American Society for Reproductive Medicine (ASRM) – Organization of fertility professionals that has many resources for clinicians and patients alike. ASRM Fact sheets will complement information you receive from our office.
Fertilitext Education – Excellent for those starting treatment. A public education service owned by one of the pharmaceutical companies.
Fertility Lifelines – Provided by Serono Pharmaceuticals, this site has information and news on fertility.
Fertility Journey – Provided by Organon Pharmaceuticals, this site has information and news on fertility.
FertilityProRegistry.com – Infertility Treatment Specialist Network
Clomiphene Citrate (Clomid, Serophene): An oral ovulation inducing medication that works as an estrogen antagonist competing with estrogen receptors both in the pituitary and on occasion at the uterine level.
Lupron (GnRH agonist): An agonist that stops your pituitary gland’s production of FSH and LH. It is taken as a daily subcutaneous (under the skin) injection which permits the other stimulation medications to work more predictably and efficiently in order to produce higher number and quality of eggs during a given treatment cycle. Its suppression ability also prevents spontaneous release of eggs at mid-cycle and prevents cycle cancellation.
Gonal F, Follistim, Bravelle, Fertinex: Highly purified forms of follicle stimulating hormone (FSH) made by recombinant DNA technology which are taken subcutaneously. They function as potent stimulators of ovarian follicular development. Gonal F is manufactured by Serono Inc and comes in ampules (75IU) and multi-dose (1200 IU) vials. Follistim is manufactured by Organon, Inc and comes in vials (75IU) and dial-up pen. Bravelle is manufactured by Ferring, Inc. and comes in vials (75 IU FSH, 1.0 IU LH). Fertinex is manufactured by Serono, Inc and is almost pure FSH (75 IU FSH,
Repronex: Highly purified preparation of FSH and luteinizing hormone (LH) in equal portions (75 IU of each) which is taken subcutaneously. Manufactured by Ferring, Inc.
hCG (Pregnyl, Profasi, Novarel, Ovidrel): Highly purified form of human chorionic gonadotropin which can be taken subcutaneously or intramuscularly. This medication is used to mimic the mid-cycle hormonal surge of LH which induces the final egg maturation and ovulation in natural or IUI cycles, or for IVF, in preparation for retrieval. Profasi is manufactured by Serono, Inc, Pregnyl by Organon, Inc, and Novarel by Ferring, Inc. Ovidrel is hCG made by recombinant DNA technology and is manufactured by Serono, Inc. IMPORTANT: After injecting this medication, home pregnancy tests will remain positive for 10-12 days after the injection regardless of whether you are or are not pregnant.
Doxycycline: Antibiotic used to decrease chance of infection following aspiration of the follicles at the time of egg retrieval.
Medrol: An oral steroid which may be given to temporarily suppress immune function during the interval following retrieval and transfer, up to the time of implantation.
Progesterone: For the purposes of IVF, natural progesterone is normally taken as daily intramuscular injections following the egg retrieval and continued until approximately 10-12 weeks of pregnancy when the placenta is making adequate amounts of progesterone. Depending on the situation, progesterone may also be prescribed in the form of vaginal suppositories, vaginal gel (Crinone) or vaginal pills (Prometrium).
Adverse Reactions & Risks to Stimulation with Gonadotropins
Local skin irritation/reaction – usually seen at the injection site and may involve tenderness and redness at the site of injection. Can be mediated by icing the effected area and alternating areas for injection.
Torsion – twisting of an ovary which causes interruption of blood flow to the ovary and significant pain. This is may become a surgical emergency if does not spontaneously resolve. May require untwisting with laparoscopy/laparotomy in order to preserve the affected ovary.
Ectopic Pregnancy: These are pregnancies that occur outside the uterus, most often in the fallopian tubes. There is a slight increase in the risk of ectopic pregnancy with IVF and IUI procedures. Close monitoring of rising hCG pregnancy levels can be an early indication of an abnormally progressing pregnancy and potential ectopic pregnancy. Some ectopic pregnancies can be managed medically with a medication injection called methotrexate. Despite adequate monitoring, some ectopic pregnancies require surgical intervention in the form of laparoscopy or laparotomy. Ectopic pregnancies can be potentially life threatening if not addressed in a timely fashion.
OHSS: Occurring following hCG administration, this is a syndrome containing several elements including sudden enlargement of the ovaries and fluid accumulation in the abdomen. OHSS can progress rapidly and requires close monitoring depending on the severity. At times, hospitalization and intensive medical management may be required. The cause of OHSS remains unknown, but it is associated with high estrogen levels in the presence of LH or hCG. Many women who become pregnant as a result of the stimulation cycle are more prone to the development of OHSS. Even with close monitoring to prevent OHSS, mild forms can occur in 5-10% of gonadotropin cycles, with severe forms less common. Early symptoms may include nausea & vomiting, shortness of breath, and rapid weight gain (greater than 5 pounds in 48 hours). Canceling a cycle (withholding hCG) can prevent OHSS from occurring and may be the safest way to proceed.
Multiple Pregnancy: multiple pregnancies (twins and above) are significantly more common with gonadotropins (15-20%) than with Clomiphene citrate (8%). The risk may be directly attributed to the total number of mature follicles. Canceling a cycle (withholding hCG or IUI) may be the safest means of preventing higher order multiples in those patients with an exaggerated response to stimulation.