Both of these hormones act on the ovaries in a coordinated fashion to recruit and develop ovarian follicles. Today, gonadotropins are obtained either as a highly-purified product from human urinary sources hMG , or are the products of genetic engineering and biotechnology recombinant FSH. Production of these proteins involves incorporating the human FSH gene into a controlled cell-line, which then produces pure FSH identical to that produced by the human pituitary gland.
These medications are given by injection to stimulate the development of follicles if ovulation is not occurring naturally, if many eggs are needed for IVF, or if no success has been met with lesser therapies. FSH should be administered by a trained fertility specialist to minimize potential side effects.
A gonadotropin treatment cycle refers to the entire process of ovulation induction or superovulation with fertility drugs, cycle monitoring, ovulation triggering, and the determination of pregnancy with a blood test. Two common types of cycles used in conjunction with gonadotropin administration are intrauterine insemination IUI and in vitro fertilization IVF. The following text is for information only. With the onset of menses, a baseline sonogram and blood tests maybe scheduled.
These are usually performed on cycle days 2, 3, or 4, where the first day of full menstrual flow is considered cycle day 1. If the baseline tests are normal, ovarian stimulation with gonadotropins begins. The stimulation phase of the treatment cycle typically lasts seven to 14 days. These tests allow the physician to evaluate the effects of gonadotropin stimulation on the ovaries.
Different women respond to gonadotropins at different rates, and even the same woman may respond differently in multiple cycles. Therefore, the gonadotropin dosage may be increased or decreased during the cycle. Multiple pregnancies, including twin pregnancies , have increased risks both for the mother and the babies. Close monitoring of a treatment cycle can help prevent a multiple pregnancy. Many doctors will cancel if more than three follicles develop or if estradiol levels are very high.
The risk of ectopic pregnancy and miscarriage is also higher with gonadotropin-conceived pregnancies. Surgery is necessary to untwist or possibly remove the affected ovary. Your risk of pregnancy complications—like pregnancy-induced high blood pressure and placental abruption —may be also slightly increased compared to a naturally conceived pregnancy. Whether this increased risk is caused by the gonadotropins or the infertility is unclear. Because gonadotropins are injectable medications, you may also experience soreness near the injection sites.
If you suspect an infection, be sure to alert your doctor right away. Your potential for pregnancy success with gonadotropins will depend on a variety of factors, including your age and the cause of infertility. A study by The Jones Institute for Reproductive Medicine looked at 1, gonadotropin treatment cycles. Younger patients had higher live birth rates. Older studies have found higher pregnancy rates with gonadotropins than this study.
However, it's possible the higher success rate came at the expense of higher risk for OHSS and multiple pregnancy. The higher price takes into account the required blood work and ultrasound monitoring. The also price varies because different women will need different amounts of drugs.
Your insurance company may pay for part of the treatment. Or, they may pay for all of it You may need to pay your fertility clinic in full first. Then, you may need to file for a reimbursement from your insurance yourself, or the clinic may handle the insurance claims for you.
Be sure to clarify all of this with your fertility clinic before you start treatment. You don't want to be surprised by a high bill at the end.
Get diet and wellness tips to help your kids stay healthy and happy. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles. Hum Reprod Update. Homburg R, Howles CM. Low-dose FSH therapy for anovulatory infertility associated with polycystic ovary syndrome: Rational, results, reflections refinements.
Human Reproduction Update. Maternal human chorionic gonadotrophin concentrations in very early pregnancy and risk of hyperemesis gravidarum: A retrospective cohort study of pregnancies after in vitro fertilization.
American Society for Reproductive Medicine. Gonadotrophin ovulation induction and enhancement outcomes: Analysis of more than cycles. Reprod Biomed Online. Your Privacy Rights. To change or withdraw your consent choices for VerywellFamily. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page.
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How Do Gonadotropins Work? What to Expect. FSH products are divided into two categories: 1 those extracted from the urine of post-menopausal women: Repronex, Menopur and Bravelle and 2 those made using genetic recombinant technology: Gonal-F and Follistim. FSH is excreted in the urine and levels increase after menopause because of the lack of good quality eggs. These products are made by extracting and purifying the urine from postmenopausal women. These products are reconstituted from a powder and given with a syringe either intramuscularly or subcutaneously.
The gene is inserted into mammalian cell cultures which then produce FSH. These drugs are given subcutaneously using a specially designed pen. There is an ongoing debate about the need to add small quantities of LH to the FSH stimulation cycle. Many physicians use Gonal-F or Follistim alone whereas others add one of the urinary products which contain LH. Clinically there appears to be little difference between these two protocols except in certain patients like those with polycystic ovarian syndrome PCOS.
Additional LH may also be beneficial in patients who are treated with Lupron leuprolide , Ganirelix ganirelix diacetate or Cetrotide cetrorelix acetate. These drugs are used to control the length of the follicular phase and prevent the premature release of the eggs. Many infertility specialists prefer to use the urinary products because they are significantly less expensive.
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