INTEGRIS Bennett Fertility

Ovulation Induction with Injections

Injectable Gonadotropins (Gonal-F, Follistim, Bravelle, Menopur)

Gonadotropins are natural hormones secreted by the pituitary gland. In the natural cycle, they stimulate the ovaries to produce and mature eggs (ovulate). When given in injection form, they stimulate the ovaries to produce and mature eggs as well, and to overcome the natural response of the ovaries to produce only a single mature egg in the natural cycle. Daily injection of gonadotropins for 7-10 days is used to correct ovulation problems and produce more than one egg. Gonadotropin ovulation induction treatment cycle, also known as Controlled Ovarian Hyperstimulation (COH), requires careful monitoring of the ovaries with ultrasounds and blood hormone levels every other day. When the eggs approach maturity, a shot of HCG is given to stimulate ovulation. Either intercourse or artificial insemination (intrauterine insemination or IUI) follow the HCG “trigger” shot 24-36 hours later. Due to the cost of the medications, ultrasounds, and blood tests during a COH cycle, its cost is significantly higher than ovulation induction with oral medications.

Indications
Women with special ovulation problems due to lack of pituitary hormones (hypothalamic anovulation) are primary candidates for COH. Women who failed to ovulate or get pregnant with oral fertility medications are candidates for COH. In in vitro fertilization (IVF), injectable gonadotropin are used to create multiple eggs.

Contraindications and Side Effects
Woman with suspected pregnancy, undiagnosed cancer, or large ovarian cysts should not be treated with injectable gonadotropins. Multiple births (20% of pregnancies following COH cycles) and ovarian hyperstimulation syndrome (OHSS, 1-10% of COH cycles) are the most serious complications of this treatment. Multiple births with this treatment may also involve triplets, quadruplets, or greater, though it is very rare (1% of pregnancies after COH). Most multiple births on this treatment will be twins. OHSS is a serious condition where the ovaries have an exaggerated response to gonadotropins, resulting in many cysts and fluid accumulation in the abdomen and lungs. If untreated, this condition may be fatal. This condition, however, when handled by an experienced reproductive specialist, is preventable and treatable.