Therapeutic Actions and Indications.
Women without primary ovarian failure who cannot get pregnant after 1 year of trying may be candidates for the use of fertility drugs. Fertility drugs work either directly to stimulate follicles and ovulation or stimulate the hypothalamus to increase FSH and LH levels, leading to ovarian follicular development and maturation of ova.
Indications
- Given in sequence with human chorionic gonadotropin (HCG) to maintain the follicle and hormone production, these drugs are used to treat infertility in women with functioning ovaries whose partners are fertile.
- Fertility drugs also may be used to stimulate multiple follicle development for the harvesting of ova for in vitro fertilization.
- Menotropins also stimulate spermatogenesis in men with low sperm counts and otherwise normally functioning testes.
- Cetrorelix inhibits premature LH surges in women undergoing controlled ovarian stimulation by acting as a GnRH antagonist.
- Chorionic gonadotropin is used to stimulate ovulation by acting like GnRH and affecting FSH and LH release.
Contraindications of fertility drugs
- Allergy to fertility drug: Prevent hypersensitivity.
- Primary ovarian failure: These drugs only work to stimulate functioning ovaries
- Thyroid or adrenal dysfunction. Drugs have effects on the hypothalamic-pituitary axis.
- Ovarian cysts: Can be stimulated by the drugs and can become larger
- Pregnancy: Due to the potential for serious fetal effects
- Idiopathic uterine bleeding: Can represent an underlying problem that could be exacerbated by the stimulatory effects of these drugs.
- Lactation: Risk of adverse effects on the baby
- Thromboembolic disease. Increased risk of thrombus formation
- Women with respiratory diseases: Alterations in fluid volume and blood flow can overtax the respiratory system.
Adverse effects of fertility drugs
- Greatly increased risk of multiple births and birth defects
- Ovarian overstimulation: abdominal plain, distention, ascites, pleural effusion
- Headache
- Fluid retention
- Nausea
- Bloating
- Uterine bleeding
- Ovarian enlargement
- Gynecomastia
- Febrile reactions possibly due to stimulation of progesterone release.
Fertility Drugs
| Drug | Indication | Dose |
|---|---|---|
| Clomifene | Anovulatory infertility | 50mg daily for 5 days, starting within 5 days of onset of menstruation (preferably on the second day) or at any time if cycles have ceased |
| Bromocriptine | Hyper prolactanaemic, infertility, Suppression of lactation, Hypogonadism, Galactorrhoea syndrome, Benign breast disease | Initially 1.25mg at bed time increased gradually to the usual dose of 2.5mg 3 times a day with food increased if necessary to a max. dose 30mgdaily |
Nursing Diagnosis
- Acute pain related to headache, fluid retention, or GI upset
- Sexual dysfunction related to alterations in normal hormone control
- Disturbed body image related to drug treatment and diagnosis
- Deficient Knowledge regarding drug therapy
- Risk for Impaired Tissue Perfusion (Cardiopulmonary, Peripheral) related to increased risk for thrombus formation
- Situational Low Self-Esteem related to the need for fertility drugs.