FDA category not assigned
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 (www.mothertobaby.org)
Drugs in Pregnancy and Lactation, 11th ed. G.G. Briggs, R.K. Freeman, C.V. Towers, A.B. Forinash
Micromedex (www.micromedexsolutions.com)
Answers to questions patients ask
1 Q1. Can I continue taking my herbal supplements while having IVF?A1. Women and their partners are encouraged to discontinue herbal supplements while undergoing assisted conception. This stems from a lack of good‐quality data on the efficacy and safety of herbal products. Furthermore, it is possible that unlicensed drugs may negatively impact upon patients’ perioperative care and treatment outcomes.
2 Q2 I take medication for a chronic illness. How will this affect my IVF cycle?A2. Women on chronic medication should undergo a risk assessment, usually performed by their general practitioner, to ascertain whether a referral to a preconception specialist clinic is warranted. Although patients will usually be able to continue their medications or switch to pregnancy‐friendly alternatives, specialist input may be required to counsel the woman about the potential effect of pregnancy on her condition, and vice versa.
3 Q3 Is it best to not take any drugs in pregnancy?A3. Whenever possible, the need to continue drugs in pregnancy should be assessed at regular intervals by all clinicians involved in a woman’s care. In addition, women with complex comorbidities (e.g. inflammatory bowel disease, asthma, renal disease, organ transplants) should be followed‐up in a tertiary referral hospital with multidisciplinary links, so that treatment can be optimized with minimal disruption to fetal development and growth.
References
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