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Gonadotropins (Gonal-F, Follistim, Menopur, Bravelle) are fertility medications containing follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH). Your physician may prescribe these medications to you if you fail to ovulate or fail to achieve pregnancy with clomiphene citrate (Clomid) therapy. Gonadotropins help to stimulate follicular (egg) development within the ovaries.
These medications are not available in oral form and must be administered by either subcutaneous (in the skin) or intramuscular (into the muscle) injection. These medications are potent and require medical supervision and monitoring. The monitoring evaluates follicular development and is done via ultrasound and through labwork. Gonadotropin therapy is often combined with intrauterine insemination to maximize pregnancy rates.
Potential side effects of gonadotropin therapy include ovarian enlargement, abdominal bloating, and ovarian hyperstimulation syndrome. Physicians walk a fine line because the goal is to stimulate egg development; yet too many follicles can be extremely dangerous to mom. Also, multiple gestations, including high order (triplets and higher) gestations are more common with injectable therapy. Cancellation of your injectable medication cycle to prevent multiple gestations is not uncommon. Our goal is for you to achieve a healthy singleton pregnancy so patients considering injectable therapy may also want to consider IVF, which allows for greater control over the risks of multiple gestations.
So, yes, there are many combinations of treatment. It is up to the physician and patient to determine which one (or combination) is most appropriate. Some women require only Clomid tablets, some require and IUI procedure added on. Gonadotropins can be added into the mix, with our without IUI or even IVF. Typically, a physician will start at the beginning and progress to more complex forms of assisted reproduction if needed.
The above links to Freedom Fertility Pharmacy. This is an excellent resource for specialty infertility pharmaceuticals and they have short instructional videos available which show you exactly how to administer injectable medications. This is helpful if you are currently undergoing (or just beginning) infertility treatment…or, even if you’re considering it, it’s nice to know what could potentially lie ahead.