Injectable fertility medications include hormones, FSH, follicle stimulating hormone and LH, lutenizing hormone
Follicle Stimulating Hormone (FSH)
When FSH and LH are produced in improper amounts by the pituitary gland, abnormalities of ovulation may occur. Gonal-F, Follistim, Bravelle and Menopur all contain FSH and function by stimulating the ovaries to develop eggs. FSH stimulation is also of great benefit in patients who lack normal pituitary function and thus require assistance to achieve ovulation. FSH has also been used to treat normally ovulating women who have not become pregnant by conventional means (as an empiric therapy) along with intrauterine insemination (IUI). In this circumstance, FSH stimulation is combined with IUI in an attempt to increase the number of eggs ovulated and, as a result, increase the likelihood of pregnancy. FSH is also used to produce Controlled Ovarian Hyperstimulation which results in producing more follicles for In Vitro Fertilization.
Success Rates with Injectable Fertility Medications
The success rate with FSH will depend upon the reason for using it. If FSH is used strictly for patients who are not ovulating, but have no other infertility factors, then success rates approach 60-70% after 3-6 IUI cycles.
If FSH/IUI is used in patients as empirical therapy to increase the likelihood of pregnancy, then success rates are approximately 30% after 3-4 cycles. That is, one in three women completing 3-4 cycles of “empiric” FSH/IUI therapy will achieve pregnancy.
Administration and Monitoring of Fertility Medication
FSH is a medication that must be given by subcutaneous injection (Bravelle, Follistim, Gonal-F and Menopur). It cannot be taken orally because it is a protein and would be digested in the stomach. At your FSH class or IVF class, your partner, or the person who will give your injections, will be taught how to administer the injections. Detailed injection instructions are available online.
Because FSH is such a potent stimulator of the ovary, close monitoring will be required during your FSH stimulation, whether you are doing IUI or IVF. Monitoring will be done in the morning so that laboratory results can be ready by the same afternoon. Monitoring will consist of two tests to assess how the FSH stimulation is progressing. These two tests are a vaginal ultrasound and a blood test to measure the serum estradiol level. Since FSH works to cause follicles to develop in the ovaries, a vaginal ultrasound will be used to follow follicular growth. Follicles of 17-20 mm size are optimal. Also, since mature follicles produce estradiol, blood samples for estradiol will be performed to assess the follicular growth.
You will schedule an appointment in our office between 8:00 and 10:30 a.m. on the days of monitoring, and you will have an ultrasound and estradiol on each monitoring day. Laboratory results do not usually return until 2:00 p.m. After laboratory results are ready, they will be reviewed by Drs. Hill, Weitzman, Eblen, Van Heertum, or Smith. to determine how much FSH you will need to take and when monitoring is needed again. Prior to your cycle you will be assigned a voice mailbox and you will be instructed on its use. On each day that you have monitoring you will need to check this mailbox between 2:00 p.m. and 3:30 p.m. to find out your results and treatment plan. We ask that you check this voice mail by 3:30 p.m. as our office closes at 4:30 and it is important that any questions be resolved prior to closing. Any calls to the physicians after regular office hours which are not emergencies will result in an additional $25.00 charge per phone call.
Ovarian Stimulation Process
You will need to begin your FSH injections within 3-5 days following your menstrual period; therefore, call the day of your menstrual period to notify our office that you are ready to start FSH. If your menstrual period starts on Saturday or Sunday, call first thing Monday morning after 8:30.
The day that you will start FSH, and the dosage that is required will be decided by your doctor. Never take more or less FSH than is prescribed. Usually, you will take FSH injections for 3-4 days before you will be monitored for the first time. No specific preparation is necessary prior to presenting for monitoring. You may eat normally, and you do not need a full bladder. On the day you report for monitoring, you will not know the evening dose of FSH until 2:30 p.m. when your laboratory values are known and have been discussed. You will then phone in to find out how much FSH to take and when your next monitoring is scheduled.
When monitoring reveals that sufficient follicular growth has been achieved, human chorionic gonadotropin (hCG) will be administered to cause ovulation. hCG, like FSH, must be given by injection, and is not active orally. You will receive the supply of hCG, and instructions for use on your first day of monitoring. 24-48 hours after hCG, you will have IUI performed. IUI will need to be scheduled by you for a time convenient for you and your partner. IUI is described in greater detail here. After your IUI, you will receive supplemental progesterone or two supplemental hCG injections. You will receive these instructions at your IUI. These medications are given because they help to support the luteal phase (last one-half) of your cycle, which is very important in early pregnancy.
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