This article discusses some important and commonly used drugs in reproductive medicine, concentrating on the management of subfertility. Clomiphene 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 clomiphene resistance or for super ovulation protocols necessary for in-vitro fertilization. The debate about recombinant vs highly purified urinary gonadotrophins continues. Metformin and aromatase inhibitors show promise but further evidence is needed to support their routine use. Both gonadotrophin-releasing homone agonists and antagonists are effective at preventing a premature surge of luteinizing 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.
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