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Other Ovulation Medicines

Although we've described the most common ovulation medications here, it's worth pointing out that several other medicines may be used in special situations for certain women. So, if the medication you're taking or are considering taking isn't mentioned in this article, it could be that you have a unique situation that is better treated with other fertility medicines. Some of these medications include:
Aromatase Inhibitors
Aromatase inhibitors are a class of medicines originally developed to treat advanced breast cancer. They're not officially approved by the Food and Drug Administration (FDA) to treat women with ovulation problems. But, because they cause ovulation, they may be used "off-label" for this reason.
Aromatase inhibitors work by stopping the action of aromatase, an enzyme that helps make estrogen from other hormones. By blocking aromatase, these drugs decrease estrogen levels. This is good for treating breast cancer, since many breast cancer tumors are sensitive to estrogen and grow in response to it. Decreasing estrogen levels also triggers the pituitary gland to release FSH. As a result, the ovarian follicles grow and mature, and ovulation occurs.
Aromatase inhibitors are an attractive alternative to clomiphene since they seem to have fewer side effects. They don't affect the endometrium or cervical mucus like clomiphene does. However, they also haven't been studied as well as clomiphene, and there is some concern that they can cause birth defects, although they haven't been reported to do so in studies so far.
For these reasons, aromatase inhibitors haven't been well accepted as a first choice for ovulation induction just yet, but some researchers suggest they might be in the future, after more information is available demonstrating their safety and healthcare providers are more comfortable using them. For now, these medicines are generally reserved for women who fail clomiphene treatment or cannot tolerate clomiphene due to side effects.
Metformin is a diabetes medication that helps make the body more sensitive to insulin and reduces blood glucose (blood sugar) levels. It is sometimes used "off-label" to treat ovulation problems.
Metformin may be especially useful for women with polycystic ovary syndrome (PCOS), especially women who are obese and who have high levels of insulin in the blood and insulin resistance. It can be used alone or in combination with clomiphene. Metformin comes as a tablet that is taken by mouth.
Dopamine Agonists
Dopamine agonists are medications that decrease how much prolactin the pituitary gland makes. Prolactin is a hormone that stimulates milk production (lactation). When prolactin levels are high, the pituitary gland doesn't release FSH or LH and ovulation does not occur.

Some women have high prolactin levels (which is known medically as hyperprolactinemia) even though they are not lactating. If high prolactin levels are interfering with ovulation, dopamine agonists such as bromocriptine or cabergoline can help. In fact, about 80 percent to 85 percent of women who are infertile because of high prolactin levels will ovulate when they take one of these medicines, and 70 percent to 80 percent will become pregnant.
Bromocriptine is the usual "go-to" medicine for women who need a dopamine agonist for fertility. This is primarily because bromocriptine has been used for years, and healthcare providers feel pretty certain it won't cause birth defects when taken to induce ovulation. If a woman has intolerable side effects from bromocriptine, however, she may be given cabergoline instead. Cabergoline seems to have fewer side effects. Either way, the medication is stopped once a woman becomes pregnant, since dopamine agonists aren't necessary to sustain a pregnancy.
Dopamine agonists are taken by mouth, but can also be inserted vaginally. Women who do not ovulate after their prolactin levels return to normal may also be given clomiphene or gonadotropins.
Gonadotropin-Releasing Hormone
GnRH is a hormone made by the hypothalamus that tells the pituitary gland to release FSH and LH. One of the interesting things about GnRH is that the hypothalamus secretes small amounts of it about every 90 minutes. Without this pulselike pattern of GnRH stimulation, the pituitary would slow down its release of FSH and LH and ovulation would not occur.
GnRH treatment is available for women whose hypothalamus does not release GnRH normally. It requires the use of a special pump that delivers the drug directly into the bloodstream every 60 to 90 minutes either as an injection into a vein (intravenously) or under the skin (subcutaneously). GnRH treatment is rarely used. 
Written by/reviewed by:
Last reviewed by: Arthur Schoenstadt, MD
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