Pharmacology

1. Infertility
Drug treatment

2. TREATMENT OPTIONS
• Treatment options for infertility include:
– clomiphene citrate
– aromatase inhibitors
– Gonadotropins
• chorionic gonadotropins, gonadotropin-
releasing hormone, gonadotropin-releasing
hormone agonists, gonadotropin-releasing
hormone antagonists
– follitropins, and other miscellaneous agents

3. CLOMIPHENE CITRATE
• a first-line agent for women with ovulatory
dysfunction
• Mechanism:
– nonsteroidal estrogen receptor modulator that
inhibits the negative feedback response on the
hypothalamus by competing with estrogen for
estrogen receptor-binding sites. This action leads
to an increase in FSH and LH levels, promoting
follicular growth and maturation, allowing
ovulation to occur by increasing the number of
eggs
• Use: fertility drug
• Adverse effect:  multiple births

4. AROMATASE INHIBITORS
Anastrozole, Letrozole
• Aromatase inhibitor  estrogen synthesis
• Use: Estrogent – dependant postmenopausal
breast cancer

5. GONADOTROPINS
• Human menopausal gonadotropin
(hMG)
– menotropins (parentral)
– used to produce ovulation

6. CHORIONIC GONADOTROPINS
• Human chorionic gonadotropin
– Choriogonadotropin alfa for injection

7. GONADOTROPIN-RELEASING
HORMONE
• Gonadorelin acetate
– The pulsatile administration of mimics the
endogenous release of GnRH from the
hypothalamus. It is indicated for the
induction of ovulation in women with
primary hypothalamic amenorrhea.
– Gonadorelin is contraindicated in women
with pituitary prolactinoma and in those
with ovarian cysts

8. GONADOTROPIN-RELEASING
HORMONE AGONISTS
• Leuprolide acetate.
• Nafarelin acetate
• Triptorelin pamoate
• Goserelin acetate.

9. GONADOTROPIN-RELEASING
HORMONE ANTAGONISTS
• Ganirelix acetate
– It is indicated for the inhibition of
premature surges of LH in women
undergoing COH (controlled ovarian
hyperstimulation )

10. PROGESTERONE
• Progesterone prepares the endometrial
lining for implantation
• Once the embryo has been implanted,
progesterone helps maintain the
pregnancy

11. FOLLITROPINS
• human follicle-stimulating hormones
(hFSH) or urofollitropins and
recombinant human follicle-stimulating
hormones (r-hFSH)
• treatment of infertility when
clomiphene therapy is inadequate

12. MISCELLANEOUS AGENTS
• Metformin
• Dopamine agonists
– Cabergoline
– Bromocriptine

13. Testosterone
• T Injection
• Supplements
– Tribulus terrestris
– Date palm pollen extracts