Fertility medications are designed to stimulate more follicles to produce more eggs. These medications increase the chance of pregnancy but, at the same time, increase the risk of multiple pregnancy and Ovarian Hyperstimulation Syndrome (OHSS). Ovarian Hyperstimulation Syndrome is when a woman’s ovaries become excessively enlarged as a result of hormone therapy that stimulates the development of follicles and prompts ovulation.
These medications are commonly used in combination with the three main assisted reproductive technologies (IUI, IVF, ICSI), in conjunction with sperm washing for the male partner.
Gonadotropins are hormones secreted by the pituitary gland that regulate reproductive activities in a number of ways.
Injectable gonadotropins are the hormones used to stimulate multiple egg growth. They are produced synthetically to provide FSH and LH in various amounts and are given by subcutaneous (under the skin) injections.
Different gonadotropin preparations (fertility drugs) are used for different purposes, at different times, but overall the aim of their use is to stimulate
- Follicular development
- Oocyte maturation
Using injectable gonadotropins gives us control over the amount and duration of the FSH stimulation that reaches the developing follicles. Most gonadotropin preparations consist of pure FSH, FSH + LH, or pure LH. The dosage of gonadotropins varies depending on how the ovaries respond.
Medications may be used individually or in combination. For example, sometimes hCG is used without using FSH; sometimes women ovulate themselves and then we inseminate them, and sometimes clomiphene citrate (FSH) and hCG are used to help a woman ovulate, and then we proceed with IVF or ICSI.
We usually start using gonadotropins a few days after a woman’s period begins. For women who don’t have normal periods we usually induce menstruation with progesterone.
• Follicle Stimulating Hormone (FSH)
FSH is the hormone that helps the ovaries begin to make eggs – it stimulates the growth of egg follicles. Without an adequate amount of FSH your eggs will not mature and your body won’t receive the right signals to prompt release of mature eggs.
To improve the success rate of infertility management, we may recommend using a gonadotropin such as Gonal-f or Puregon to sustain higher levels of FSH over a longer period of time. This can be achieved by injecting FSH in the form of an injectable gonadotropin on a daily or alternate day basis.
• Human Chorionic gonadotropins (hCG)
After follicles are mature, the woman is given an injection of human chorionic gonadotropin (hCG) to trigger ovulation (egg release). (Profasi/Pregnyl)
• Lutenizing Hormone (LH)
LH is a hormone produced by the pituitary gland and causes the ovary to produce one or more eggs, to secrete the hormone progesterone, and to form the corpus luteum. Some women respond better when LH is added to the protocol.
• Gonadotropic Releasing Hormone (GnRH)
GnRH is released in intermittent pulses and regulates the release of FSH and LH from the pituitary, in order to cause egg development and eventual ovulation.
• GnRh Agonists (Lupron)
GnRH Agonists initially cause a release of FSH and LH from the pituitary gland. With continued use a GnRH agonist blocks or suppresses the action of GnRH (down regulate) to prevent a premature surge of LH that can result in premature ovulation.
• GnRH Antagonists
GnRH Antagonists prevent the release of LH and FSH from the pituitary and prevent the LH surge.
Progesterone is the body’s natural hormone produced for implantation and maintenance of a pregnancy. Progesterone suppositories are often prescribed for intrauterine insemination (IUI), in vitro fertilization (IVF) and recurrent pregnancy loss. Progesterone can be administered as an oral medication, vaginal suppository or intramuscular injection.
* For some patients we use a medication called Prometrium. This is a peanut-based preparation, so you must let us know if you have a peanut allergy and we will use a more suitable alternative.
Estrace are synthetic estrogen tablets used to thicken your endometrial lining in preparation for a frozen embryo transfer.
• Clomiphene citrate (Clomid, Serophene)
Clomiphene citrate is a follicle stimulating hormone, and a common starting point for helping the ovarian follicles to grow and mature. The medication works by blocking the effects of estrogen throughout the body, which responds by secreting more FSH. The corresponding rise in FSH stimulates growth of the follicles.
Some women will not ovulate with clomiphene citrate therapy and others will ovulate but not become pregnant. In some cases the FSH rise that can be attained with clomiphene citrate is either too low or does not last long enough to provide sufficient FSH stimulation to correct the underlying problem.
Clomiphene citrate is generally given to women between days 3-7 or 5-9 of the cycle. Progress must be closely monitored to minimize chances of side effects, such as Ovarian Hyperstimulation Syndrome.
Clomiphene citrate is also used to treat Polycystic Ovarian Syndrome.
Lupron is a GnRH agonist used to improve your egg production by ‘down-regulating’ your hormones prior to using the actual fertility medications, a process that allows us to have a better chance of recruiting healthier eggs for fertilization.
Lupron is administered as a subcutaneous (under the skin) shot using a variety of protocols. Women undergoing these protocols learn how to give themselves the medications, and are given a Lupron ‘kit’ and specific instructions. You may experience some hot flashes, headaches or joint discomfort while taking it. These symptoms are quite rare because Lupron is only used for a short time and the dosage is quite small. Some redness or irritation may occur at the injection site.
Lupron may also be used in higher doses, to treat endometriosis by lowering the amount of estrogen, which in turn helps decrease the amount of tissue that is generated in endometriosis.
Metformin (Glucophage®) is another medication for treating Polycystic Ovarian Syndrome. The combination of metformin and clomiphene citrate improves ovulation in the PCOS patient.
Bromocriptine prevents a woman’s body from producing a hormone called prolactin, which gets in the way of the bodies’ normal release of FSH.