Medications: Gonadotropins

The term gonadotropin refers to compounds that directly stimulate the ovaries. These medications are generally combinations of follicle stimulating hormone (FSH) and luteinizing hormone (LH) or pure FSH.

Since these are the hormones the pituitary uses to stimulate follicular growth, the ovarian response is often very dramatic. The hypothalamus and pituitary are unable to "shut off" this stimulation so these injections act as a constant stimulant to the follicles.

There is significant concern for ovarian hyperstimulation using gonadotropins. These medications should be used only as directed by your physician.

Unfortunately, not everyone will have an adequate response to their dose of gonadotropins. When starting your first cycle, the dose is estimated taking into account several factors (age, ovulatory status, polycystic ovaries).

Your dose will be adjusted based on your response to these medications. In some women with advancing age or premature failure of the ovaries, there is a possibility of these medications not being able to stimulate any significant response.

Regular evaluation of serum estradiol is performed to monitor response and to help avoid ovarian hyperstimulation. These values will be reviewed on the day the test is done. Your dose may be increased or decreased depending on this lab value. This brings home the importance of verifying that we have your correct contact information so we can reach you if any adjustments are necessary.

Gonadotropins may be used in conjunction with Lupron. The Lupron acts to prevent a spontaneous signal from the pituitary that triggers ovulation (LH surge).

Ovulation is almost always triggered by human chorionic gonadotropin (HCG). HCG mimics the LH surge and thereby induces ovulation. The advantage of using HCG is to coordinate insemination or retrieval in a more timely fashion.

Currently, we do not have a preference for which gonadotropins you use except in select medical conditions. Patients with hypothalamic amenorrhea should use a compound containing LH (Humegon, Pergonal, Repronex). There are many other factors that may influence your decision:

• Repronex and Humegon are generally less expensive.
  • Some medications claim to stimulate follicle more rapidly and therefore use less medication.
  • Prices fluctuate often so, look into several sources for your medications.
  • Be sure there are not specific restrictions imposed by your insurance carrier.
• Subcutaneous (SQ) injections are often easier to administer if you are giving your own injections.
  • As the number of ampules you use increases, the SQ injections may become more uncomfortable.
• Vials are a little easier to mix than ampules.
  • Vials are bottles with rubber stoppers on top.
  • Ampules are glass containers.

The following table compares the commonly available gonadotropins.