Treatment Of Prolactin & Thyroid Disorders

Some women have medical conditions that either impact their ability to ovulate or  potentially affect  how they respond to treatment during ovulation induction. Women with high levels of prolactin, a hormone secreted from the pituitary, and which is normally at low levels in non-pregnant women, may become anovulatory (do not ovulate). Lowering prolactin levels with a medication such as bromocriptine may rectify this.

Other women may have problems with their thyroid gland, which impacts their ability to ovulate. Correcting the imbalance of thyroid stimulating hormone (TSH) may restore fertility if this is determined to be causing the impairment. Many anovulatory and oligoovulatory (ovulate irregularly) women are screened for abnormal prolactin or TSH levels during their initial evaluation.

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Elevated Androgens

Some women produce high levels of androgens (male sex hormones) from their adrenal glands and ovaries. After a thorough evaluation to rule out more serious adrenal problems, these women may be given medications to lower their adrenal androgen production. The lower androgen levels may correct menstrual abnormalities for some women. Women with symptoms of excess androgen production (masculine hair growth patterns, acne, etc.) can be screened to see if they might benefit from this type of treatment.

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GnRH antagonists

Some women undergoing ovulation induction with injectable gonadotropins will have a spontaneous mid-cycle hormonal surge before developing follicles are mature. When that happens, most of the eggs will not mature normally and fertilization will not occur. These premature surges may be prevented by the use of medications called GnRH antagonists. These medications suppress the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary.These medications are typically used at the same time as gonadotropins for controlled ovarian hyperstimulation, but should not be mixed, or injected in the same spot.

GnRH antagonists can be given at any time during the early to mid-follicular phase of the treatment cycle.

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Human Chorionic Gonadotropin (HCG)

Human chorionic gonadotropin (hCG) is naturally produced by the placenta in pregnant women. It has a similar action to LH, and as such can be used to mature follicles and trigger ovulation. This is done when gonadotropins are used to stimulate ovulation.

 In anovulatory women who are being treated with FSH-containing preparations, hCG is used to induce final maturation of the oocyte and trigger ovulation by acting like the normal LH surge following ovarian stimulation.The occurrence of ovulation following hCG administration should be checked by ultrasound scanning and serum estradiol measurements. The success of hCG in inducing ovulation is dependent upon the effectiveness of the preceding follicular stimulation and the correct timing of administration.

In male infertility, some hCG preparations may be used for the treatment of prepubertal cryptorchidism (undescended testicles) not due to anatomical obstruction. Human Chorionic Gonadotropin is also used to treat secondary hypogonadism.

Side effects of this treatment in males include increased androgen production, occasional fluid and sodium retention and possible gynecomastia.

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