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Gonadotropins (Gonal F, Follistim, Repronex, Bravelle and Menopur) are medications similar to hormones produced by the pituitary gland (FSH and LH) that are used to simulate oocyte (egg) development. They are administered by injection (usually subcutaneous). These injections are usually started on day 3 of the menstrual cycle and are continued for several days until developing oocytes are judged to be mature. Daily dosages and length of time needed for adequate stimulation varies from patient to patient and from cycle to cycle, but most patients will require these injections for about 7-10 days. Gonadotropins are used in women who do not ovulate with clomiphene citrate or when development of multiple follicles is appropriate. All patients using gonadotropins receive an injection of hCG when monitoring reveals follicular size and estrogen levels to be appropriate.

These medications are excreted from the body and will leave no long lasting effects on the menstrual cycle. Subsequent cycles should return to their usual pattern prior to medication administration. Alcohol and tobacco should be avoided during a stimulation cycle. You should inform the nurse of any medications (prescription or over the counter) or herbal remedy supplements you are taking. Normal activities and sexual relations may be continued during the period of ovarian stimulation.

Risks of ovulation induction include hyperstimulation syndrome and multiple pregnancy. Hyperstimulation of the ovary is uncommon since estradiol levels and ovarian sonograms are used to closely monitor the stimulation cycle. Hyperstimulation of the ovaries is more likely to occur when there are a large number of follicles and the estrogen (E2) level is very high. If too many follicles develop or the blood estrogen levels are too high, the gonadotropin cycle will be cancelled to reduce the risk of hyperstimulation or high order multiple pregnancy. Symptoms of hyperstimulation include sudden weight gain (3-5 pounds or more), excessive abdominal bloating, and/or pain. If you experience any of those symptoms, or have other concerns, call the office you are seen at and ask to speak to one of the nurses. Multiple births occur in 25%-30% of patients using gonadotropins. Twins occur in about 20-25%, and triplets or more in around 5% of conceptions using gonadotropin therapy.

Progesterone is a hormone that helps to ready the uterine environment for implantation or the early embryo. Progesterone can be administered intravaginal, oral or intramuscular route. Vaginal or oral capsules (100mg or 200mg) are taken 2 or 3 times daily; vaginal suppositories (25, 50 or 100mg) are inserted twice daily. The IM injection is 50 mg/cc. This injection is in a peanut oil base so please advise the nurses if you are allergic to nuts. The injection is given once daily, usually in the late afternoon. Side effects of progesterone may mimic premenstrual symptoms and include abdominal bloating, full breasts, and fatigue. The vaginal medications occasionally cause vaginal irritation.

Human chorionic gonadotropin (hCG) is required to ripen the follicles and make ovulation occur. The hCG is available in two forms. In the first form, hCG is packaged as 10,000 international units of drug as a dry powder. This needs to be dissolved in the diluent provided before the injection can be prepared. Only 2 cc of fluid is used for dilution. The medication is given between 8:00pm – 10:00pm. In the second formulation, hCG is available in premixed syringes for subcutaneous administration.