Gonadotropins

These drugs, also known as injectables, are often prescribed along with human chorionic gonadotropin (hCG) for ovulation induction after failure on clomiphene. They may also be prescribed in conjunction with assisted reproductive technologies such as in vitro fertilization (IVF) to hyperstimulate the ovaries to produce multiple follicles. They are also used for some cases of male infertility (i.e. deficient sperm production due to pituitary problems).

This drug therapy is effective and capable of causing mild to severe adverse reactions, therefore patients must be carefully evaluated before and during gonadotropin therapy. Women will be tested for ovarian competence, and tubal and uterine pathology (this may include a laparoscopy and/or hysterosalpingography. In men, a semen analysis will be performed and any endocrine problems will be checked.

Gonadotropins used to treat infertility are derived and purified from naturally-occurring human sources, often prepared by recombinant DNA technology.

How It Works

Gonadotropins are similar in action to naturally produced follicle stimulating hormone (FSH), the hormone that stimulates the ovaries, and stimulates the growth of the follicle and the maturation of the egg.

Although gonadotropins cause the follicles to mature, they do not induce ovulation. For ovulation to occur, a second hormone called hCG (human chorionic gonadotropin) is administered in the absence of the LH surge occurring in natural ovulation. hCG acts like luteinizing hormone (LH). It completes follicular maturation, induces ovulation and releases the mature egg from the follicle.

Infrequently, women may be infertile due to a condition called hypogonadotropic hypogonadism. In this condition, they produce very low levels of the gonadotropins necessary for follicle development, including both follicle stimulating hormone (FSH) and luteinizing hormone (LH). Some injectable gonadotropin preparations (called menotropins) do contain both FSH and LH, and patients will still require administration of hCG to trigger ovulation.

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How To Take It

Because responses can vary, even cycle to cycle, your healthcare provider will determine the most effective dose for you per cycle based on your individual needs. Depending on the preparation, gonadotropins are administered as a subcutaneous (under the skin) or intramuscular injection, usually once daily. Your healthcare provider will give you full instructions on the procedures to follow.

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Side Effects

In clinical trials, more common side effects associated with this type of therapy were abdominal pain and discomfort, mild to moderate OHSS, ovarian cysts, injection site reactions, nausea, urinary tract infection, vaginitis, headache, fatigue, flu-like symptoms (such as chills, body aches and pain, fever), breast tenderness, diarrhea, feeling faint, laboured breathing, nasal congestion, sore throat, upper respiratory tract infection, dermatological symptoms (i.e. rash, itchy skin), and nervousness.

The most frequent serious adverse event requiring clinical intervention is severe ovarian hyperstimulation syndrome (OHSS) and its complications, although this is rare. Severe OHSS is characterized by ovarian enlargement, severe abdominal pain, nausea, vomiting, weight gain, decreased urination, fluid in the abdomen and/or around the lungs, difficulty breathing, and thromboembolic (blood clot) events. If severe OHSS occurs, hospitalization should occur and treatment should be stopped.

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Results

Success rates will vary with gonadotropin therapy as it can be prescribed for different purposes including ovulation induction in anovulatory women and/or the development of multiple follicles for use with ART procedures. Success rates will vary depending on your age, your diagnosis before treatment, response to treatment and the type of procedure used. You should discuss the probability of the success of treatment in your case with your physician.

Your physician should also discuss with you the risk of multiple births, which may happen more frequently with gonadotropin therapy. The majority of multiple births are twins, although most births (approximately 80%) are singletons.

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