Infertility: medications and paying cash

Overview

Infertility is usually defined as not conceiving after twelve months of regular unprotected sex, or six months for women over 35. The causes fall into a few groups: ovulation problems, most often from polycystic ovary syndrome; blocked or damaged fallopian tubes; male factors such as low sperm count; and unexplained infertility. Both partners are usually assessed at the start.

Where the problem is ovulation, oral medicines are the first step. Clomiphene is FDA-approved to treat ovulation problems in women trying to conceive. Letrozole, an aromatase inhibitor approved for breast cancer, is not FDA-approved for fertility treatment, but it is now preferred for polycystic ovary syndrome because it leads to more live births than clomiphene in that group; using it is the prescriber’s decision. Metformin is added for some women with insulin resistance, which is also not an FDA-approved use and is the prescriber’s decision. Ovulation is confirmed with blood tests, home kits or ultrasound, and treatment usually continues for a limited number of cycles.

If oral medicines do not work, or for tubal and male-factor infertility, treatment moves to injectable hormones with monitoring, intrauterine insemination, or IVF, which are specialist services with medicines dispensed through specialty pharmacies.

Choosing between the options when you pay cash

For the oral stage, a cycle needs only a few tablets, and the main variable is where the prescription is filled. Letrozole and clomiphene are both available as generics; ask the pharmacy to confirm it can supply yours before the cycle starts. A prescription you can take to any pharmacy, ideally covering several cycles, lets you compare quotes.

Injectable gonadotropins, trigger shots and progesterone support for IVF are dispensed differently: specialty pharmacies and manufacturer programs are involved, and a cycle can need several medicines at once. Asking the clinic for a written medication list and getting quotes from more than one specialty pharmacy lets you compare like for like.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Letrozole
  Tablets (Femara and generic)
  Generic: Yes · Once a day
• Clomiphene
  Tablets (generic, including Clomid)
  Generic: Yes · Once a day
• Metformin
  Tablets (immediate-release), Extended-release tablets, Oral solution
  Generic: Yes · Two or three times a day with meals, or once a day extended-release
• Estradiol
  Tablets (generic), Weekly patches (Climara, Menostar and generic), Twice-weekly patches (Vivelle-Dot, Minivelle and generic)
  Generic: Yes · Daily tablets, or patches on a set schedule
• Progesterone
  Oral capsules (Prometrium and generics), Vaginal gel in prefilled applicators (Crinone), Vaginal inserts (Endometrin and generics)
  Generic: Yes · Once or twice a day

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• Which cause of infertility are we treating, and has my partner been assessed?
• Letrozole or clomiphene for me, and why?
• How will ovulation be confirmed each cycle?
• Can I have a prescription I can fill at any pharmacy, covering several cycles?
• If we move to injectables, which specialty pharmacies should I get quotes from?

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