Gonadotropins

If you have tried taking Clomid unsuccessfully, your doctor may suggest moving you to the next phase of fertility medications - gonadotropins. While clomiphene stimulates the pituitary gland, most gonadotropins aim to directly affect the ovaries and stimulate the development of eggs. You may also be prescribed gonadotropins if you have polycystic ovarian syndrome, luteal phase defects or an unexplained fertility problem. Gonadotropins can also help you produce several mature eggs if you are undergoing an assisted reproductive technology (ART) procedure.

While it is more common for women to be prescribed gonadotropins, such medications can also be prescribed to men who with hormonal imbalances, abnormally low sperm counts or poor sperm motility.

There are several different medications categorized as gonadotropins.

• Follicle Stimulating Hormone (FSH) - FSH affects the production of egg follicles. If you are undergoing an ART procedure or if you have ovulation problems, you will receive injections of FSH to help stimulate your ovaries to produce several mature eggs.
• Human Menopausal Gonadotropin (hMG) - This hormone is made up of FSH and luteinizing hormone (LH) and is derived from the purified urine of menopausal women. Like FSH, it is used to stimulate your ovaries and help mature eggs develop.
• Human Chorionic Gonadotropin (hCG) - This drug has two purposes in the treatment of infertility: When used with hMG and FSH, hCG stimulates the follicle to release a mature egg, and it strengthens the uterine lining, improving the likelihood of implantation. It is derived from the purified urine of pregnant women and administered by injection.
• Gonadotropin-Releasing Hormone (Gn-RH) - Gn-RH works to normalize your reproductive system in order to regulate ovulation by stimulating the pituitary gland to secrete FSH and LH. It can be administered by injection or in a nasal spray given twice a day.

Whatever gonadotropin medication you take, you will start receiving injections approximately three days into your cycle and continue them for seven to 12 days, depending on how long it takes your eggs to mature. Once they have matured, you will either schedule your ART procedure for a few days later, or you and your partner will be instructed to go home and have intercourse.

If you have not gotten pregnant after undergoing three cycles of gonadotropins, your doctor may suggest increasing the dose. However, you may only use these medications for a maximum of six cycles. If you do not get pregnant within that time, you might want to consider changing treatments.

Common side effects from the use of gonadotropins include bloating, fluid retention, weight gain and abdominal tenderness. Fortunately, newer medications, such as Gonal F and Follistim, cause fewer of these side effects. You may also find it difficult to administer your own injections, but recent advances have made self-administration easier by using smaller needles.

Some women who take fertility drugs develop a condition called ovarian hyperstimulation syndrome (OHSS), which occurs when the body responds too well to the medication and produces too many eggs. Weight gain and an intense bloated feeling accompany this condition as a result of the ovaries swelling and leaking fluid into the abdominal cavity. In most cases, OHSS will resolve itself with careful monitoring by a doctor. In rare cases, the condition can be life-threatening.

The total cost of one cycle of gonadotropins is typically between $2,000 and $5,000.