Drugs in reproductive medicine

This article discusses some important and commonly used drugs in reproductive medicine, concentrating on the management of subfertility. Clomifene citrate is an effective first-line therapy in anovulation, resulting in 80% ovulation rates and 50–60% pregnancy rates. Gonadotrophins are effective ovulation-induction agents in cases of clomifene resistance or for superovulation protocols necessary for in vitro fertilisation. Metformin and aromatase inhibitors show promise, but further evidence is needed to support their routine use. Both gonadotrophin-releasing hormone agonists and antagonists are effective at preventing a premature surge of luteinising hormone, but it is unclear whether the antagonists, with their patient-friendly shorter cycle, will become the approach of choice. Concerns about the carcinogenic effects of infertility drugs do not seem to be supported by epidemiological evidence, but because of a possible time-lag effect, this area merits surveillance. Future developments include more patient-friendly drug-delivery systems.