Women who fail to respond to clomiphene are often moved on to the next phase of fertility medications – gonadotropins. Unlike clomiphene, which looks to stimulate the pituitary gland, gonadotropins attempt to directly affect the ovaries and stimulate follicle development. While it is more common for women to be prescribed gonadotropins, men are also sometimes prescribed the medications. Men with hormonal imbalances often respond well to the treatment and it is common to use gonadotropins to help men with unexplained, abnormally low sperm counts or those with less than 40% sperm motility.
What You May Take
There are a variety of different treatment medications that fall under the category of gonadotropins.
- Follicle Stimulating Hormone (FSH): This hormone directly affects the production and maturation of egg follicles. Women with ovulation problems or those undergoing assisted reproductive technology (ART) will receive FSH injections to help stimulate the ovaries to produce mature eggs. FSH treatment is administered through injections starting on day 2, 3 or 4 of a woman’s cycle and is continued for five days. The minimum dosage is 75IU per day and may be adjusted during your cycle for improved results.
- Human Menopausal Gonadotropin (hMG): Like FSH treatment, hMG is used to directly stimulate the ovaries, thereby helping follicle development. It is also used on women undergoing ART. The name stems from the fact that the drug is derived from the purified urine of menopausal women. However, it is made up of FSH and lutenizing hormone (LH). This injectable fertility medication comes in units of 75IU of hMG or 150IU of FSH and LH. Women receive injections once or twice a day and the dosage will vary according to the patient’s needs.
- Human Chorionic Gonadotropin (hCG): Derived from the purified urine of pregnant women, this drug may be used for two purposes. When used with hMG and FSH, hCG stimulates the follicle to release a mature egg. HCG is also used to sustain the corpus luteum in order to improve the uterine lining, thereby aiding the implantation process. The medication is administered by injection. The dosage varies from woman to woman depending on the desired outcome of the treatment.
- Gonadotropin-Releasing Hormone (Gn-RH): This form of treatment looks to normalize the reproductive system in order to avoid premature or complete lack of ovulation. Unlike the other gonadotropin medications, this drug stimulates the pituitary gland, thereby causing the secretion of FSH and LH. Gn-RH may be administered by a daily injection or possibly in a nasal spray form given twice a day. Dosage of the medication varies according to the desired outcome of the treatment.
Between 20% and 60% of women using gonadotropins will conceive. Of these women, it is estimated that 70% to 85% will have a live birth. Most pregnancies occur within the first three cycles of treatment. However, if no pregnancy occurs within that time, you may want to consider changing treatments. If you choose to stay on gonadotropins, be aware that you can only use these medications for six cycles.
Because these drugs stimulate the development of egg follicles, your chances of having a multiple pregnancy increase from anywhere between 10% and 40%. While a multiple pregnancy can be a wonderful thing, it is important to note that there are more risks associated with this type of pregnancy.
Common side effects of this treatment include bloating and fluid retention, weight gain and possibly a tender stomach. Some women also find it difficult to self-administer the injections. However, newer versions of these drugs have been developed to help minimize the associated side effects and to make administering the treatment easier.