Introduction: Induction of ovulation with gonadotropins requires advanced training of the physician and a great deal of patient and physician commitment. All of RMA's physicians are highly qualified to provide this treatment. Our offices are open 7-days a week to provide the access necessary for optimal treatment. These therapies are not without risk and should be used only as directed and with close monitoring and follow-up.
The Drugs: Each of these drugs is a protein hormone. Gonal F and Follistim Pen are made by recombinant DNA technology, while Menopur and Bravelle are isolated from the urine of menopausal women and freeze-dried into a powder. All of them have been specially processed to ensure maximum safety and potency. Because they are in powder form, they must be reconstituted with sterile water or saline before injection. The hormones that these drugs provide are Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which are hormones that your pituitary gland normally produces. Although FSH is the hormone primarily responsible for follicular development, both FSH and LH play a role in the normal development and ovulation of ovarian follicles. LH is normally responsible for triggering ovulation when a mature follicle is present. Each of these drugs acts directly on the ovaries and do not have activities elsewhere in the body.
Gonal F / Follistim Pen: (75 IU FSH, no LH) are pure FSH made by recombinant DNA technology and are given subcutaneously. Gonal F is made by Serono Inc. and comes in ampules (75 IU) and multi-dose (1200 IU) vials and pens. Follistim is made by Organon, Inc. and comes in vials and pens (75 IU).
Menopur: (75 IU FSH, < 0.1 IU LH): is almost pure FSH and is given subcutaneously. Menopur is a more purified form of Bravelle and is made by Ferring, Inc.
Bravelle: (75IU FSH, 1.0 IU LH) highly purified FSH and is given subcutaneously. Is similar (but more highly purified to the old drug Metrodin. Bravelle is made by Ferring, Inc.
HCG (Human chorionic gonadotropin, the "pregnancy hormone"): Its actions are identical to LH, but it lasts longer. It is used to simulate the normal mid-cycle LH surge, which causes the final maturation of the egg and ovulation. It is used because the FSH-containing drugs have altered the normal feedback mechanisms and the LH surge may not occur on its own. Pregnyl and Novarelare isolated from the urine of pregnant women and given intramuscularly. Pregnyl is made by Organon, Inc. and Novarel is made by Ferring. Ovridel is HCG that is made by recombinant DNA technology by Serono and is given subcutaneously.
Indications for Treatment: In women who do not ovulate on their own, these drugs induce ovulation, thus the term Ovulation Induction. In women who do ovulate on their own, these drugs are used to produce more follicles from the ovaries in a controlled fashion, thus the expression Controlled Ovarian Hyperstimulation (COH). Gonadotropins are a first line drug for anovulatory women with normal to low FSH and LH levels. They are a second line drug for women who fail to ovulate or conceive after optimal clomiphene citrate (and/or metformin) therapy. They may also be a first or second line drug for ovulatory women with unexplained infertility and endometriosis. In most women, any of the six FSH-containing gonadotropins may be appropriate to use. However, in certain situations, one drug may be more advantageous to you. The choice of medicines will be discussed at your counseling session prior to initiating therapy.
Multiple Pregnancies - Multiple pregnancies are more common with gonadotropins than with clomiphene citrate (Clomid, Serophene). The risk is directly proportional to the number of mature follicles. Overall, multiple pregnancies represent 15-20 % of the gonadotropin induced pregnancies with 2-5 % of all pregnancies being high order multiple pregnancies (e.g. Triplets or more)
Ovarian Hyperstimulation Syndrome (OHSS) is a sudden enlargement of the ovaries and accumulation of fluid in the abdomen. It can be a rapidly progressive medical emergency, which may require hospitalization and even intensive care services in its worst form. The cause is unknown, but it is associated with high estrogen levels. Many of the women who develop it are pregnant. The monitoring is designed to attempt prevent OHSS from occurring. Still, it happens in milder forms in 5-10% of gonadotropin cycles. Severe forms are less common. Early symptoms may include weight gain (over 5 pounds), bloating, nausea vomiting, diarrhea and shortness of breath. If you think you have these symptoms, please notify us immediately.
Cancellation of the Cycle - Canceling the cycle (not giving the hCG or doing the IUI) can prevent OHSS and multiple pregnancies. At times, this may be the safest way to proceed. Cycles may also be canceled for inadequate response.
This is listed to provide you with an overall perspective regarding the general effectiveness of this therapy. The results that you obtain are dependant upon many factors including the woman's age, quality of sperm and quality of pelvic anatomy, as well as other diagnoses that may be present.
|Indication for Ovulation Induction or COH||% Ovulating (per cycle)||% Pregnant (per cycle)||Total % Pregnant after 3 cycles|
|Anovulation (e.g. PCOS)||75 - 90%||14 - 17%||37 - 42%|
|Unexplained infertility / Endometriosis (no IUI)||100%||8.7%||23.8%|
|Unexplained Infertility / Endometriosis (with IUI)||100%||17 - 25%||42 - 56%|