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Fertility Drugs - Gonadotropins and Clomiphene Citrate - Available at IVF New Jersey

Clomiphene Citrate and Gonadotropins are fertility drugs that may be prescribed to you by the physicians of IVF New Jersey. Each fertility drug has very specific instructions for usage.

• Clomiphene Citrate Therapy
• Gonadotropin Therapy
• Long-term Side Effects of Clomiphene Citrate/Gonadotropins
• Summary of the Clomiphene Citrate Cycle
• Summary of the Gonadotropin Cycle
• Reconstitution of Fertility Drugs
• Administration of Fertility Drugs

Clomiphene Citrate Therapy

Clomiphene citrate (CC) is an oral fertility drug that is used by IVF New Jersey in the treatment of patients who do not ovulate or who ovulate infrequently. Serophene and Clomid are the two brands of clomiphene citrate manufactured in the USA. There is no difference between these two fertility drugs, although sometimes one or the other can be less expensive. Clomiphene citrate is used in other situations besides ovulatory disorders. In patients for whom there is no known cause for their infertility, clomiphene citrate — in conjunction with intrauterine inseminations (IUI) — has been found to improve the ability to conceive.

Clomiphene citrate plus intrauterine insemination is used at IVF New Jersey when sperm concentration and/or motility is low, or when antisperm antibodies are a factor in infertility. Patients with endometriosis who have not conceived following medical or surgical treatment are candidates for clomiphene citrate. Finally, patients who have abnormal ovulation, that is a “luteal phase defect,” can also be successfully treated with clomiphene citrate therapy at IVF New Jersey.

Clomiphene Citrate Protocol

Clomiphene citrate is administered as a 50 mg tablet. The dosage ranges from one to five tablets per day on days 3 through 7 of the menstrual cycle, (alternatively, clomiphene citrate may be administered on days 5 through 9). Clomiphene citrate stimulates the body to produce increased amounts of the hormone FSH. FSH in turn stimulates the eggs to grow and mature. Typically, two to four eggs will mature when clomiphene citrate is administered. Ovulation will occur in one of two ways: one, a naturally occurring surge of the hormone LH (as detected by the change in color of an ovulation kit); and two, by administration of a fertility drug referred to as human chorionic gonadotropin (hCG). This fertility drug goes by the trade names Ovidrel®, Profasi®, Novarel®, and Pregnyl®, and is administered when we determine that the eggs are mature and ready to ovulate. This is determined by monitoring blood levels of estradiol and the size of the egg sacs by ultrasound. It is well known that ovulation will occur approximately 36 to 40 hours after the injection, and therefore inseminations are timed accordingly.

A typical treatment cycle involves taking two tablets of clomiphene citrate on days 3 through 7 of the menstrual cycle. On day 12, a blood test to measure estradiol and ultrasound measurement of the egg sacs are performed. As stated above, the intrauterine insemination will then take place 36 to 40 hours after hCG is administered. After hCG, the patient will notice a rise in her basal body temperature chart and possibly abdominal bloating and discomfort. This is due to enlargement of the ovaries caused by both clomiphene citrate and hCG administration. One week after hCG, a progesterone level is obtained to check for ovulation and adequate progesterone levels to “support” a pregnancy. At this time, a decision is made to administer progesterone if the level is too low. If the cycle is unsuccessful, menstruation will occur approximately 16 days from the time of the hCG injection. Your physician should be notified if you are three to four days late for the menstrual period so that we may perform a pregnancy test.

Clomiphene Citrate Side Effects

Clomiphene citrate acts by actually “deceiving” the body into believing that the estrogen level has been decreased. The side effects caused by clomiphene citrate are mostly the result of these “anti-estrogen” effects. These include hot flashes, vaginal dryness, mood swings, headaches, and visual disturbances. All of these symptoms may be experienced, and they will stop once you have completed the course of fertility drugs treatment at IVF New Jersey. Should you develop any type of visual disturbance, please inform us and stop taking clomiphene citrate.

A common concern in using clomiphene citrate is the possibility of multiple pregnancies. In approximately 5 percent of pregnancies, there will be more than one fetus. The vast majority of times this will be a twin pregnancy. Another problem is the possible development of large ovarian cysts after hCG is administered. These cysts will typically cause abdominal discomfort and bloating. In rare instances the ovaries will become very enlarged, requiring hospitalization for administration of intravenous fluids and observation. This is a rare event that occurs in less than 1 percent of patients undergoing clomiphene citrate therapy. Typically, these cysts will disappear within two to three weeks, and surgery is rarely if ever required for their removal. When cysts do develop, it is suggested that physical activity be restricted, including withholding coital activity. Finally, it should be noted that clomiphene citrate has not been found to cause an increase in birth defects as compared to patients who conceive naturally.

Clomiphene Citrate Success Rate

The success rate with clomiphene citrate therapy depends on the individual patient's clinical problems. For patients who do not ovulate or ovulate infrequently, close to 80 percent will be able to ovulate using clomiphene citrate at IVF New Jersey. The pregnancy rate per fertility drug cycle is approximately 15 percent, and 40 percent of patients will become pregnant within six cycles. These success rates will differ, however, when there are additional factors affecting a couple's fertility. These factors may include endometriosis, cervical factor, luteal phase defect, male factor, and unexplained infertility. Success rates for these patients are approximately 10 percent per fertility drug cycle.

Gonadotropin Therapy

Gonadotropins are used by the physicians of IVF New Jersey in the treatment of patients who do not ovulate or ovulate infrequently. Most patients who have difficulty ovulating are treated initially with clomiphene citrate (Clomid, Serophene). When clomiphene citrate is unsuccessful, the next regimen is a combination of clomiphene citrate and gonadotropins, or gonadotropins alone.

Gonadotropins are used in other situations besides ovulatory disorders. In patients with no known cause for their infertility, gonadotropins, in conjunction with intrauterine inseminations (IUI), have been found to improve the ability to conceive. Gonadotropins plus IUI is used at IVF New Jersey when sperm concentration and/or motility is low, or when antisperm antibodies are a factor delaying fertility. Patients with poor cervical mucus will benefit by improvement in ovulation. Patients with endometriosis who have not conceived following medical or surgical treatment are also candidates for gonadotropins. Finally, patients who have abnormal ovulation, or “luteal phase defect,” can also be successfully treated with gonadotropin therapy at IVF New Jersey.

Lupron Depot®, Cetrotide, and Ganarelix

These medications are very similar to a brain hormone known as gonadotropin releasing hormone (GnRH). GnRH is responsible for the release of the pituitary gonadotropins described above. One of those hormones, LH, is responsible for triggering ovulation. We want to prevent the release of LH and avoid ovulation of the eggs prior to egg retrieval. By administering GnRH-like medications, we can suppress the release of LH and prevent premature ovulation. These fertility drugs are administered subcutaneously.

The choice of a particular gonadotropin or GnRH-like medication depends on many factors. Every patient and fertility drug is unique, and the physicians at IVF New Jersey will recommend a course of therapy that is considered best for you.

Gonadotropin Prerequisites

There are prerequisites for starting gonadotropin therapy at IVF New Jersey, the most important being that an open and functioning fallopian tube must be present. This can be confirmed by performing a laparoscopy. In addition, sperm must be present in such a quantity as to provide a reasonable chance of obtaining a pregnancy (for example, at least 1 to 3 million motile sperm after being “washed” for intrauterine insemination). These prerequisites are justified because gonadotropin therapy is a demanding experience that involves considerable time and expense. Above all, the medication is quite expensive, with the average treatment cycle costing $700 to $1000 for the fertility drug itself.

Gonadotropin Protocol

Gonadotropins that are prescribed by the specialists of IVF New Jersey can be given by intramuscular or subcutaneous injection. After the fertility drug is absorbed into the blood stream, it is carried down to the ovaries, where it stimulates the eggs to develop and mature. Typically, three to eight eggs will mature when gonadotropins are administered, but ovulation of these mature eggs will not occur unless another fertility drug is given, which is referred to as human chorionic gonadotropin (hCG). This medication goes by the trade names Ovidrel®, Profasi®, Novarel®, and Pregnyl®, and is administered when we determine that the eggs are mature and ready to be ovulated. This is determined by monitoring the estrogen blood levels and also the size of the egg sacs by ultrasound. When the estrogens and ultrasound show that two or more egg sacs are properly developed, we administer hCG. It is well known that ovulation will occur approximately 36 to 40 hours after the hCG injection, and therefore inseminations are timed accordingly.

After hCG, the patient will notice a rise in her basal body temperature chart and possibly abdominal bloating and discomfort. This is due to enlargement of the ovaries caused by both gonadotropins and hCG administration. One week after the hCG injection, a progesterone level is obtained to check for ovulation and adequate progesterone levels to “support” a pregnancy. If the cycle is unsuccessful, menstruation will occur approximately 14 days from the time of the hCG injection. Your physician should be notified if you are three to four days late for your menstrual period in order that we perform a pregnancy test.

Gonadotropin Side Effects

Gonadotropins have some important side effects. A common concern is the possibility of multiple pregnancies. In approximately 20 percent of pregnancies, there will be more than one fetus. The vast majority of times this will be a twin pregnancy, with triplet pregnancies occurring uncommonly; in rare situations, quadruplets and quintuplets may be present. In addition, there is a greater miscarriage rate with gonadotropins than natural conception (25 percent versus 15 percent per cycle). Another problem is the possible development of large ovarian cysts after hCG is administered. These cysts will typically cause abdominal discomfort and bloating. In rare instances, the ovaries will become very enlarged and will require the patient be hospitalized for the administration of intravenous fluids and observation. This is a rare event which occurs in less than 1 percent of patients undergoing gonadotropin therapy. Typically, these cysts will disappear within two to three weeks and surgery is rarely if ever required for their removal. When these cysts do develop, it is suggested that physical activity be restricted including withholding coital activity. Some additional side effects that may occur include headaches, nausea, breast discomfort, general aches, and mood swings. It should be noted that we have not found an increase in birth defects in “gonadotropin babies” at IVF New Jersey as compared to patients who conceive naturally.

Gonadotropin Cycle Cancellation

Gonadotropin cycles may be canceled for a variety of reasons. On menstrual cycle day 3, we perform a “baseline” blood estradiol test and ultrasound. If the estradiol level is too high, and/or there are one or more large cysts on the ovaries, we will delay the administration of the fertility drugs at IVF New Jersey until the beginning of the next menstrual cycle. In addition, if gonadotropins are begun and the response to the fertility drug is poor, the cycle will be canceled and restarted after the next menstrual period. Similarly, one can have a good response, but find that after six or seven days of gonadotropins the estradiol levels go down. This is due to either a premature “LH surge” or premature ovulation. In these situations, the eggs have not matured properly so it best to stop the cycle at this time.

Gonadotropin Success Rate

The success with gonadotropin therapy depends on the individual patient's clinical problems. For patients who do not ovulate or ovulate infrequently, close to 100 percent will be able to ovulate using gonadotropins. The pregnancy rate per fertility drug cycle is approximately 25 percent, and over 60 percent of patients will become pregnant within five to six cycles. These success rates will differ, however, when there are additional factors affecting a couple's fertility. These factors may include endometriosis, cervical factor, luteal phase defect, male factor, or unexplained infertility. Success rates for these patients will range from approximately 10 percent to 20 percent per gonadotropin treatment cycle.

Long-term Side Effects of Clomiphene Citrate/Gonadotropins

There are no known long-term side effects associated with clomiphene citrate or gonadotropin use at IVF New Jersey or elsewhere. Although these fertility drugs stimulate the release of multiple eggs from the ovary, they do not cause a woman to undergo “premature menopause.” Another point of concern is a possible association with clomiphene citrate/gonadotropins and ovarian cancer. A 1993 study indicated a possible increase in the incidence of ovarian cancer in infertile women who did not conceive and who took fertility drugs. There are a number of drawbacks to this study, including the very small number of patients and the lack of details regarding which fertility drugs were used and their duration of use. This has prompted the authors to indicate that their findings are “by no means certain ... and very tenuous.” They do not recommend that we alter our current practice of prescribing fertility drugs.

We should further point out that a 1987 study failed to find an association with clomiphene citrate/gonadotropins and ovarian cancer. Since 1993, other studies have examined the incidence of ovarian cancer in women who had been treated with fertility drugs. None of these studies has shown a statistically significant increased incidence of ovarian cancer. Disparities such as these indicate that further long-term studies are needed to give us a definite answer to this question. Therefore, until we obtain this information, we ask you to take into account the unlikely possibility of an increased risk of developing ovarian cancer if you are treated with fertility drugs.

It should be noted that infertility alone is a risk factor in ovarian cancer. The lifetime risk of developing ovarian cancer in the “average” woman is about 1 to 2 percent and increases to 2 to 3 percent in infertile women. It is important to note that infertile women who become pregnant lower their risk of ovarian cancer.

Summary of the Clomiphene Citrate Treatment Cycle

Day 2-4 of menses

Come in for a sonogram and blood test. Appointments are not necessary except on Sundays. Blood tests and sonograms are performed from 7:00-9:30 a.m. weekdays and 8:00-9:30 a.m. on Saturdays and holidays in Somerset, 7:00-9:30 a.m. Monday-Friday in Freehold, and 7:00-9:00 a.m. Monday-Friday in Princeton Junction.
If the sonogram and blood estradiol (E2) are normal, a clomiphene citrate 50mg tablet is taken twice per day on days 3 through 7.

Day 11 or 12

Blood E2 determination and sonogram. At this point, the E2 levels and size of the egg sacs may indicate the eggs are ready for ovulation (release) from the egg sac. If so, we will call to advise you to administer hCG, usually in the evening. If you are having an IUI, this will normally be done the second day after hCG, usually in the late morning. If having intercourse and not IUIs, begin the evening of hCG and continue daily or every other day until at least the second day after hCG.

7 Days after hCG Administration

Blood progesterone level is determined to confirm ovulation. Progesterone tablets, oral or vaginal, may be prescribed.

Approximately 16 days after hCG

If conception has not taken place, the menstrual period will begin on or about this time. When you are three to five days late for your period, please come to the office to have a pregnancy test.

Summary of the Gonadotropin Treatment Cycle

Day 2-4 of menses

Come in for a sonogram and blood test. Appointments are not necessary except on Sundays. Blood tests and sonograms are performed from 7:00-9:30 a.m. weekdays and 8:00-9:30 a.m. on Saturdays and holidays in Somerset, 7:00-9:30 a.m. Monday-Friday in Freehold, and 7:00-9:00 a.m. Monday-Friday in Princeton Junction.
If the sonogram and blood estradiol (E2) are normal, gonadotropins will be prescribed.

Day 6

Blood E2 determination. If E2 is rising as expected, the gonadotropin dose will not be changed. If the E2 level is too high, we will decrease the gonadotropin dose; if it is too low, we will increase the gonadotropin dose. IF WE DO NOT CALL YOU BY 8:00 p.m., CALL IVF NEW JERSEY (ANSWERING SERVICE) AND ASK THAT WE CONTACT YOU AS SOON AS POSSIBLE.

Day 8

Blood E2 determination and possibly sonogram to check for enlargement of follicles (egg sacs). We will phone to advise of the gonadotropin dose that should be given.

Day 10-11

Blood E2 determination and sonogram. At this point, the E2 levels and size of the egg sacs may indicate that the eggs are ready for ovulation (release from the egg sac). If so, we will call to advise you to administer hCG, usually in the evening. If you are having an IUI, this will normally be done the second day after hCG, usually in the late morning. If having intercourse and not IUIs, begin the evening of hCG and continue daily or every other day until at least the second day after hCG.

7 Days after hCG administration

Blood progesterone level is determined to confirm ovulation. Progesterone may be prescribed.

Approximately 14 days after hCG injection

If conception has not taken place, the menstrual period will begin on or about this time. When you are three to five days late for your period, please come to the office to have a pregnancy test.

Attention:
While taking fertility drugs do not take Advil®, Motrin®, or anything containing ibuprofen (except during menstrual periods).

Reconstitution (Mixing) of Fertility Drugs

Lupron Depot®

1. Wipe the top of the vial with rubbing alcohol.
2. Pull back on the plunger to the 0.05(5 unit), 0.1(10 unit), or 0.2(20 unit) mark.
3. Insert the needle through the rubber stopper and inject the air.
4. Invert the bottle and withdraw the appropriate amount (0.2, 0.1, 0.05) of Lupron Depot®.
5. Remove any air bubbles by flicking the barrel of the syringe and pushing the air out once it reaches the top.
6. Follow the instructions for subcutaneous injection of fertility drugs.

Gonadotropins in ampules (Gonal-f®, Pergonal, and Fertinex®)

1. To open ampule, hold the ampule with the dot facing away from you and wrap gauze around the neck of the ampule.
2. Grasp the top of the ampule between your thumb and index finger. Carefully snap the top off by pulling it back towards yourself.
3. Using a 22G, 1½" needle, withdraw 1cc of sterile water or diluent and remove air bubbles by tapping on the barrel of the syringe and pushing them out once they reach the top.
4. Squirt the water into the first amp of medication, aiming toward the side of the amp. Allow the powder to dissolve, swirling gently if needed.
5. Withdraw the entire mixture.
6. Squirt the water into the next amp, again aiming towards the side of the amp. Continue repeating steps 4 and 5 until all of the necessary ampules of medication have been mixed.
7. When you are finished mixing, you should have 1cc of mixture.
8. Remove any air bubbles.
9. Recap the needle and exchange for a 27G, ½" needle. Follow instructions for subcutaneous injection of fertility drugs. (Please note that in some cases, your IVF New Jersey doctor may instruct you to use the intramuscular technique. In that case, you would proceed with the 22G, 1½" needle. You will be told specifically if this is your situation.)

Gonadotropins in vials (Follistim®, Repronex®, and Bravelle®)

1. Flip the plastic cap off the vials and wipe the top of each vial with rubbing alcohol.
2. Using a 22G, 1½" needle, pull back on the plunger to the 1cc mark. Insert the needle into the vial of water or diluent and inject the air.
3. Invert the bottle and withdraw 1cc of water or push the needle all the way into the vial and withdraw 1cc of water. Either method is acceptable, but please be sure that the needle tip is in the water.
4. Remove any air bubbles by tapping on the barrel of the syringe and pushing the air out once it reaches the top.
5. Inject the water into the first vial of medication, aiming toward the side of vial. Allow the powder to dissolve, swirling gently if needed.
6. Withdraw the entire mixture.
7. Squirt the water into the next vial, again aiming toward the side. Continue repeating steps 5 and 6 until all of the necessary vials of medication have been mixed.
8. Remove any air bubbles. You should have 1cc of mixture.
9. Recap the needle and exchange for a 27G, ½" needle. Follow instructions for subcutaneous injection of fertility drugs. (Please note that in some cases, your IVF New Jersey doctor may instruct you to use the intramuscular technique. In that case, you would switch to another 22G, 1½" needle. You will specifically be told if this is your situation.)

Multi-Dose Gonal-f® (1200iu kit)

1. Flip off the plastic cap on the vial and wipe the top of the vial with an alcohol pad.
2. Remove the needle cap from the pre-filled syringe of water.
3. Carefully insert the needle directly through the rubber stopper of the vial and slowly inject the water. Withdraw the needle and discard the syringe.
4. Do not shake the bottle, but gently swirl until all of the powder has dissolved and the mixture is clear.
5. You will be instructed as to the exact dosage and will notice that the syringes in the kit come with markings for units. Use the chart below to determine your dosage:
   
   1 amp ....... 75iu
   2 amp ....... 150iu
   3 amp ....... 225iu
   4 amp ....... 300iu
   5 amp ....... 375iu
   6 amp ....... 450iu
   7 amp ....... 525iu
   8 amp ....... 600iu
   
6. Wipe the rubber stopper with rubbing alcohol each day.
7. Using the syringes provided in the kit, pull back on the plunger to the appropriate marking for that day's dosage. Insert the needle through the stopper and inject the air into the vial.
8. Invert the bottle and pull back on the plunger until fluid fills to the appropriate marking.
9. Remove the syringe from the vial and check to make sure there is no air in the syringe.
10. You are now ready to inject. Proceed to the subcutaneous injection directions.
    Store the remaining Gonal-f® in the vial in your refrigerator. It is stable and can be used for the next 28 days. Remove the vial 15 minutes before your injection the next day and begin at step 6.

IMPORTANT: There are several different types of chorionic gonadotropin. Please make sure you check the name on the box to confirm that you are administering correctly.

Ovidrel® (chorionic gonadotropin)

1. Wipe the top of the vials with alcohol.
2. You may use either a 22G 1½" needle to mix, or a 27G ½" needle.
3. Pull back on the plunger of the syringe to the 1cc mark.
4. Insert the needle through the vial of water and inject the air.
5. Either invert the bottle to withdraw 1cc of water, or push the needle all the way into the vial and withdraw 1cc of water. Either method is acceptable, but make sure the tip of the needle is always sitting in the liquid.
6. Remove any air bubbles.
7. Insert the needle through the vial of medication (powder) and inject the water, aiming toward the side of the vial.
8. Allow the powder to dissolve completely, swirling gently if needed.
9. Again, either invert the bottle to withdraw the mixture, or push the needle all the way into the vial and withdraw the mixture.
10. Check for any air bubbles and remove. You should still have 1cc of mixture.
11. Change to a new 27G, ½" needle and follow the instructions for subcutaneous injection of fertility drugs.

Profasi®, Pregnyl®, Novarel® (chorionic gonadotropin)

1. Wipe the top of the vials with an alcohol swab.
2. Using a 22G 1½" needle, pull back on the plunger to the 2cc mark.
3. Insert the needle through the rubber stopper of the vial of water and inject the air.
4. Invert the bottle and withdraw 2cc of water. Remove any air bubbles.
5. Inject the needle through the vial of medication (powder) and inject the water, slowly aiming toward the side of the vial.
6. Allow the powder to dissolve, swirling gently if needed.
7. Invert the bottle and withdraw the entire 2cc of mixture.
8. Remove any air bubbles. Check to make sure you have 2cc of mixture.
9. Change the needle to another 22G, 1½" needle. Follow the instructions for the intramuscular injection technique.

Progesterone

1. Wipe the top of the vial with an alcohol swab.
2. Attach an 18G, 1½" needle to a 3cc syringe.
3. Pull back on the plunger to the appropriate amount (½, 1, or 1½).
4. Insert the needle through the rubber stopper and inject the air into the vial.
5. Invert the bottle and withdraw the appropriate amount of Progesterone.
6. Check for any air bubbles and remove.
7. Switch to a 22G, 1½" needle and follow the instructions of intramuscular injection of fertility drugs.

Delestrogen®

(Remember: Delestrogen® is given twice weekly, not daily)

1. Using a 1cc syringe, attach an 18G 1½" needle.
2. Wipe the top of the vial with rubbing alcohol.
3. Insert the needle through the rubber stopper and inject the air.
4. Invert the bottle and withdraw the appropriate amount of medication (0.2cc, 0.4cc, 0.6cc, 0.8cc, etc.).
5. Remove any air bubbles.
6. Recap the needle and switch to a 22G, 1½" needle. Follow instructions for intramuscular injection.

Administration of Fertility Drugs

Subcutaneous Injection Technique

1. Choose an injection site on the thigh, abdomen, or outer part of the arm. (Note: We recommend the abdomen.)
2. Wipe the injection site with an alcohol swab and allow to dry completely.
3. Using your non-dominant hand, squeeze an area of fatty tissue.
4. Holding the syringe in your dominant hand like you would hold a pen, inject the needle quickly at a 90-degree angle.
5. Withdraw the plunger slightly to check for blood. (If blood appears, remove the syringe and apply pressure to the injection site. Choose a new site and begin again.)
6. Inject the fluid slowly.
7. Remove the needle and apply pressure to the injection site.

Intramuscular Injection Technique

1. Choose an injection site in the upper outer quadrant of the rear end, just behind the hip bone.
2. Wipe the injection site with an alcohol swab and allow to dry completely.
3. Using your non-dominant hand, pull the skin taut.
4. Holding the syringe in your dominant hand like you would hold a pen, inject at a 90-degree angle with one swift motion.
5. Withdraw slightly on the plunger to check for blood. (If blood appears, remove the syringe and apply pressure to the injection site. Choose a new site and begin again.)
6. Inject the fluid slowly.
7. Remove the syringe and apply pressure to the injection site.

IMPORTANT REMINDERS:

• Always wash your hands before beginning, and work on a clean surface.
• You may experience some burning or redness at the injection site. This is completely normal and can usually be relieved by applying a hot compress. To minimize burning, be sure to allow the alcohol to dry completely before injecting the fertility drugs.
• If you are taking HCG (Profasi®, Ovidrel®, etc.) for an IVF cycle, it is imperative that you take it exactly at the time the doctor instructs. If you are taking it for an IUI cycle, you should take it sometime in the evening between 6 and 10 p.m.
• DO NOT USE ICE TO NUMB INJECTION SITES. Ice will interfere with the absorption of the fertility drugs.
• REMEMBER: Do not use any ibuprofen products during your treatment cycle, except during menstruation.

If you are have questions about using fertility drugs, including Clomiphene Citrate and Gonadotropin, contact IVF New Jersey. We would be happy to answer any and all questions.