulation) in women who don't ovulate regularly or who can't ovulate at all
tamoxifen – an alternative to clomifene that may be offered to women with ovulation problems
metformin – particularly beneficial for women with polycystic ovary syndrome (PCOS)
gonadotrophins – can help stimulate ovulation in women, and may also improve fertility in men
gonadotrophin-releasing hormone and dopamine agonists – other types of medication prescribed to encourage ovulation (NHS choices 2017)

Some women may get pregnant using fertility drugs alone or they may be offered them in combination with other treatments such as IUI and IVF.

Most of the women we spoke to had been offered Clomid. This often marked the start of their journey through fertility treatment. (We did not interview anyone who was successful with fertility drugs, although they are often successful.)

For Janine and her husband taking Clomid was the first step on what she described as a “treatment escalator” which went on to include ICSI, donor eggs and eventually adoption. But for others, Clomid is all that is needed to achieve a successful pregnancy. Those who attended more than one clinic or compared notes with other couples, were sometimes surprised to find that standard practice varied at different clinics and that there are “no easy answers” as to which treatments to try in which order. Belinda, for example, changed clinics and was given different advice.

Lulu was not keen on trying fertility drugs but eventually tried a few months of clomiphene (Clomid). She got pregnant but then miscarried.

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Age at interview: 40

Sex: Female

Age at diagnosis: 31

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And I was also at this point trying to do things to improve my overall health, like cut back on the drinking, you know. Usual things. People say oh take a holiday, you know, which you didn’t want to listen to and so we kept on trying and then eventually we thought well may be we would give fertility drugs a try and so I think it was at the end of 1999 I gave fertility drugs a go and took Clomid and the first month nothing happened, the second month nothing happen and then the third month I took two or three out of the pills or something like that and I just chucked the rest in the bin.

So I thought I have had enough of this lot and I actually got pregnant. And because I remember it because it was about the time of the millennium. But at six weeks, six or seven weeks I had a miscarriage. So… which in some ways it was great because I know I could get pregnant. But it was awful because I knew that you are back to that square one again and I think that is one of the things I will say about infertility is that when you have a miscarriage you back to the beginning again and that is you are back at square one again.

Well we thought, well great, we got pregnant, maybe we should give it a bit more time. I might get pregnant on my own. So we left it nine months or so and again nothing happened and went back to the GP and he said, “Give Clomid another go.” He said, “You can do another three cycles of it.” This time I had a really bad reaction to the Clomid. I mean it really. It was like having PMT ten times over and I think I gave it a couple of goes and I just decided that that was really, you know, not for me.

So a few months later we got referred again. And you know it was just, you know it was going back through cycles and you know it was going over and over and it never went away. You know my desire for children never went away. And I had started doing some work by this point. I was working and you know doing my homeopathy nutrition which was great and I was really enjoying that and but I could never put that aside, the thing that I did want to have a child.

So we went back to the hospital again and this time they said well why don’t you try IUI with fertility drugs. So I was a bit unsure about fertility drugs because the experience that I had had. And they say well you can try Tamoxifen.

Clare lost a lot of weight before starting on clomiphene (Clomid) which she hoped would be a ...

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Age at interview: 35

Sex: Female

Age at diagnosis: 31

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Here’s the Clomid. Go away and try. I reckon you’ll be pregnant by Christmas.” So we rushed out the clinic, absolutely thrilled. You know, I’d lost all this weight. This was the magic tablet I was going to take to make me ovulate and to get me pregnant. We started taking them in September and we had naively very high hopes that that would be it, I’d be pregnant on the first cycle. And it didn’t happen. October, took them again. It didn’t happen. The drugs were starting to make me feel quite depressed as well, so that was making things worse. Took them again in November. And during that cycle we actually decided that we weren’t entirely happy with the hospital, and we’d go and pay for a private consultation. And we went to our local private fertility clinic, which we’d, you know, never considered before, and were told that not only was my polycystic ovarian diagnosis completely incorrect, but the scan showed that the Clomid was hyperstimulating my ovaries and I was produce, producing far too many follicles. And the scan further showed that I actually had blocked tubes, and I wasn’t going to be able conceive on Clomid. It would have to be IVF.

Belinda and her husband found there is considerable uncertainty about the benefits of taking clomiphene (Clomid), and not enough research to inform their decision.

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Belinda and her husband found there is considerable uncertainty about the benefits of taking clomiphene (Clomid), and not enough research to inform their decision.

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Age at interview: 35

Sex: Female

Age at diagnosis: 34

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I suppose there are some choices. It is like initially, we when we were seen at the first clinic, and they suggested going on Clomiphene, just like a normal tablet which you take each month just for a few days. And so initially was just to take that for six months, and if that hadn’t worked then we would progress on to IUI. But then when we changed clinics, they were saying, well they haven’t really found Clomiphene that useful for unexplained infertility. They did say like we could carry on with that if we wanted to, but they were suggesting IUI instead. So – and then when we saw the consultant at the local hospital then he was saying he thought that Clomiphene was a better option. So it was just made us feel like we were going back to where we were to begin with. And we tried that for a couple of months and it didn’t work, so we just decided to go ahead with the treatment. And, yet, it is so much cheaper you are talking about the price of a prescription rather than something like £900 so there is a big difference in the price. But yes, the problem is there isn’t enough research done so you don’t know exactly how successful treatment is to compare the two of them. Because of course they have always been done with people like with different problems and like different age groups and things so you can never really do a direct comparison between the two. So we did find that really difficult and I don’t know, we are both people who like answers to problems and like things to be straightforward and there is no easy answer to it and you just have to go with what you feel is right. And at the time we just decided that we felt it was right to continue with the treatment plan that we had got, rather than going back to may be where we had been at the beginning. Because we decided it was a step backwards rather than a step forward. And yes, it might have saved us money but you don’t know.

Side effects

Clomiphene (Clomid) can have unpleasant side-effects for some women, even if they felt they had been warned and prepared for a state of “hormonal hell”. Lulu (see above) said it was “like having PMT (pre menstrual tension) ten times over”. After three months on clomiphene, Maggie stopped because she felt “I’m moody, I’m spotty and I can’t have kids”.

Maggie tried Clomid for three months but the mood swings, flushes, spots and weight gain were...

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Age at interview: 36

Sex: Female

Age at diagnosis: 30

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I’d read about Clomid being described as hormonal hell, so I guess I was fairly prepared for this, for some adverse side effects. The consultant had been fairly honest with me as well, and had given me a big long list of the things that I could potentially expect. I guess really that’s what they have to do to make you aware of there are, you know, thing, there’s no such thing, there’s nothing without complications. So w-, the fertility drugs, Clomid I did find affected my mood swings certainly. I would find myself feeling very very angry. And I knew that it was irrational and unreasonable, but I just found myself feeling full of fury. And it, that was very very difficult. I’ve always been a fairly chilled out kind of person, and to feel this rage was really just something completely new for me and very difficult to deal with, and not pleasant for people around me either. So that, the, the mood swings were one thing. I also did gain an awful lot of weight, and I found that my skin changed as well. I’d always had a fairly good skin. Even as a teenager I’d never had a particular skin problem. And, but with Clomid I found along my jaw and on my chin I would have horrendous spots, which again really did affect my self-esteem. I was like, “God, you know, I’m moody, I’m spotty and I can’t have kids.” It felt fairly miserable. The other thing, the weight gain, and also extremely bad hot flushes as well. I would feel this kind of, this heat rising up from me. It felt like it was rising up from my stomach, and I would know that my face would be scarlet and I would be sweating. And this was in winter. And combined with the spots and the weight and the anger, it really wasn’t great. So I tried Clomid for three months. And then we went to see our fertility specialist, who said, “Okay, you know, that hasn’t worked. We’ll move on to IUI.”

Martha had secondary infertility; a prescription for clomiphene was the first step. She found the...

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Age at interview: 34

Sex: Female

Age at diagnosis: 30

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I mean my memory is that you just have, I, anyway had, a million side effects just, you can have like PMT but like nine times worse, you know, you have got all these just sort of mood swings and whatever and feeling sick with it. And I remember getting really, when you finally ovulated with it, probably because you were producing more follicles it is really, really painful and sort of bleeding, and also it is just disgusting. I mean I have heard of people who have taken it, say they had no problem with it. So I think, you know, you probably react to it badly or you don’t.

I think it is something they like to offer you because it is easy, you know, here is your tablets go away and take them and you know, if it works that is great, but I think a lot of the time it doesn’t really work and I think it is one of those things that is really supposed to be used if you have certain problems, but they do use it as a kind of blanket cure, just figuring well if you produce more eggs may be you are more likely to produce a baby, but, [laughs] it didn’t happen.

Another woman who took clomiphene for three months reflected that “it is not a pleasant experience and it doesn’t do a lot for your sex life either I’m afraid”.

Last reviewed July 2017.
Last updated July 2017.