Injectable Medications

Gonadotropins are the naturally occurring hormones that stimulate the gonads (ovaries in the female, testes in the male). Follicle stimulating hormone (FSH) and luteinizing hormone (LH) are the primary gonadotropins. A fertility medication such as Menopur®, Follistim®, or Gonal-f® can be used to act on the ovaries in the same way as naturally-occurring gonadotropins, stimulating follicular development and ovulation.

Indications

In most cases, gonadotropin therapy is used when treatment with clomiphene citrate has failed because these more aggressive fertility medications carry somewhat higher risks.

Administration

Gonadotropins are administered by injection. The dose will vary from woman to woman, and is determined by the doctor based on the patient’s body weight, age, hormonal evaluation results, and the doctor’s previous experience.

During treatment with gonadotropin-based fertility medication, the patient will be carefully monitored through ultrasounds and blood tests to determine the precise timing of ovulation and to ensure that no complications are arising.

Once the follicles have reached maturity, a dose of human chorionic gonadotropin (hCG) is administered. This triggers the final maturation of the eggs, followed by their release into the fallopian tubes.

Effects

While clomiphene citrate works by triggering the body to release FSH, gonadotropins simply mimic the effects of FSH in the body and directly stimulate the ovaries to develop follicles and begin the ripening of the eggs. The dose of hCG that is given at the end of the treatment cycle takes the place of the naturally occurring luteinizing hormone (LH) that causes the eggs to complete their maturation process and be released from the follicles. Because this type of fertility medication bypasses the body’s natural monitoring system, its effects, as well as its risks, are stronger than those of clomiphene citrate treatment.

Risks

The most common risk of gonadotropin therapy is multiple pregnancy. Most cases of multiple pregnancy involve twins, but three or more embryos can put the mother at risk for complications. If the doctor determines that the number of follicles being stimulated is too high and the risk of multiple pregnancy too great, the patient may choose to cancel the cycle and avoid pregnancy, undergo aspiration of some of the follicles to reduce the number of eggs that will be released, or undergo in vitro fertilization. During an IVF procedure, all of the eggs will be aspirated, then fertilized outside of the body before a controlled number are placed into the uterus.

Another risk associated with injectable medications is ovarian hyperstimulation syndrome. This condition can range from mild to severe and symptoms include nausea, diarrhea, shortness of breath, fluid retention, and weight gain. Most often seen in women who have very high estrogen levels and a large number of follicles, this condition is rare, especially in its more serious forms. However, our doctors will monitor patients undergoing gonadotropin therapy for signs of OHSS to ensure that, should it develop, it can be identified and treated quickly.