Gonadotropins are an important part of many fertility treatments
Human menopausal gonadotropins (hMG’s) are the hormones that your pituitary gland normally secretes to stimulate the ovulation of one egg from your ovary. These hormones are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Injectable hMG’s serve to stimulate or enhance the maturation of several eggs within the ovaries. The following are types of hMG’s that your physician may prescibe Follistim, Gonal F, Repronex and Menopur. In addition, an hCG product such as Ovidrel or Novarel to complete the maturation of the eggs and allow them to be released from the ovaries for fertilization.
How do you take fertility medications?
Patients often have concerns about the use of needles and syringes to administer fertility medications. Now there are prefilled cartridges with ready-to-use medication, so there’s no mixing or preparation. These are two of the pens that are used to give injectable medications.
How do I know if I need gonadotropins instead of Clomid?
Patients under the age of 35 often start with Clomid for 3-4 months. If no pregnancy occurs, consideration is given to moving on to gonadotropins. If a patient is over 35 she may begin treatment with gonadotropins. Both options are discussed in a consultation with your doctor.
How do I start a gonadotropin cycle?
You will need to have had a basic fertility workup, including lab, HSG and a semen analysis for your partner. You will be asked to call the office on day 1-2 of your menstrual cycle to arrange a baseline estradiol blood test and an ultrasound. These tests must occur on day 2 or 3, so if you start your period on a Saturday. Please call the office early Monday morning to schedule a same-day appointment.
The injections typically begin on day 3 of your cycle and should occur at approximately the same time every day, usually between 6 pm and 10 pm. You take injections for about 10-12 days or until you are close to ovulation. You or your partner will be administering the injections at home. One of our nurses will carefully review the injection process with you before you leave the office.
How do you monitor gonadotropins?
Your cycle will be monitored carefully with ultrasound and blood estradiol (estrogen) levels. Ultrasounds are performed with a vaginal probe, which enables us to evaluate the size and number of follicles present. Follicles are the fluid-filled sacs within the ovary that contain the eggs. Eggs are too small to see on ultrasound. However, measuring the follicle gives information about the maturity of the egg inside. Ultrasounds are usually scheduled after you have been on medication for 5 days. They may be required every 1-2 days until your follicles are mature.
Estradiol levels are monitored along with ultrasounds to help evaluate the developing follicles. Estradiol is a form of estrogen, which should increase as the follicles mature. We draw these levels in our offices between 8 am and 10 am at the Frisco, Dallas and Grapevine locations. Throughout your cycle one of our physicians will review the results of your ultrasound and estradiol levels and adjust your medication dosage accordingly. When the follicles reach a state of maturity as evidenced by your ultrasounds and estradiol results, your physician will have you take your hCG injection to trigger the release of the eggs from your ovaries. Most patients will ovulate 36-40 hours after the injection.
On days you have had an ultrasound, and/or estradiol test, you will receive a call from a nurse with medication instructions and your next appointment. We ask that you be available by phone to speak with our staff on the days you have had ultrasound or bloodwork monitoring so we can verbally confirm your medication dose and set up you follow-up appointment.
Are gonadotropin cycles sometimes canceled?
Yes. If the estradiol levels are not rising appropriately or if there is inadequate follicular development, the cycle may need to be canceled. Conversely, if the estradiol level rises too high or if there are too many follicles present, the doctor may counsel you to discontinue the cycle and not take hCG. It is always difficult for patients to be told the cycle needs to be canceled, but your safety comes first. When hyperstimulation is present and the risk of multiples is high, it is usually the best approach. Even if the cycle is canceled and no hCG is given, there is a 15% chance that spontaneous ovulation may occur. Therefore you will be advised not to have intercourse until your menstrual period begins.
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