Injectable & Other Fertility Medications

Follicle Stimulating Hormone (FSH) & Human Menopausal Gonadotropin (hMG)

Brand names: Gonal-F®, Follistim®, Bravelle®

Action: When given to premenopausal women, these medications stimulate the ovaries to form follicles that mature and produce eggs.

Form: Subcutaneous injection, using multi-dose vials or pre-loaded injection "pens"

Dosage & Use: A typical regimen usually involves seven to 12 days of injections during which the patient's cycle is monitored with blood tests and with pelvic sonograms (ultrasounds). When the estradiol levels and ultrasounds indicate that ovulation is imminent, an injection of human chorionic gonadotropin (HCG) is given (see below).

Risks, Side Effects:
Fertility drug use can cause ovarian hyperstimulation, multiple pregnancies (twins, triplets, etc.), and possible premature delivery or pregnancy loss including ectopics. The patient may have local soreness or redness at the injection sites.

Hyperstimulation causes a temporary enlargement and swelling of the ovaries. Symptoms can include low abdominal pain, pressure, weight gain, and swelling, and usually begin five to eight days after ovulation is induced. The symptoms usually disappear after menstruation if the patient avoids physical activities and sexual intercourse. Rarely, a patient may need to be hospitalized for observation and fluid hydration. Treatment consists of bed rest and pain medication in extreme situations, fluid may have to be drained from the abdomen. The risk of hyperstimulation is minimal when the patient is carefully monitored.

About 20 to 40 percent of patients have multiple pregnancies. Most of these are twins (75 percent), but triplets or higher multiples account for 25 percent. Most pregnancies (60 to 80 percent) are singletons. Multiple pregnancies usually involve premature delivery.
Some studies have suggested a slight increase in ovarian cancer in women who have taken fertility medication, but these studies have been disputed. Newer studies suggest that women who are never able to conceive, regardless of whether or not they take fertility drugs, may be at greater risk for ovarian cancer.

Human Chorionic Gonadotropin (HCG)

Brand names: Profasi®, Ovudrel®, Pregnyl®

Action: A hormone that matures the developing follicles and triggers release of an egg from its follicle. In men, HCG may be used to enhance sperm production.

Form: intramuscular (IM) injection or subcutaneous (SQ) injection

Dosage & Use: Following the administration of a cycle of ovulation-inducing medication (such as FSH), HCG is needed to provide the surge of luteinizing hormone (LH) to the release of the egg(s). Ovulation will occur 36 to 41 hours after the injection of hCG. Intercourse, insemination, or egg retrieval (for in vitro fertilization) is timed appropriately.

Gonadotropin Releasing Hormone (GnRH) Antagonists

Brand names: Antagon®, Cetrotide®

Action: Used during a treatment cycle in conjunction with fertility medications, to control the timing of ovulation. Particularly useful in patients with diminished ovarian reserve as evidenced by borderline FSH levels, advanced age, and prior poor stimulations.

Form: Subcutaneous injection

Dosage & Use: Usually begun after five or six days of stimulation with fertility medications, typically when the lead follicle is 14mm in diameter on ultrasound.

Risks, Side Effects:
Some of the initial studies with the GnRH antagonist found pregnancy rates that were slightly lower than IVF cycles with agonists. However, more recent data suggest that pregnancy rates are as good, and in some situations better than with GnRH agonists with the use of these agents.

Leuprolide Acetate

Brand name: (Lupron®)

Action: Acts on the brain to initially stimulate and then to suppress the body's own hormone production, thus preventing follicle development and egg release. Doctors use it in combination with other medications to improve timing of treatment cycle.

Form: Subcutaneous injection

Dosage & Use: Usually begun before administration of ovulation-inducing medications.

Risks, Side Effects: GnRH agonists can overly suppress some patient's ovaries when they are begun in the midluteal phase.

Progesterone

Brand name:

Action: A hormone that helps prepare the endometrium, the lining of the uterus, for the arrival and implantation of an embryo.

Form: Intramuscular (IM) injection or by vaginal suppository, capsule, gel and certain formulations can be taken by mouth.

Risks, Side Effects:
Side effects may include:

• Changes in sexual desire or ability
• Changes in vaginal bleeding
• Facial hair growth
• Fluid retention and swelling
• Headache
• Increased sweating or hot flashes
• Loss of appetite or increase in appetite
• Mood changes, anxiety, depression, frustration, anger, or emotional outbursts
• Nausea, vomiting
• Skin rash
• Stomach discomfort
• Weight gain or weight loss
• Vaginal yeast infection (irritation and white discharge)
• Breast tenderness or discharge
• Numbness or pain in the arm or leg
• Pain in the chest, groin or leg
• Severe headache
• Stomach pain
• Sudden shortness of breath
• Unusual weakness or tiredness
• Vsion or speech problems
• Yellowing of skin or eyes