Fertility Drugs: Cheaper On The Internet?

The headlines of many of the country’s largest newspapers rang this week echoing a call by the World Health Organization (WHO) to decry the unconscionable distribution of medications of inferior quality to the world’s poorer populations (See The Washington Post’s Op-Ed page 13 July or New York Times Science Section of the same day). While the WHO was very upset about Chinese and Indian firms making medications used in the treatment of life-threatening diseases such as tuberculosis, malaria, and bacterial infections, the sometimes overwhelming cost of some of our infertility procedures and the overall costs the medications used in any of the Assisted Reproductive Technologies (ART) cause many patients to seek solace on the internet. There are two aspects of this that concern me greatly however: the importance placed upon the presence of “all natural” ingredients and the possible quality of the individual products themselves.

Medications for the treatment of infertility abound, touting everything from increased pregnancy rates to increased intelligence in the created child. Most of them again state that they are made from “all-natural” products and the assumption is frequently made that these products are better than those created in the laboratory of a big pharmaceutical company. Here you must understand something of how the body actually works, so forgive me for getting very scientific for a minute. Every medication, whether it was scraped from a naturally growing root or created in a lab, works by first attaching itself to an appropriate receptor on the surface of the cell. Below is an example of a receptor on the cell surface, in this case the receptor for insulin. Once the receptor is filled, a wonderful cascade

of events occurs which eventually leads to the specific effect necessary within the cell. The receptors don’t know natural or synthetic; they just react when filled by an appropriate molecule. The reaction on the inside of the cell is exactly the same in either case. A similar situation would be a burglar trying to get into your house and steal your possessions. Does it matter whether they walked in an open front door or broke the kitchen window to get in? They are still going to do the very same thing once they get into the house. That makes the basic choice akin to a decision on who you are going to trust: a for-profit company with no watchdog ever evaluating their claims or their product, or a pharmaceutical company that has the Food and Drug Authority (FDA) watching their every move.

Two examples of this will underscore my point. The plant St. John’s wort has been used to treat depression for centuries. It is very commonly sold over the counter in the US as a remedy for this debilitating problem. In Germany, the equivalent of their FDA regulates and monitors all vitamin and supplement production – even if sold over the counter. When the German pharmaceutical houses are finished making their version of this medication, the by-products of its creation (what they are really trying to throw out) is commonly sold to American companies, and then eventually sold as St. John’s wort. The majority of OTC ST. John’s wort in this country comes from this waste product.

Even more disturbing is a product called Vigara©, an imitation version of the very frequently used Viagra©. While more commonly used for something very different, we at SIRM use this medication often to increase the thickness of the endometrium. Examination of this medication on a scientific basis in New England Journal found that as there was no federal agency inspecting the overall quality of some of the pills containing up to five times the stated dosage of the active ingredient. For an individual not previously evaluated for heart health, this could cause a real health risk.

The bottom line is, ordering things from uncontrolled sources can certainly be effective, for not all of the medications purchased in this manner are fraudulent, but the risks can not only be very real, but they can also interfere with what you and your doctor are trying to achieve. Please tell your physician everything you are taking and ask him/her of their opinions on specific sites and products. They should not dismiss any of this information out of hand. I keep a compendium of natural medications in my office to look these products up and find out. You will be able to discuss these possibilities with them and, at a minimum, you will be doing things in a safer manner and still be able to save.

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