IUI and Gonadotropins
Whether or not to use fertility medications in combination with IUI is a question your doctor will help you answer. The answer depends both on the specific infertility diagnosis and on a woman's age. The theory behind using fertility drugs with IUI is to ensure that an egg or eggs will be available to meet the sperm that is artificially inseminated - that is, the sperm that is placed directly into the uterus during IUI.
Fertility medications accomplish exactly this purpose. They induce ovulation, the production of eggs, and allow for specific timing of ovulation so that it coincides with exposure to sperm. There are two types of fertility drugs commonly used in conjunction with IUI: Clomid (Clomiphene Citrate) and a class of drugs called gonadotropins.
What Are Gonadotropins?
Gonadotropins are injected fertility medications that contain either Luteinizing Hormone (LH) or Follicle Stimulating Hormone (FSH) or a combination of the two. Fertility doctors use these medications in combination with IUI to mimic the actions of these normally occurring hormones in a woman's body and to thus stimulate the ovaries to produce egg follicles for fertilization.
In fertile women, LH and FSH are hormones released each month during the menstrual cycle. These two hormones are responsible for stimulating the growth of an egg follicle. Elevated blood levels of FSH indicate that the ovary is maturing. Upon the maturation of an egg, LH levels surge, triggering ovulation. In fact, ovulation kits, which are a popular tool used by women and fertility clinics to indicate when a woman is ovulating, look for this LH surge as a predictor of ovulation.
Gonadotropins are a class of self-injected fertility medications. Some of the individual gonadotropins include Gonal-f, Follistim, Bravelle, Luveris, and Menopur.
In addition, as part of the IUI procedure, a related fertility drug called hCG is often injected just prior to ovulation in order to boost the LH surge and to ensure ovulation. This hCG injection has appropriately been coined the "trigger shot."
One key deciding factor for whether a fertility specialist will prescribe oral Clomid in combination with IUI as opposed to injected gonadotropins is a woman's age. Gonadotropins are considered a more aggressive treatment, and are more likely to be recommended to younger women who have no known ovulation problems. On the other hand, proceeding directly to gonadotropin treatment might be advised for infertile women over the age of 35.
Gonadotropins and Super-Ovulation
The term "super-ovulation" is another way to describe the action of Gonadotropins during the IUI process. Normally, a women's body produces only egg follicle each month. With the injection of gonadotropin fertility drugs, several egg follicles may be produced, giving rise to the concept of a woman being "super-ovulated." In all of these cases, there is strong evidence to indicate that super-ovulation with gonadotropins combined with IUI significantly improves the chances for conception over IUI alone.
In comparison with Clomid, gonadotropin use carries a greater risk for multiple pregnancies and for a condition known as ovarian hyperstimulation syndrome (OHSS). Furthermore, the cost per cycle of injected gonadotropins is much higher than the cost of orally taken Clomid. For this reason gonadotropins are often used as a second resort once oral fertility drugs do not succeed in achieving pregnancy.