Ovulation Induction - Gonadotropins

Follistim, Gonal-F, Bravelle, Repronex, Menopur - These compounds are human hormones produced by the pituitary gland (LH and FSH) and are used to stimulate ovarian follicular development. They can be urinary, meaning they are extracted from the urine of postmenopausal women; or recombinant, meaning they are produced by bacteria that are genetically altered to produce LH and FSH specifically.

These drugs can't be ingested orally, and are therefore administered by injection. Hormone injections are administered subcutaneously in most cases. Occasionally, intramuscular administration is necessary.

Injections usually begin on day 3 of the menstrual cycle and continue for several days until the developing follicles are approximately 16-20 millimeters in diameter. Daily dosage, and the length of time needed for adequate stimulation, varies from patient to patient, and from cycle to cycle. Most patients will receive injections for 7-8 days.

During the stimulation with these gonadotropins patients are monitored closely with ultrasounds and estradiol levels.

These compounds are used in women who do not ovulate, or did not respond to clomiphene citrate(CC), or to produce multiple follicles for insemination or an ART procedure such as in vitro fertilization.

An injection of hCG is given to cause ovulation when ultrasound and estrogen measurements indicate appropriate follicular development. All of these compounds are excreted from the body and will leave no long lasting effects on the menstrual cycle. Remember these hormones are naturally produced by the pituitary gland, they are chemically the same, they are not synthetic (man-made) like CC. Dosages are adjusted based upon a myriad of factors, including but not limited to the patient's response to treatment, age, appearance of her ovaries, and her medical diagnosis.

Potential other side effects can include: ovarian cysts, nausea, vomiting, diarrhea, abdominal cramps, bloating, weight gain (usually mild), irritation at the injection site, and multiple births.

Multiple births occur about 20 to 25% of the time.

Failure to adequately monitor and adjust dosage can lead to a very serious condition, ovarian hyperstimulation syndrome (OHSS). This syndrome is characterized by ovarian enlargement, followed by abdominal pain, abdominal distention, weight gain, circulatory problems, sometimes requiring hospitalization. OHSS can be very serious. Therefore once a patient start on a regimen of gonadotropins it is very important that they follow the physician and nurse coordinator's instructions.