NCLEX Review Guide: Maternity and Newborn Medications - Fertility Medications
Fertility Medications Overview
Ovulation Stimulants
Clomiphene (Clomid) - Selective estrogen receptor modulator that blocks estrogen receptors in the hypothalamus, leading to increased FSH and LH release. First-line treatment for anovulatory infertility with typical dosing of 50-100mg daily for 5 days starting cycle day 3-5.
Letrozole (Femara) - Aromatase inhibitor that reduces estrogen production, causing increased gonadotropin release. Often preferred over clomiphene due to lower multiple pregnancy rates and better endometrial development.
Gonadotropins (FSH/LH) - Direct hormone replacement including Gonal-F, Follistim, and Menopur. Require careful monitoring with ultrasound and estradiol levels due to high risk of ovarian hyperstimulation syndrome (OHSS).
Memory Aid: CLOMID
Cycles - Monitor menstrual cycles
LH surge - Triggers ovulation
Ovulation - Primary goal
Multiple births - Risk factor
Infertility - Primary indication
Day 3-5 - Typical start time
Key Points
Monitor for visual disturbances with clomiphene - discontinue if occurs
OHSS symptoms: abdominal distension, weight gain >2 lbs/day, difficulty breathing
Timing is critical - ovulation typically occurs 5-10 days after last dose
GnRH Agonists and Antagonists
Mechanism and Clinical Use
GnRH Agonists (Lupron, Synarel) - Initially stimulate then suppress pituitary gonadotropin release through receptor downregulation. Used to prevent premature LH surge during IVF cycles and treat endometriosis-related infertility.
GnRH Antagonists (Cetrotide, Ganirelix) - Immediately block GnRH receptors without initial stimulation. Preferred in IVF due to shorter treatment duration and reduced risk of OHSS compared to agonists.
GnRH Agonists vs Antagonists
Aspect
Agonists
Antagonists
Onset
Delayed (flare effect)
Immediate
Duration
Longer treatment
Shorter treatment
OHSS Risk
Higher
Lower
Cost
Lower
Higher
Male Fertility Medications
Hormonal Treatments
hCG (Human Chorionic Gonadotropin) - Mimics LH action to stimulate testosterone production in males with hypogonadotropic hypogonadism. Administered 2-3 times weekly subcutaneously with monitoring of testosterone levels and sperm parameters.
Clomiphene for Males - Increases endogenous testosterone and FSH levels in men with low testosterone-to-estrogen ratios. Monitor for mood changes and visual disturbances similar to female use.
Clinical Scenario
A 32-year-old male with oligospermia is prescribed clomiphene 25mg daily. What key teaching points should the nurse emphasize?
Take medication at the same time daily
Report any visual changes immediately
Semen analysis will be repeated in 3 months
Avoid excessive heat exposure to testes
Nursing Considerations and Safety
Assessment and Monitoring
Obtain comprehensive reproductive history including previous pregnancies, menstrual patterns, and fertility treatments