None known
|
|
Dexamethasone
|
Various
|
Off‐label: ovulation induction in clomid‐resistant PCOS; recurrent implantation failure
|
Category C BNF: increased risk of oral clefts
|
CYP3A inducers (e.g. carbamazepine, rifampicin) and inhibitors (e.g. clarithromycin)
|
|
Dehydroepiandrosterone (DHEA)
|
Testosterone precursor
|
Off‐label: prior to IVF in women with low ovarian reserve
|
FDA category not assigned BNF: animal data suggest risk, e.g. virilization of female fetuses
|
Bromocriptine Carbamazepine Dexamethasone Insulin Phenytoin
|
|
Dopamine agonists (e.g. Bromocriptine, Cabergoline)
|
D2 receptor agonists
|
FDA: hyperprolactinemic disorders Off‐label: infertility of pituitary origin; adjunct in the treatment of OHSS
|
Category B BNF: Bromocriptine: compatible with pregnancy Cabergoline: human data suggest low risk
|
Dopamine antagonists Antihypertensive drugs
|
|
Gonadotropins
|
Human gonadotropin analogues
|
FDA: ovarian stimulation and ovulation induction
|
Category X
|
None known
|
|
GnRH agonists
|
GnRH receptor agonists, desensitization with prolonged exposure
|
FDA: prevention of premature LH surge in women undergoing COS Off‐label: ovulation trigger in high responders
|
Category X
|
None known
|
|
GnRH antagonists
|
GnRH receptor blockers
|
FDA: prevention of premature LH surge in women undergoing COS Off‐label: treatment of OHSS
|
Category X
|
None known
|
|
hCG
|
LH analogue
|
FDA: ovulation induction in anovulatory women; follicular maturation in COS Off‐label: luteal phase support in IVF
|
Category X—intrauterine death
|
None known
|
|
hGH
|
IGF‐1 production
|
Off‐label: adjuvant therapy in low responders in IVF
|
Category B
|
None known
|
|
Intralipid infusions
|
Unclear—possible immune modulator
|
Off‐label: recurrent implantation failure / pregnancy loss
|
Category C BNF: compatible with pregnancy
|
Oxine
|
|
Intravenous immunoglobulin (IVIg)
|
Immune modulator
|
Off‐label: recurrent implantation failure / pregnancy loss
|
Category C BNF: compatible with pregnancy; no known embryo‐fetal risk
|
None known
|
|
Metformin
|
Various ‐ euglycemic
|
Off‐label: improvement of menstrual cycle regularity or hyperandrogenism in women with PCOS
|
Category B BNF: human data suggest low risk
|
Furosemide increases metformin concentration Nifedipine increases the absorption of metformin
|
|
Prednisolone
|
Various
|
Off‐label: treatment of APS
|
Category D BNF: increased risk of orofacial clefts
|
Anticoagulants CYP3A4 inducers and inhibitors NSAIDs
|
|
Progesterone
|
Sex steroid hormone
|
FDA: luteal phase support in ART
|
FDA category not assigned
|
None known
|
|
Sildenafil
|
Phosphodiesterase 5 inhibitor
|
Off‐label: female infertility with endometrial factor; increase endometrial thickness
|
Category B BNF: limited human data—animal data suggest low risk
|
Alpha blockers Anti‐hypertensives Nitrates CYP3A4 inhibitors (increase the concentration of sildenafil)
|
|
Tamoxifen
|
Selective estrogen receptor modulator
|
Off‐label: alternative to clomiphene in PCOS / women with thin endometrium in response to clomiphene
|
Category D BNF: contraindicated (fetal growth restriction, miscarriage and preterm birth)
|
Erythromycin Letrozole Nifedipine Rifampicin
|
ACE, angiotensin‐converting enzyme; APS, antiphospholipid syndrome; ART, assisted reproductive treatment; BNF, British National Formulary; COS, controlled ovarian stimulation; COX, cyclooxygenase; CYP, cytochrome P; FDA, Food and Drug Administration; GnRH, gonadotropin‐releasing hormone; hCG, human chorionic gonadotropin; hGH, human growth hormone; IGF, insulin‐like growth factor; IVF, in vitro; fertilization; LH, luteinizing hormone; NSAID, nonsteroidal anti‐inflammatory drug; OHSS, ovarian hyperstimulation syndrome; PCOS, polycystic ovary syndrome.
Key points
Challenge: Conventional and herbal drugs in patients undergoing ART.
Background:
Patients undergoing ART and pregnant women commonly take prescribed and/or over‐the‐counter medicinal products.
Drugs, whether medical or herbal, may have harmful effects on a pregnancy, ranging from miscarriage to developmental anomalies and fetal growth restriction.
Management:
Regularly reassess the need for medication in women trying to conceive or who become pregnant, and where possible consider nonpharmacological interventions.
Avoid drugs in the first trimester if possible.
Prescribe if the expected benefit outweighs the risks.
Prescribe drugs that have long been used in pregnancy with a good safety record over new or untested drugs.
Use the smallest effective dose for the shortest period of necessity.
Consult a pharmacist or teratology information service when in doubt about a drug’s most up‐to‐date safety profile in pregnancy.
Always involve women in decisions made about pharmacological interventions in pregnancy.
Additional information:
BNF (www.medicinescomplete.com)
UK Teratology Information Service (www.uktis.org)
TOXBASE (www.toxbase.org)
MotherToBaby
