Gonadotropins may be used in women with ovulation disorders or in women undergoing ART procedures, such as IVF. Their role during these treatments is to stimulate the ovaries to produce multiple eggs.
Follicle stimulating hormone (FSH) and luteinizing hormone (LH) are known as gonadotropins. They are the primary hormones responsible for regulating the female reproductive cycle. The pituitary gland produces and releases both hormones in the brain.
Some women have a hard time conceiving because the pituitary gland either fails to produce the appropriate amount of gonadotropins needed for ovulation, or fails to release gonadotropins at the appropriate time during the reproductive cycle. If the right amounts of gonadotropins are not released at the right time, mature follicles may not develop and ovulation may not occur.
Commercially produced Gonadotropins are derived from two sources: biological (urine-based) or manufactured (recombinant). Urine-based products have been used to enhance fertility for over thirty years. These products, often referred to as human menopausal gonadotropins (hMG), are purified medications extracted from the urine of postmenopausal women through a complex bio-technical engineering process. Recombinant products only contains FSH.
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Factors to Consider
Important factors to know when considering gonadotropin therapy include:
- Route of administration. Recombinant products are administered by subcutaneous (under the skin) injection. With the exception of one medication, urine-based products are administered by intramuscular (within a muscle) injection. Subcutaneous injections allow a woman to self-inject the medication, whereas intramuscular injections require the assistance of a health care provider or partner.
- Dose. The purity of recombinant gonadotropins may allow women to use lower doses for a shorter duration of time compared to the urine-based products.
- Variability. Both urine-based and recombinant products are carefully manufactured to assure that they do not contain harmful contaminants. However, it is difficult to extract or separate FSH and LH from urinary proteins in urine-based products. This leads to products that contain lower amounts of FSH and LH. In contrast, the manufacturing process that uses recombinant technology producers purer FSH.
- Side effects. The frequency of side effects are similar in patients receiving both recombinant and urine-based gonadotropins. The side effects include headache, breast pain and OHSS characterized by abdominal pain, pelvic pain, bloating, nausea, vomiting, and weight gain. However, because of their purity, recombinant products may be associated with fewer injection-site related side effects, such as pain, redness, itching or swelling.
- Effectiveness. Both urine-based and recombinant products have been proven to be safe and effective for women who fail to ovulate due to pituitary failure and in women undergoing ART procedures, such as IVF.
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Gonadotropin Plus Intrauterine Insemination
Gonadotropin in conjunction with intrauterine insemination cycle has a 15 to 20 percent success rate per cycle for unexplained infertility of three years duration, and a 15 percent chance of multiples (including higher order multiples). The medication, depending on the amount used in one cycle and number of ultrasounds required, usually costs $2,000 to $3,000 per cycle.
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