Fertility Drugs: A Quick Overview of Gonadtropins


The term gonad describes an organ that produces sex cells (or gametes) such as sperm or egg. Thus, a woman’s ovaries and a man’s testes are both called gonads. Gonadotropins are hormones secreted by your pituitary gland that stimulate the growth and activity of your gonads. Therefore, these hormones play a part in egg and sperm production, as well as the development of physical traits like your voice, muscle, hair and breasts.
Your body naturally produces two kinds of gonadotropins: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones are necessary for ovulation – the production of eggs. A woman may naturally have low hormone levels and be unable to ovulate. To boost hormone levels, a patient undergoing fertility treatment is often given scheduled injections of gonadotropin fertility drugs.
There are three classes of these fertility drugs: human menopausal gonadotropin (hMG), recombinant human follicle-stimulating hormone (rFSH), and human chorionic gonadotropin (hCG). hMG contains natural amounts of FSH and LH, while rFSH is created in the laboratory. Both are used to aid in the development of eggs. Once this happens, hCG acts similar to LH and is used to stimulate ovulation.
Right now you’re probably wondering how the heck to process all of these names, so let me break it down for you. Without enough FSH and LH, a woman cannot ovulate properly and requires hormone supplements like hMG, rFSH and hCG. Unfortunately, when you are prescribed one of these supplements, it won’t go by its generic name, but by a specific brand name. The most commonly used hMG is Bravelle or Repronex, rFSH is Follistim or Gonal-F, and hCG is Novarell, Ovidrel or Pregnyl.
These hormone supplements are often used in combination with other fertility treatments such as in vitro fertilization or intrauterine insemination. For more information on the process of using gonadotropins, click here. For more on the side effects of using gonadotropins, click here.


Clomiphene Citrate


Clomiphene Citrate (Clomid)

Clomid citrate is commonly the first medication that is pre­scribed for patients who are unable to ovulate on their own with unspecified infertility in combination with insemina­tion. Women who have normal fallopian tubes, regular 28 day cycles, and partners with a normal sperm count, but are still experiencing infertility, are termed as having ‘unspecified’ infertility. The pituitary gland regulates the amount of FSH (follicle stimulating hormone) and LH (leutenizing hormone) in the system. These two hormones play a key role in ovulation. The levels of these hormones determine when and how many eggs are developed and re­leased. LH is responsible for the further maturation and re­lease of the egg(s).

Clomid citrate is an anti-estrogen medication. This means that it tricks the pituitary gland into thinking that the levels of estrogen in the body are low, causing the pituitary gland to secrete additional FSH and LH. This increase of FSH and LH stimulates the development of the follicles which contain the egg(s). Clomid citrate is taken as a pill, and is generally pre­scribed as one (50mg) pill each day for 5 days in the beginning of the menstrual cycle (days 3-7). A mature follicle is usually found around day 12 of the cycle. If ovulation does not occur, the medication can be changed to reflect the patient’s needs. Ultrasound is the best way to determine the number and maturity of the follicles. Ovulation predictor kits can be used to measure if there has been a surge of LH mid-cycle, indicating ovulation has occurred. Ovula­tion occurs about 24-28 hours after the detection of the LH surge in the urine. Once ovulation has occurred, natural or artificial insemination is performed in an attempt to fertilize the egg(s) that have been produced.


All About Injectables


Injectable medications are used for IVF or IUI cycles. One of the main processes in an IVF or IUI treatment cycle is the controlled stimulation of the ovaries, to produce eggs. The medications used in ovulation induction are called gonadotropins. Brand names include Follistim, Gonal-F, Menopur, Bravelle, and Repronex. Gonadotropins are primarily used to treat two types of women: 1) those who do not ovulate, ovulate irregularly, or have failed to conceive using Clomiphene citrate (Clomid) and 2) women who ovulate on their own, but may need help in producing multiple eggs, and whose bodies would benefit from the enhanced hormonal environment.
How do they work?
Gonadotropins are natural hormones that trigger the ovaries to make eggs. They are generally safe to use, but do require experience and careful monitoring.In a natural menstrual cycle without any medications, a woman produces one or two follicles, which are fluid filled sacs that contain an egg. The growth of the eggs and their release from the follicles are influenced by the secretion of two hormones from the pituitary gland: Follicle Stimulating Hormone (FSH); and Luteinizing Hormone (LH), both known as gonadotropins.When a woman becomes menopausal, her pituitary gland secretes large amounts of these hormones in an attempt to stimulate the ovaries, which no longer function. Gonadotropins (other than Follistim and Gonal F) are manufactured by extracting FSH and LH from the urine of post-menopausal women. Menopur contains both FSH and LH, while Bravelle contains only FSH.For a woman going through infertility treatments, these extracts must be injected and cannot be taken orally, because they would be digested by the stomach.Recently, gonadotropins (Gonal-F, Follistim) have been manufactured in the laboratory using recombinant technology, which allows a pure form of FSH to be produced. This is not a human tissue or urinary by-product, it is a recombinant FSH. Since it is more pure, it may be self-injected, using a small needle just under the skin.