Trying to conceive is an extremely emotional and stressful process, especially when things don’t progress as easily as planned, or hoped for. The pressure put on women from diagnostic tests, prescriptions, and monitoring can sometimes be too much to bear. Whatever your reason for avoiding fertility drugs, I hope that this post serves as an encouragement and a resource to help you make the best decision for you and your health.
Reasons for Fertility Drugs
The main reason for fertility struggles among women is ovulatory dysfunction. This means that throughout the menstrual cycle, the body struggles to mature and release a healthy egg, at the correct time in relation to the hormonal fluctuations that naturally occur during a woman’s cycle. [Read more about hormonal changes that take place during the menstrual cycle.]
Ovulation (and everything leading up to it)
During the first half of the cycle (the follicular phase), the pituitary gland releases luteinizing hormone. This hormone acts on the ovaries to produce estrogen, which allows ovarian follicles to mature so they can eventually release an egg. As the follicle continues to ripen and approaches ovulation, the estrogen level suddenly surges upward, and then drops very quickly. This estrogen surge/drop communicates to the pituitary gland that it is time for ovulation. The pituitary gland responds by creating a surge of its own—this time, luteinizing hormone (LH). When the ovaries receive this intense LH signal from the pituitary gland, the follicle bursts open and the egg is released—ovulation has occurred.
Because fertility struggles so often result from ovulation dysfunction, most fertility drugs target these hormonal pathways that lead up to ovulation. Here’s a list of the most common fertility drugs, why they’re used, how they work, and the natural approaches you might choose to use instead.
[As always, the information shared on this website is for educational purposes only. It is not intended to diagnose, manage, or treat any disease. Always speak with your own doctor before starting something new.]
The Most Common Fertility Drugs & Natural Alternatives
1. Clomiphene Citrate (Clomid)
Clomiphene citrate (Clomid) is the first line treatment for women with ovulatory dysfunction, as its main action is to trigger ovulation by intercepting the LH/estrogen feedback loop at the level of the pituitary gland. Once in the blood stream, the drug mimics the positive feedback given by estrogen, as it binds to estrogen receptors in the pituitary gland. This amplifies the LH surge released by the pituitary gland, giving a strong signal to the ovary that it’s time to release the egg. For some women, this results in ovulation, conception, implantation, and pregnancy. But for others, it doesn’t. One of the main reasons for this is that in addition to triggering an LH surge, clomiphene citrate limits the thickness of the endometrial lining, making implantation less likely to be successful.
Natural Alternative: Clomid dosing typically begins on the second day of the cycle (anywhere from day 2 to day 5) and continues for 5 days. In place of Clomid, 20 mg daily doses of black cohosh (Cimicifuga racimosa extract) can be used daily for 10 days beginning on cycle day 2. In addition to triggering an LH surge, black cohosh results in higher progesterone levels during the luteal phase, subsequently improving the thickness of the endometrial lining. [Reference]
Letrozole functions similarly to Clomid, by stimulating the pituitary gland to create a surge of luteinizing hormone. However, Letrozole is different from Clomid in the way it brings about this LH surge. Instead of binding to estrogen receptors like Clomid, Letrozole artificially creates an estrogen drop by blocking the enzyme that produces estrogen (aromatase). For this reason, Letrozole is considered an aromatase inhibitor. In women who suffer from elevated estrogen levels (or estrogen toxicity), Letrozole can artificially balance hormones long enough to allow ovulation to take place.
Natural Alternative: Instead of using a prescription drug, some women prefer to use natural means for reducing estrogen levels. In addition to lifestyle behaviors like a balanced diet and moderate exercise, diindolylmethane and calcium-d-glucarate can be used to promote estrogen detoxification.
Diindolylmethane (DIM) inhibits aromatase [reference], preventing excess production of estrogen when dosed at 100-400 mg daily, with 200 mg being most common.
Calcium-D-Glucarate promotes estrogen metabolism and excretion, and prevents absorption of exogenous estrogens and estrogen-like hormones [reference] when dosed at 1500-3000 mg daily.
In women with insulin resistance, (a common associated manifestation of PCOS,) the pancreas produces larger than normal levels of insulin. Insulin acts on ovarian follicles during the maturation process, causing them to respond to luteinizing hormone too early, preventing ovulation [reference]. Although Metformin is typically considered to be a drug for diabetes, it can be used to treat ovulatory dysfunction triggered by insulin resistance. Many patients want to avoid the use of Metformin due to side effects, such as loose stools, nausea, and vitamin deficiencies. Others don’t feel comfortable using prescription drugs. Whatever your reasoning, these natural alternatives may be a better option for you.
Natural Alternative: Lifestyle behaviors are the #1 way to improve insulin resistance (moderate exercise, managing stress, dietary methods for blood sugar control) but in the case of PCOS, insulin resistance is triggered by hormones. Lifestyle behaviors are still highest on the list, but sometimes they aren’t enough.
- Berberine doses of up to 1500 mg a day (three 500 mg doses with meals) have been shown to improve blood sugar control and insulin resistance as well as or better than Metformin. [Reference]
- Myo-Inositol prevents the effects of insulin on the ovaries, supporting healthy maturation of follicles and subsequent ovulation. Myo-Inositol is dosed at 4000 mg daily, along with 400 μg of folic acid, taken with meals [Reference].
Another important hormone in the pathway leading to ovulation is prolactin. This hormone is typically credited for stimulating the production of breast milk, so levels are expected to be elevated in late pregnancy and during the postpartum period. Prolactin levels normally remain elevated for as long as a woman is breastfeeding. But sometimes, they stay elevated even after weaning. This is called hyperprolactinemia, and sometimes women struggle with it even if they’ve never been pregnant. (In some cases, elevated prolactin may be the result of a pituitary tumor or other pathology, so you should speak with your doctor if you have concerns about this.)
When prolactin levels are high, they communicate with the pituitary gland, inhibiting the production of luteinizing hormone. (As we discussed earlier, luteinizing hormone stimulates ovulation.) In the postpartum period, this makes sense–getting pregnant isn’t the best idea if you’ve just had a baby. But most women eventually want to have more children! So, doctors prescribe Bromocriptine to inhibit the production of prolactin in patients with hyperprolactinemia.
Natural Alternative: Vitex (Chasteberry, Chastetree, Agnus-Castus) fruit extract has been proven as an effective option for managing a variety of fertility concerns, including ovulation dysfunction resulting from latent hyperprolactinemia [Reference]. Dosage typically ranges from 20-40 mg daily for 2-3 menstrual cycles. Vitex should not be used for longer than this.